Premature / Prolonged Rupture of Membranes (PROM)

Definition:

• Premature rupture is defined as when the bag of waters breaks prior to the onset of labor before 37 weeks of pregnancy.
• Prolonged rupture is defined as when the bag of waters ruptures 24 or more hours before the onset of labor.

Benefits of an intact bag of water (BOW):

• At term you will have between 1-1 ½ Liters of sterile amniotic fluid. Vitamin C with Bioflavinoids and zinc makes the amniotic sac strong, elastic and resilient.
  
• The amniotic fluid acts as a shock absorber to the baby.
  
• Allows the baby to move freely
  
• Helps the baby keep his temperature up.
  
• Keeps the membranes from sticking to the baby’s skin.
  
• Prevents cord compression.

Incidences and Causes:

• 10% -12% of all labors begin when the BOW breaks (95% of these moms labor within 24 hours)
  
• It may come from the vagina in drops or as a great gush.
  
• Your amniotic sac may rupture due to poor nutrition, which will lead to weak membranes and make you more susceptible to infection.
  
• It may be due to trauma from a pelvic exam of penetration during intercourse
  
• Other causes include a loose or incompetent cervix, chorioamnionitis (an infection of the membranes) from a variety of organisms, or polyhydramnious (too much amniotic fluid)

Things to consider:

• Overall infant mortality from PROM is 5% (with infection being the biggest cause of death)
  
• Labor may begin at any time and result in a preterm birth.
• The main concern when the water is broken is that the womb is now open to infection, which is a concern to both mother and baby.
  • There is no increased risk of infection if there are no vaginal exams
  • Is there already an infection present?
  • The bodies own defense to infection is to continually replace the amniotic fluid, which with the down and outward flow discourages bacteria from moving upward
• Prolapsed umbilical cord does not frequently accompany PROM unless the baby is presenting as a footling breech or with his shoulder.
  
• Oligiohydramnious (not enough amniotic fluid) is associated with PROM.
  
• Mothers who are induced for PROM face3-5 times the risk of cesarean section.

Special Considerations for PROM before 37 weeks:

• Infant mortality from PROM for preterm babies is 30% (with infection being the biggest cause of death) * Please remember when we say 30% we are talking about any baby from 28-37 weeks gestation whose membranes ruptured before the onset of labor.
  
• If the BOW breaks several weeks early it is possible for it to reseal.
  
• Lung maturity of the baby - Respiratory distress syndrome due to baby’s lungs not being mature is a bigger worry to the baby before 37 weeks than infection is.
  30% of all preterm babies are born breech (with the bum or foot/feet 1st) malpresentation (other than head down) is associated with prematurity
  
• There is an increased risk of cord prolapse with a smaller and earlier baby
• Some caregivers recommend bed rest if at all possible.

If your membranes are ruptured, here are some suggestions:


• Call immediately if you think that your membranes have ruptured. Some things that I will want to know are; what color is it? Clear, clear with white particles, brown or green?
• How does it smell? Please save something that your amniotic fluid leaked on for closer inspection later on.
  
• Continue to eat well. Soon you will be birthing your baby. Keep your energy levels good. You and your baby need to keep your immune system up.
  
• Please take your temperature at the onset of membrane rupture and take it every few hours until birth.
  
• No hand – genital, mouth-genital contact. Don’t put anything inside your vagina! You and the baby are both vulnerable to infections now.
  
• Have someone else clean the toilet before you use it an every few hours afterward.
• Wash your hands before and after using the bathroom. Use white, non-perfumed paper to wipe from front to back.
• Please don’t use public restrooms.
• Some caregivers suggest a shower after every bowel movement.
  
• If at all possible don’t wear underwear or a pad. If you are wearing a pad please change it every couple of hours. Some mothers wear a dress or a gown and line the places that they sit with chux or clean cloth diapers so that they can change often and so that they can have an idea of how much fluid they are loosing.
  
• 250 mg. Of vitamin C every few hours with no more than 2 grams in 24 hours.
  
• Increase your intake of clear liquids (liquids can help replenish the amniotic fluid) Keep your salt intake up.
  
• Please call if the fluid becomes anything other than clear, if you are having any uterine / abdominal tenderness, you are having any kind of foul smelling discharge, your temperature goes above 100.4, your heart rate feels like it is racing, your baby’s activity level is different than normal, you are concerned that there is a problem.
  
• As always take notice of fetal movements. If you are concerned you might keep a chart.
  
• Take it easy and rest. Pay attention to your body.