Premature Rupture of Membranes 

When your water breaks before labor begins, it's known as premature rupture of membranes, or PROM. It might be referred to as "prelabour rupture of membranes". The more recent and better term is preterm labor, which refers to membrane rupture prior to the onset of labor without suggesting prematurity. Your membranes usually burst once labor (or contractions) commences.
The membranes are an amniotic sac, which is a fluid-filled sac that contains amniotic fluid. It covers the fetus when it is pregnant. Amniotic fluid helps the fetus develop its muscles and bones, cushions its movements, and guards against infection. The amniotic fluid surrounding the fetus begins to leak or gush out of the vagina when the membranes rupture. The patient and the fetus is at increased risk of infections.

Causes of Premature Rupture of Membranes

• The most common cause is bacterial infections like chlamydia, gonorrhea, and mycoplasma.
• Short cervix is also one of the reasons for rupture of membranes.
• Over distension by polyhydramnios.
• Low socioeconomic status
• If there is a previous history of premature rupture of membranes then the mother is at risk of development of Premature Rupture of Membranes.

Diagnosis of Premature Rupture of Membranes

• The best indicator of premature rupture of membranes is obvious draining from the vagina.
• A nitrazine paper test is done to diagnose the condition.
• If the nitrazine paper test gives blue color. This means there is a leak of amniotic fluid in the vagina and hence it is a diagnostic of premature rupture of membranes. In this scenario, we have to give antibiotics to prevent infection and we need to try to induce labor in 24 to 48 hours.
• If the nitrogen paper test is red this means the vagina is still acidic and there is no leak of amniotic fluid. In vaginitis, it can give a red color.
• Fetal fibronectin is another diagnostic measure of premature rupture of membranes. The presence of fetal fibronectin in vaginal secretions indicates premature rupture of membranes.
• There will be an increase in alpha-fetoprotein in vaginal secretions.
• Under the microscope there will be ferning of the fluid from the vagina.
• Another test used to diagnose premature rupture of membranes is the indigo Carmine dye test.
• In the Indigo Carmine dye test, the dye is injected into the amniotic sac and a pad is placed in the maternal perineum. The woman will be directed to move around for 10 to 15 minutes. If there is a leakage, the dye will come out in secretions and stay in the pad and will be indigo bluish color, and hence premature rupture of membranes will be diagnosed.

Complications of Premature Rupture of Membranes

• Preterm labor
• Intramniotic infection can occur.
• Placental abruption
• Umbilical cord prolapse
• It can lead to prolonged rupture of membranes.

Management of Premature Rupture of Membranes

• If the rupture of membranes is less than 34 weeks:
• We need to check that the pregnancy is uncomplicated. If the pregnancy is uncomplicated then expectant management should be followed and antibiotics like ampicillin and azithromycin should be continued.
• Corticosteroids should be started and regular fetal surveillance should be done.
• If there are signs of fetal or maternal compromise or there are signs of infection then delivery should be done along with infusion of ampicillin and gentamicin.
• Corticosteroids should be administered for lung maturity of the fetus.
• If the gestation period is less than 32 weeks then magnesium should be started.
• If the gestation period is less than 37 weeks but more than 34 weeks then delivery should be initiated along with GBS profile access with penicillin G. Corticosteroids should be added for fetal lung maturity.

Also Read: Puerperium: Understanding the Postpartum Period

Hope you found this blog helpful for your Obstetrics for OBS-GYN preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.