Premature Rupture of Membrane (PROM)

Subject: Midwifery II (Theory)

Overview

Spontaneous burst of waters at any time after 22 weeks of pregnancy but before the commencement of labor is known as premature rupture of a membrane (PROM), and before 37 weeks of gestation is known as preterm PROM. Possible causes include variables causing an increase in intrauterine pressure, numerous pregnancies, polyhydramnios, late pregnancy coitus, factors in the cervix such as the incompetent cervix, fetal malpresentation such as footling presentation, transverse or oblique lying, and so on. Maternal pyrexia, maternal tachycardia, fetal tachycardia, uterine discomfort, foul-smelling discharge, and unclean blood satin discharge are all symptoms of intrauterine infection. Aseptic examination with a sterile speculum to establish liquor pressure, rule out cord prolapse and obtain a high vaginal swab.

Spontaneous rupture of membranes at any time after 22 weeks of pregnancy but before the commencement of labor is referred to as premature rupture of a membrane (PROM) and before 37 weeks of gestation is referred to as preterm PROM.

Incidence

Rupture of the membrane happens before the commencement of the second stage of labor in around 5-10% of cases, and it occurs before the onset of the third stage of labor in another 25% of cases. It only happens in 2-4 percent of cases before 34 weeks.

Causes

Almost the majority of the time, the causes remain unknown. However, the following are some possible causes:

  1. Factors causing a raised intrauterine pressure:
  2. Multiple pregnancies
  3. Polyhydramnios
  4. coitus in late pregnancy
  5. Trauma
  6. Factors in the cervix as incompetence cervix.
  7. Faulty application of the presenting parts
  8. Malpresentation of a fetus as footling presentation, transverse or oblique lie.
  9. Placenta previa
  10. Disproportion
  11. Abnormal presentation
  12. Weakening due to infection a nearby blood clot ( bacterial enzyme action)
  13. Trauma
  14. Developmental defects
  15. Acceleration of loss of collagen over the last 10 weeks of pregnancy
  16. General factors
  17. Lower socio-economical status
  18. Poor nutrition
  19. Smoking

Clinical Features

  • A history of a rapid gush of fluid per vaginal or continuous leakage of fluid per vaginal.
  • Maternal pyrexia, maternal tachycardia, fetal tachycardia, uterine discomfort, foul-smelling discharge, and unclean blood satin discharge are all symptoms of intrauterine infection.
  • Early indicators of labor include painful uterine contractions (labor pain), as well as the existence of a show.

Diagnosis

  • Clear fluid is leaking from the vagina.
  • Speculum examination: liquor escaping via the cervix, liquor collecting in the posterior fornix.
  • Investigations
  • Fern test: crystallization of liquor on a slide after drying.
  • Alcohol can be tested for fetal squamous, hair, and vernix.
  • Nile blue sulfate analysis
  • Methylene blue examination
  • PH indication: The pH rises to 6-6.2.

Dangers

  • To the mother: There is an increased liability to infection.
  • To the fetus
  • Preterm labor and prematurity
  • Intrauterine infection
  • Cord prolapsed

Management

  • Investigation: If a pregnant woman presents with vaginal leaking of clear fluid, the following tests should be performed:
  • Complete blood count
  • Urine is collected for routine analysis, culture, and sensitivity testing.
  • Vaginal swab with high sensitivity for culture
  • A fetal biophysical profile is obtained using USG.
  • Aseptic examination with a sterile speculum to establish liquor pressure, rule out cord prolapse and obtain a high vaginal swab.
  • A vaginal digital examination should be avoided in most cases.
  • Maintain the patient's bed rest and use a sterile vulval pad to monitor for any future leaks.
  • Every 4 hours, check the maternal pulse, temperature, and fetal heart sound.
  • Prophylactic antibiotics should be used to decrease maternal and newborn infection.
  • See the RH clinical protocol for therapy of premature membrane rupture.

References
Things to remember
  • Spontaneous rupture of membranes at any time after 22 weeks of pregnancy but before the commencement of labor is referred to as premature rupture of a membrane (PROM) and before 37 weeks of gestation is referred to as preterm PROM.
  • The bulk of the time, the causes remain unknown.
  • However, factors producing an increase in intrauterine pressure, numerous pregnancies, polyhydramnios, coitus in late pregnancy, factors in the cervix such as the incompetent cervix, malpresentation of a fetus such as footling presentation, transverse or oblique lying, and so on are possible causes.
  • Maternal pyrexia, maternal tachycardia, fetal tachycardia, uterine discomfort, foul-smelling discharge, and unclean blood satin discharge are all symptoms of intrauterine infection.
  • Aseptic examination with a sterile speculum to establish liquor pressure, rule out cord prolapse and obtain a high vaginal swab.
Questions and Answers

The term "preterm PROM" refers to spontaneous membrane rupture that occurs before 37 full weeks of gestation while "term PROM" refers to spontaneous membrane rupture that occurs at any time after 22 weeks of pregnancy but before the start of labor.

The bulk of the time, the causes remain unknown. But these are some of the potential reasons:

  • Factors causing a raise intrauterine pressure:
    • multiple pregnancy
    • polyhydramnios
    • coitus in late pregnancy
    • trauma
  • Factors in the cervix as incompetence cervix:
    • Faulty application of the presenting parts
    • Malpresentation of a fetus as footling presentation, transverse or oblique lie.
    • Placenta previa
    • Disproportion
    • Abnormal presentation
    • Weakening due to infection a nearby blood clot ( bacterial enzyme action)
    • Trauma
    • Developmental defects
    • Acceleration of loss of collagen over the last 10 weeks of pregnancy
  • General factors:
    • Lower socio-economical status
    • Poor nutrition
    • Smoking

Investigation:

The following tests should be sent if a pregnant lady exhibits vaginal leaking of clear fluid:

  • Complete blood count.
  • Urine is tested regularly, sensitively, and culturally.
  • High vaginal swab for sensitivity and culture.
  • A fetal biophysical profile with USG.
  • Performing an aseptic examination with a sterile speculum to take a high vaginal swab, rule out cord prolapse, and confirm the pressure of alcohol.
  • In general, vaginal digital examination should be avoided.
  • Maintain the patient's bed rest and use a sterile vulval pad to catch any more leaks.
  • Every four hours, take the mother's temperature, heart rate, and pulse.
  • To prevent infections in the mother and the newborn, administer prophylactic antibiotics.

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