| Basic Information |
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| Description |
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A spontaneous break or tear in the amniotic fluid sac before the
onset of labor. It may happen at any time during a pregnancy and
occurs in approximately 10 to 15% of all pregnancies.
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| Frequent Signs and Symptoms |
- A leakage or a gush of blood-tinged amniotic fluid from the vagina.
- Fever or foul-smelling vaginal discharge associated with
uterine tenderness (often indicates an infection).
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| Causes |
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The exact cause is unknown. There is often a combination
of PROM, preterm labor and infection involved.
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| Risk Increases With |
- Poor nutrition and poor hygiene.
- Lack of proper prenatal care.
- Weak (incompetent) cervix.
- Increased intrauterine pressure due to excessive amniotic
fluid or multiple pregnancies.
- Defect in the strength of the membrane itself.
- Uterine infection.
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| Preventive Measure |
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No specific preventive measures other than to avoid risk
factors where possible.
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| Expected Outcome |
- In a term pregnancy, labor and delivery usually occur
within 24 hours following the rupture. In some preterm
pregnancies, the period after the rupture until delivery may
extend into weeks, or even months.
- Outcome for a preterm rupture varies depending on the
length of the pregnancy. If prior to 24 weeks' gestation, the
outlook is poor.
- On rare occasions, the leakage will cease, and the
membranes are said to "seal over." The amniotic fluid
reaccumulates.
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| Possible Complications |
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Extensive intra-amniotic infection, which will generally
result in intensive uterine tenderness, fever, and fast heart
rates for both mother and fetus. If this occurs, intravenous
antibiotics and induction of labor are necessary regardless
of gestational age. In some cases, intra-amniotic infection
can lead to serious consequences for both mother and child.
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| Treatment/Post Procedure Care |
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| General Measures |
- Hospitalization is normally required for further diagnostic
studies and to make determinations about treatment and
delivery.
- With a pregnancy longer than 36 weeks or where fetal
lung maturity has been established, treatment leans toward
delivery; 80% of patients go into spontaneous labor within
12 to 24 hours. For some patients, labor may be induced
immediately, particularly if there are any signs of infection.
This may require a cesarean birth.
- For a pregnancy of longer than 24 to 26 weeks' duration,
hospitalization until delivery is recommended for some
patients. Others may be allowed to return home after 72
hours in the hospital to await labor. In either instance,
careful monitoring of vital signs and laboratory blood studies
will continue to check for infections and fetal distress.
Labor will need to be induced if problems develop. Avoid
any vaginal douches and sexual intercourse if you are at
home.
- For a pregnancy of less than 24 to 26 weeks, the fetal
risks increase. These include compression deformities due
to the collapse of amniotic membranes around the fetus
and pulmonary problems (hypoplasia). In the case of PROM
occurring before 24 weeks, the fetal survival rates are less
than 20% and among those fetuses that survive, there is a
high frequency of developmental defects. Termination of a
pregnancy may need to be discussed with the parents.
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| Medication |
- Oxytocin may be used to induce labor.
- Antibiotics, if an intrauterine infection is present, and
sometimes as an infection prevention therapy while awaiting spontaneous labor.
Steroids may be prescribed prior to delivery in some cases
to enhance fetal pulmonary maturity.
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| Activity |
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Bed rest while awaiting labor and delivery. You may be
allowed some walking around with medical approval.
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| Diet |
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No special diet unless labor and delivery are immediate.
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| Notify Your Healthcare Provider If |
- You or a pregnant family member has a leakage or gush of
amniotic fluid (water) from the vagina. Call immediately.
This may be an emergency!
- If you are being treated as an outpatient for PROM and
any new signs or symptoms develop or there is further leakage of the fluid.
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