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Prelabor rupture of membranes
Breakage of the amniotic sac before the onset of labour / From Wikipedia, the free encyclopedia
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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]
Prelabor rupture of membranes | |
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Other names | Premature rupture of membranes |
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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] |
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]