Premature Rupture of Membranes

(PROM)
  • Definition

    Premature rupture of membranes (PROM) is the breaking of the amniotic sac before labor begins. The sac contains amniotic fluid and the developing baby. With PROM, the amniotic fluid inside the sac leaks or gushes out of the vagina. This is also known as your water breaking.
    Fetus with Amniotic Sac
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    Copyright © Nucleus Medical Media, Inc.
    PROM occurs during the third trimester after 37 weeks of gestation. A related condition called preterm premature rupture of membranes (PPROM) occurs before 37 weeks of gestation.
    Call your doctor right away if you suspect that your water has broken.
  • Causes

    The causes of PROM are not clearly understood. Some of the possible causes are:
    • Early dilation of the cervix . This may be due to the weight of baby and placenta, or changes in the cervix itself.
    • Infections of the vagina, uterus, or membranes surrounding the fetus.
  • Risk Factors

    Factors that may increase your chance of PROM include:
    • PROM in earlier pregnancies
    • Infection in the amniotic sac
    • Other infections in mother, such as, chlamydia
    • Bleeding during the pregnancy
    • Amniocentesis
    • Nutritional deficits
    • Low body mass index
    • Smoking during pregnancy
  • Symptoms

    The main symptom of PROM is fluid leaking from the vagina. You may experience a sudden gush of fluid or a slow, constant trickle. It can be difficult to distinguish between a slow amniotic trickle or urine. Your doctor can do simple tests to determine this.
    Symptoms include a fever above 100.5 degrees Fahrenheit (38 degrees Celsius). If you have any of these symptoms, call your doctor right away.
    Complications from PROM may include:
  • Diagnosis

    If a large amount of fluid is leaking from the vagina, diagnosing PROM can be straightforward. To confirm the diagnosis, the doctor may do the following tests:
    • Visual exam—the doctor may be able to see a trickle of fluid through the cervix, or a pool of fluid collected behind the cervix
    • Nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
    • Microscopic exam of the fluid
    The doctor will also check you for fever and other signs of infection. He will monitor your baby for any signs of distress.
  • Treatment

    Labor usually begins within hours after PROM. If labor does not begin soon after your water breaks, the risk of infection increases. In many cases, labor will be induced by giving you medications. Antibiotics may also be given.
    You and your baby will be watched closely to look for signs of any problems developing. For example, your baby’s heart rate will be monitored.
  • Prevention

    Researchers are investigating ways to prevent PROM. Taking antibiotics during the second and third trimester may reduce your risk. Taking vitamin C may also lower your chance of developing PROM. You can also take steps for a healthier pregnancy, like quitting smoking.
  • RESOURCES

    American Pregnancy Association http://www.americanpregnancy.org

    National Institute of Child Health and Development http://www.nichd.nih.gov

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    References

    ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109(4):1007-1019. Reaffirmed 2012.

    Placental abruption. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 14, 2013. Accessed August 1, 2013.

    Premature rupture of membranes: causes, risks, and treatment. Pregnancy Info website. Available at: http://www.pregnancy-info.net/prom.html. Accessed August 1, 2013.

    Premature rupture of membranes at term (term PROM). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 5, 2013. Accessed August 1, 2013.

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