Premature rupture of membranes (PROM) is the pregnancy related complication. It involves the rupture of the fetal membranes before the 37th week of gestation. In most cases, this occurs near term, but when membrane rupture occurs before 37 weeks’ gestation. It is known as preterm rupture of membrane (PPROM). Generally, the incidence of PPROM in all pregnancy is approximately 2 to 3% Which further leads to one third of preterm births. It also increases the chances of pre-maturity .which results into various other perinatal and neonatal complications, including a 1 to 2 % risk of fetal death . Physicians caring for pregnant patients should be proficient in the management of PPROM because early diagnosis and proper management results into better outcomes.
One of the major complications of PPROM is early delivery. The latent period this is the time from membrane rupture until delivery.Basically is inversely proportional to the gestational age at which premature rupture of membranes (PROM) take place . When PROM appear too early, surviving neonates may develop sequelae such as malpresentation, oligohydramnios, cord compression, necrotizing enterocolitis, neurologic impairment, respiratory distress syndrome and intraventricular hemorrhage .
Risk Factors And Pathophysiology of PPROM
Various risk factors are associated with PPROM. Black patients are at higher risk of PPROM in comparison to white patients . Patient who have lower socioeconomic status, a history of sexually transmitted infections, smokers, have vaginal bleeding, or have uterine distension, have had a previous preterm delivery are consider at higher risk.
Some procedure may also result in PPROM such as amniocentesis and cerclage. According to the Bendon et al, Choriodecidual infection or inflammation may also result in preterm PROM. A reduction in the collagen content of the membranes also has been suggested to make patients susceptible to PPROM . There is no single etiology for PPROM. It is likely that various factors are responsible for the development of PPROM.
The diagnosis of PROM requires a thorough history, physical examination, and selected laboratory studies. Healthcare providers also remove some fluid to test it. This is to check if it’s amniotic fluid, urine or vaginal fluid. Testing may include.
- pH (acid-base) balance testing: The pH balance of vaginal and urine is different from amniotic fluid. Healthcare provider put fluid on a test strip to check the balance.
- Microscopic examination: When amniotic fluid is dry, it has a fern-like pattern.
Management of Premature Rupture of Membranes
In some conditions early induction of labor is not possible. Healthcare providers recommend medication for the management of premature rupture of membrane risk factors. These include:
Corticosteroids: A single course of corticosteroids can decrease the risk of respiratory distress syndrome, necrotizing enterocolitis and intraventricular hemorrhage . Generally, Corticosteroids are suggested only for a gestation age of 32 weeks or fewer.
Antibiotics: Antibiotics can be helpful in reducing the chance of infection and neonatal sepsis associated with premature rupture of membranes. Evidence also suggests that antibiotics can prolong the latent period between PROM and the onset of labor