Preterm Premature Rupture of the Membranes (PPROM)
PROM and PPROM - What's the Difference?
Premature rupture of the membranes (PROM) occurs when the amniotic sac that surrounds a baby in the uterus either breaks or leaks fluid (liquor) before the mother actually enters into labor. Most women experience their water breaking while they are in labor. When it occurs prior to labor and during or past the 37th week of gestation it is called premature rupture of the membranes or PROM. Should there be leaking or a gush of water before 37 weeks the condition is known as preterm premature rupture of the membranes, or PPROM. This situation, which occurs in about three percent of pregnancies, is dangerous for both mother and baby and needs immediate medical attention.
Complications Associated with Preterm Premature Rupture
When the membranes rupture, the mother generally goes into labor within 24 hours in later term pregnancies. In pregnancies that are preterm, the labor can come on, and usually does, within a week of the rupture of the membranes. This is not problematic when the pregnancy is past 37 weeks. However, prior to that time, the risks are much higher and preterm labor and delivery is almost always the result. The complications associated with prematurity are serious and include:
· cord compression
· respiratory distress in the baby
· placental abruption
· brain damage and poor lung development in baby
· death of the baby
What Causes PPROM?
Although the cause of PPROM is not really clear, there are some infections and risks that seem to be consistently associated with it. One that is somewhat rare but has been implicated is amniocentesis. It is thought that PPROM is caused by a combination of factors, which include:
· sexually transmitted diseases
· lower socioeconomic status
· past history of PPROM
· bleeding during pregnancy
· multiples (twins or triplets)
· too much water in the sac (polyhydramnios)
· cerclage (a stitch around the cervix to stop the baby from being born too early)
Managing PPROM Presents Challenges
When PPROM occurs between 24 and 37 weeks gestation, it tends to be quite challenging to manage - more so than when PROM occurs at term. The risks to the baby increase significantly and often the mother is hospitalized in a place where there is a neonatal intensive care nursery where the baby can receive intensive medical care if needed. Even though the longer the labor is detained, the better for both baby and mother, delivery of PPROM at any point usually occurs within a week of the rupture. Very few women remain pregnant more than three or four weeks after PPROM. Sometimes, after an amniocentesis there is rupture of the membranes which spontaneously seals on its own. However, this is the exception rather than the rule.
Babies who are born after 24 weeks gestation can, in some cases, survive but there are often long-term developmental problems due to the early delivery. Prior to 24 weeks, the outcome is usually very poor with babies born at 22 weeks unable to survive. The longer the doctor can stall the labor, the better the baby's chance at survival.
Standard Treatment for PPROM
The standard treatment for PPROM includes antenatal corticosteroid medication that is meant to speed up lung maturity when the rupture occurs at or before 34 weeks. Additional treatments for PPROM may include:
· bed rest to see if the leaking can be stopped
· antibiotics to treat or prevent infection in the amniotic fluid
· amniocentesis, sometimes used to check the development of the baby's lungs and to see if there is infection in the uterus
· use of tocolytics (anti-contraction medications, also called labor repressants) to try buy time for maturation of the baby's lungs
· drug induced induction if there is an infection or if there is solid evidence that the baby's lungs are mature enough
Learn more about premature rupture of the membranes in the article in this section.