Definition

Tue, May 23, 2006

Members Premature rupture of membranes (PROM) is an event that occurs during pregnancy when the sac containing the developing baby (fetus) and the amniotic fluid bursts or develops a hole prior to the start of labor. user"D Description During pregnancy, the unborn baby (fetus) is surrounded and cushioned by a li uid called amniotic fluid. !his fluid, along with the fetus and the password placenta, is enclosed within a sac called the amniotic membrane. !he amniotic fluid is important for several reasons. "t cushions and protects Visitors the fetus, allowing the fetus to move freely. !he amniotic fluid also allows 4lic% here to register free the umbilical cord to float, preventing it from being compressed and cutting off the fetus#s supply of o$ygen and nutrients. !he amniotic membrane contains the amniotic fluid and protects the fetal environment from the outside world. !his barrier protects the fetus from organisms (li%e bacteria or viruses) that could travel up the vagina and potentially cause infection. earch &lthough the fetus is almost always mature at between '()*+ wee%s and can be born without complication, a normal pregnancy lasts an average of *+ wee%s. &t the end of *+ wee%s, the pregnancy is referred to as being ,term., &t term, labor usually begins. During labor, the muscles of the uterus contract repeatedly. !his allows the cervi$ to begin to grow thinner (called effacement) and more open (dilatation). -ventually, the cervi$ will become completely effaced and dilated. "n the most common se uence of events (about .+/ of all deliveries), the amniotic membrane brea%s (ruptures) around this time. !he baby then leaves the !elated "e#s uterus and enters the birth canal. 0ltimately, the baby will be delivered out of the mother#s vagina. "n the '+ minutes after the birth of the baby, Clinical Trials the placenta should separate from the wall of the uterus and be *pdate+ May ,-, delivered out of the vagina. 2006 1ometimes the membranes burst before the start of labor, and this is $ealth $ighlights+ called premature rupture of membranes (PROM). !here are two types of May ,-, 2006 PROM. One occurs at a point in pregnancy before normal labor and delivery should ta%e place. !his is called preterm PROM. !he other type 'arly Treatment of PROM occurs at '()*+ wee%s of pregnancy. $elps .eople /ith .rehypertension PROM occurs in about 2+/ of all pregnancies. Only about 3+/ of these cases are preterm PROM. Preterm PROM is responsible for about '*/$eart 0enes Could of all premature births. $elp '(plain 1D Millions of Dollars /asted on *nnecessary !he causes of PROM have not been clearly identified. 1ome ris% factors include smoking, multiple pregnancies (twins, triplets, etc.), and e$cessMedical Tests+ tudy Causes and symptoms amniotic fluid (polyhydramnios). 4ertain procedures carry an increased ris% of PROM, including amniocentesis (a diagnostic test involving e$traction and e$amination of amniotic fluid) and cervical cerclage (a procedure in which the uterus is sewn shut to avoid premature labor $ealth%to& '(clusi)es condition called placental abruption is also associated with PROM, although it is not %nown which condition occurs first. "n some cases of

preterm PROM, it is believed that bacterial infection of the amniotic membrane causes it to wea%en and then brea%. 5owever, most cases of PROM and infection occur in the opposite order, with PROM occurring first followed by an infection.

$ealth '(clusi)e %rchi)es

!elated Topics !he main symptom of PROM is fluid lea%ing from the vagina. "t may be a afety 4 .re)ention sudden, large gush of fluid, or it may be a slow, constant tric%le of fluid. !he complications that may follow PROM include premature labor and delivery of the fetus, infections of the mother and6or the fetus, and compression of the umbilical cord (leading to o$ygen deprivation in the 2itness fetus). 7abor almost always follows PROM, although the delay between PROM "utrition and the onset of labor varies. 8hen PROM occurs at term, labor almost always begins within 3* hours. -arlier in pregnancy, labor can be delayed up to a wee% or more after PROM. !he chance of infection increases as the time between PROM and labor increases. 8hile this may cause doctors to encourage labor in the patient who has reached '(perts 2%3 term, the ris% of complications in a premature infant may cause doctors .ediatrician to try delaying labor and delivery in the case of preterm PROM. "urse !he types of infections that can complicate PROM include amnionitis and endometritis. &mnionitis is an infection of the amniotic membrane. "utritionist -ndometritis is an infection of the innermost lining of the uterus. &mnionitis occurs in +.9)2/ of all pregnancies. "n the case of PROM at 2itness Trainer term, amnionitis complicates about ')29/ of pregnancies. &bout 29) 3'/ of all cases of preterm PROM will be complicated by amnionitis. !he presence of amnionitis puts the fetus at great ris% of developing an overwhelming infection (sepsis) circulating throughout its bloodstream. Preterm babies are the most susceptible to this life)threatening infection. 'ncyclopedia One type of bacteria responsible for overwhelming infections in newborn babies is called group : streptococci. Condition %5& Diagnosis Depending on the amount of amniotic fluid lea%ing from the vagina, 2un Time diagnosing PROM may be easy. 1ome doctors note that amniotic fluid '5Cards has a very characteristic musty smell. & pel)ic e(am using a sterile medical instrument (speculum) may reveal a tric%le of amniotic fluid leaving the cervi$, or a pool of amniotic fluid collected behind the cervi$. 6ife Clock One of two easy tests can be performed to confirm that the li uid is amniotic fluid. & drop of the fluid can be placed on nitra;ine paper. <itra;ine paper is made so that it turns from yellowish green to dar% blue when it comes in contact with amniotic fluid. &nother test involves smearing a little of the fluid on a slide, allowing it to dry, and then viewing it under a microscope. 8hen viewed under the microscope, dried amniotic fluid will be easy to identify because it will loo% ,feathery, li%e a fern. Once PROM has been diagnosed, efforts are made to accurately determine the age of the fetus and the maturity of its lungs. Premature babies are at great ris% if they have immature lungs. !hese evaluations can be made using amniocentesis and ultrasound measurements of the

