| Prelabor rupture of membranes | |
|---|---|
| Other names | Premature rupture of membranes |
 | |
| Positive fern test with amniotic fluid as seen under the microscope | |
| Specialty | Obstetrics |
| Symptoms | Painless gush or a steady leakage of fluid from the vagina[1] |
| Complications | Baby: Premature birth, cord compression, infection[2][1] Mother: Placental abruption, postpartum endometritis[2] |
| Types | Term, preterm[2] |
| Risk factors | Infection of the amniotic fluid, prior PROM, bleeding in the later parts of pregnancy, smoking, a mother who is underweight[2] |
| Diagnostic method | Suspected based on symptoms and examination, supported by testing the fluid or ultrasound[2] |
| Differential diagnosis | Urinary incontinence, bacterial vaginosis[3] |
| Treatment | Based on how far along a woman is in pregnancy and whether complications are present[2] |
| Frequency | ~8% of term pregnancies,[2] ~30% of preterm pregnancies[4] |
Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labour.[2] Women usually experience a painless gush or a steady leakage of fluid from the vagina.[1] Complications in the baby may include premature birth, cord compression, and infection.[2][1] Complications in the mother may include placental abruption and postpartum endometritis.[2]
Risk factors include infection of the amniotic fluid, prior PROM, bleeding in the later parts of pregnancy, smoking, and a mother who is underweight.[2] Diagnosis is suspected based on symptoms and speculum exam and may be supported by testing the vaginal fluid or by ultrasound.[2] If it occurs before 37 weeks it is known as PPROM (preterm prelabor rupture of membranes) otherwise it is known as term PROM.[2]
Treatment is based on how far along a woman is in pregnancy and whether complications are present.[2] In those at or near term without any complications, induction of labor is generally recommended.[2] Time may also be provided for labor to begin spontaneously.[1][2] In those 24 to 34 weeks of gestation without complications corticosteroids and close observation is recommended.[2] A 2017 Cochrane review found waiting generally resulted in better outcomes in those before 37 weeks.[5] Antibiotics may be given for those at risk of Group B streptococcus.[2] Delivery is generally indicated in those with complications, regardless of how far along in pregnancy.[2]
About 8% of term pregnancies are complicated by PROM while about 30% of preterm births are complicated by PROM.[2][4][6] Before 24 weeks PROM occurs in fewer than 1% of pregnancies.[2] Prognosis is primarily determined by complications related to prematurity such as necrotizing enterocolitis, intraventricular hemorrhage, and cerebral palsy.[2][7]
- ^ a b c d e Norwitz ER, Arulkumaran S, Symonds I (2007). Oxford American Handbook of Obstetrics and Gynecology. Oxford University Press, USA. p. 268. ISBN 9780195189384.
- ^ a b c d e f g h i j k l m n o p q r s t u v Committee on Practice BO (January 2018). "ACOG Practice Bulletin No. 188: Prelabor Rupture of Membranes". Obstetrics and Gynecology. 131 (1): e1–e14. doi:10.1097/AOG.0000000000002455. PMID 29266075. S2CID 329991.
- ^ Desai SV, Tank P (2012). Handbook on Preterm Prelabor Rupture of Membranes in a Low Resource Setting. JP Medical Ltd. p. 22. ISBN 9789350255803.
- ^ a b Keeling JW (2013). Fetal and Neonatal Pathology. Springer Science & Business Media. p. 325. ISBN 9781447136828.
- ^ Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA, Buchanan SL, Morris J (3 March 2017). "Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome". The Cochrane Database of Systematic Reviews. 2017 (3): CD004735. doi:10.1002/14651858.CD004735.pub4. PMC 6464692. PMID 28257562.
- ^ Duff P (2016). "Management of Premature Rupture of the Membranes in Term Patients". The Global Library of Women's Medicine. doi:10.3843/GLOWM.10119.
- ^ Mercer BM (2009). "Preterm Premature Rupture of the Membranes". The Global Library of Women's Medicine. doi:10.3843/GLOWM.10120.