PROM: Looking for the Development of Infection
Hospital or home?
In the time between the PROM (premature rupture of the membrane) being diagnosed and labor starting, there seems to be little consensus on where women should be managed.
Many doctors prefer women to remain as hospital inpatients during this time. This allows a regular check on temperature, pulse rate and development of womb tenderness which may indicate infection.
Twice weekly blood tests looking for signs of a response to infection and weekly vaginal swabs are often instigated.
Increasingly, however, doctors are beginning to feel that the risks of infection with PROM have been previously overstated, and many are now happy for women to be managed at home after an initial period in the hospital.
Daily temperature checks are helpful and the other investigations mentioned above can be done in the clinic.
Will My Baby Survive and be Healthy if Born Early?
This is something that a doctor from the neonatal unit will be able to discuss. Survival rates vary in different parts of the world and in different units.
In the UK, when delivery occurs after 30 weeks gestation, the outlook for the baby is very good, all other things being equal. Between 28 to 30 weeks there is still a good chance of a normal outcome, although some infants will run into problems.
An infant delivering at 24 to 25 weeks can be expected to have a difficult time on a neonatal unit, and unfortunately many do not survive. Every day between 25 and 28 weeks is important and chance of survival without long-term problems gradually improves. These are, of course, gross generalisations, and individual factors will apply.
What About Very Early Membrane Rupture?
At 20 to 23 weeks, survival is unfortunately poor (20% to 25%) and there is a high incidence of handicap in those who do live.
PROM before 20 weeks' gestation is associated with significant risk of infection and survival chance is negligible, and usually then with significant handicap.
Some elect termination of pregnancy in this case to protect the mother from what can sometimes be an overwhelming infection. Unfortunately there is no therapy available to replace the fluid or, at present, to plug the hole in the membranes.
However, survival is not impossible. Some women have had their liquor break prior to 20 weeks and gone on to give birth to babies that, after much time in intensive care, have developed into healthy babies. This is not the common outcome, though.
If you find yourself in this situation, discuss with your doctor what the best course of action is for you.