fetus# si;e. &mniocentesis also allows the practitioner to chec% for infection. Other indications of infection include a fe)er in the mother, increased heart rate of the mother and6or the fetus, high white blood cell count in the mother, foul smelling or pus)filled discharge from the vagina, and a tender uterus. Treatment !reatment of PROM depends on the stage of the patient#s pregnancy. "n PROM occurring at term, the mother and baby will be watched closely for the first 3* hours to see if labor will begin naturally. "f no labor begins after 3* hours, most doctors will use medications to start labor. !his is called inducing labor. 7abor is induced to avoid a prolonged gap between PROM and delivery because of the increased ris% of infection. Preterm PROM presents more difficult treatment decisions. !he younger the fetus, the more li%ely it may die or suffer serious permanent damage if delivered prematurely. =et the ris% of infection to the mother and6or the fetus increases as the length of time from PROM to delivery increases. Depending on the age of the fetus and signs of infection, the doctor must decide either to try to prevent labor and delivery until the fetus is more mature, or to induce labor and prepare to treat the complications of prematurity. 5owever, the baby will need to be delivered to avoid serious ris%s to both it and the mother if infection is present, regardless of the ris%s of prematurity. & variety of medications may be used in PROM> Medication to induce labor (o$ytocin) may be used, either in the case of PROM occurring at term or in the case of preterm PROM and infection. !ocolytics may be given to halt or prevent the start of labor. !hese may be used in the case of preterm PROM, when there are no signs of infection. Delaying the start of labor may give the fetus time to develop more mature lungs. 1teroids may be used to help the fetus# lungs mature early. 1teroids may be given in preterm PROM if the fetus must be delivered early because of infection or labor that cannot be stopped. %ntibiotics can be given to fight infections. Research is being done to determine whether antibiotics should be given prior to any symptoms of infection to avoid the development of infection.

.rognosis !he prognosis in PROM varies. "t depends in large part on the maturity of the fetus and the development of infection. .re)ention !he only controllable factor associated with PROM is smo%ing. 4igarette

smo%ing should always be discontinued during a pregnancy. 7ey Terms %mniocentesis & medical procedure during which a long, thin needle is inserted through the abdominal and uterine walls, and into the amniotic sac. & sample of amniotic fluid is withdrawn through the needle for e$amination. %mniotic fluid !he fluid within the amniotic sac? the fluid surrounds, cushions, and protects the fetus. %mniotic membrane !he thin tissue that creates the walls of the amniotic sac. Cer)ical cerclage & procedure in which the cervi$ is sewn closed? used in cases when the cervi$ starts to dilate too early in a pregnancy to allow the birth of a healthy baby. .lacenta !he organ that provides o$ygen and nutrition from the mother to the fetus during pregnancy. !he placenta is attached to the wall of the uterus, and leads to the fetus via the umbilical cord. 2or 8our 1nformation 9ooks @arite, !homas A., and 8illiam <. 1pellacy. ,Premature Rupture of Membranes., "n Danforth#s Obstetrics and @ynecology, ed. Aames R. 1cott, et al. Philadelphia> 7ippincott 4o., 2..*. Pernoll, Martin 7. ,Premature Rupture of Membranes., "n 4urrent Obstetric and @ynecologic Diagnosis and !reatment, ed. &lan 5. De4herney and Martin 7. Pernoll. <orwal%, 4!> &ppleton B 7ange, 2..*.

.eriodicals 5annah, Mary -., et al. ,"nduction of 7abor 4ompared with -$pectant Management for Prelabor Rupture of the Membrane at !erm., !he <ew -ngland Aournal of Medicine, ''*, no. 2( (2C &pr. 2..()> 2++9D. 5annah, Mary -., et al. ,Maternal 4oloni;ation with @roup : 1treptococcus and Prelabor Rupture of Membranes., &merican Aournal of Obstetrics and @ynecology 2EE (Oct. 2..E)> EC+D. Parry, 1amuel, and Aerome F. 1trauss """. ,Premature Rupture of the Fetal Membranes> Mechanisms of Disease., !he <ew -ngland Aournal of Medicine ''C, no. 2+ (9 Mar. 2..C)> (('D. 8alling, &nne D. ,4orticosteroids and &ntibiotics for Management of PROM., &merican Family Physician 99, no. 9 (&pr. 2..E)> 2.(+. :rgani;ations American

College of Obstetricians and Gynecologists. 409

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