Premature Rupture of Membranes
- It is defined as rupture of membranes a least 1 hour prior to onset of labor but after 37 weeks of gestation (Term PROM)
- If this happens before 37 weeks, it is own as PPROM.
Risk Factors for PROM
- Increase friability / decrease in tensile strength of membranes (mainly due to infections with Chlamydia or bacterial vaginosis, etc.)
- Multiple pregnancy
- Cervical incompetence
- Previous history of PROM
A history of a gush of fluid or trickle causing a woman to be constantly wet may suggest the diagnosis. The following can be done:
- Sterile speculum examination
- Fluid turns yellow, nitrazine paper blue (pH of amniotic fluid is 7.0-7.7 compared with vaginal pH of 4.5)
- Red litmus paper turns blue
- Microscopic 'ferning' of vaginal fluid (refers to crystallization of amniotic fluid on drying)
- Alpha-fetoprotein levels in the fluid (amniotic fluid contains AFP)
- FFN in the vaginal fluid will indicate that the fluid is liquor
- 0.1% Nile blue sulfate test (orange colored cells seen). This is a test for lung maturity.
- USG will show oligohydramnios
- Bed rest
- Prophylactic Antibiotics
- Progesterone injection (weekly) or suppository (daily) till 35 weeks of pregnancy.
- The predominant risk for patients with PROM between 32 to 36 weeks is chorioamnionitis therefore management should be towards delivery.
- The predominant risk with PROM between 28 to 32 weeks is hyaline membrane disease. Therefore administration of glucocorticoids and prolongation of latent phase are beneficial for the fetus with the condition that patient should not have chorioamnionitis.
- Preterm labor
- Fetal pulmonary hypoplasia especially in PPROM
- Inflammation of the fetal membranes usually is a manifestation of intra-uterine infection. It frequently is associated with prolonged membrane rupture and long labor. Grossly, infection is characterized by clouding of the membranes.
- The diagnosis is clinical. There is presence of fever and at least two of the following: maternal tachycardia, fetal tachycardia, uterine tenderness, foul odor of amniotic fluid, or maternal leukocytosis.
- When mono- and polymorphonuclear leukocytes infiltrate the chorion, the resulting microscopical finding is designated chorioamnionitis. These cells are maternal in origin. Conversely, if leukocytes are found in amniotic fluid (amnionitis), or the umbilical cord (funisitis), the cells are fetal in origin.
- Management of overt clinical chorioamnionitis is antimicrobial administration and delivery.