Premature Rupture of the Membranes
Premature rupture of the membranes (PROM) is when the sac of water surrounding the baby breaks and the liquor leaks out. This can happen either at the end of pregnancy, or earlier on well before the due date. When it happens near the end (after 37 weeks, or term) it is known as PROM - it is still deemed premature as labour contractions haven't started.
Should I be Induced?
There is much debate as to what to do when PROM happens at term. Some believe that labour should start within 24 hours or the risk of infection outweighs the risks of induction of labour.
Others feel that the risk of infection remains low for the next 72 hours and waiting gives the benefit of avoiding the 'cascade of intervention' that may occur with induction of labour - by this time, most women will have gone into labour, anyway. In either case, the risk to the baby is very small and either way to go is reasonable.
Preterm PROM (before 37 weeks) is much more likely to lead to problems and this will be discussed in more detail.
Have My Waters Actually Gone?
This may sound a stupid question, but it is not always immediately obvious if this is the case. There are two bags of water in the pelvis, the other, of course, being the bladder, and its not at all unusual for women to leak urine at some time during pregnancy. If there is an ongoing leak, particularly after having been lying flat for some time (suggesting pooling of fluid in the vagina) and it smells sweet, then it may be liquor. There is no foolproof way of telling and if there is any doubt, a doctor or midwife should be consulted for an examination.
An examination will involve feeling your abdomen (to see if it feels like there's less water around the baby) and a speculum examination - like when you have a smear test done. The cervix is visualised and you'll be asked to cough. If the waters have gone, a gush of water is often seen coming out of the cervix.
Some doctors use Amni-stix or nitrizine sticks, which change colour when dipped into liquor. These are not 100% accurate and can be falsely positive in the presence of bleeding, with some vaginal infections or if you've had unprotected sex recently. Swabs are also taken to check for the presence of infection.