Premature rupture of the membranes

by Claudia Ravaldi

What is pProm and what is important to know.

A summary by Dr. Margaret Mascherpa and Laura Avagliano, gynecologist.

Definition

We speak of pPROM when the rupture of the membranes occurs, outside of labor, before the pregnancy has reached term. This event can also occur in very early gestational periods, putting the continuation of pregnancy at risk.

Risk factors

The rupture of the membranes is almost never attributable to a single cause, it is rather the result of the sum of several events and risk factors, not always all known and / or preventable.

Causes

It is important to distinguish spontaneous rupture of membranes from rupture that occurs following invasive procedures performed with sterile instruments, such as amniocentesis. In the latter case, the prognosis of pregnancy is in fact much better. In cases of spontaneous rupture of the membranes, on the other hand, it is very common to find an infection of the amniotic cavity among the causes, which makes the prognosis much more severe.

Clinical presentation and diagnosis

The pPROM manifests itself as uncontrolled loss of fluid from the genitals and the diagnosis is based on identifying and ascertaining the loss of fluid at the gynecological examination.

Course

Rupture of the membranes is an irreversible event that often precedes the onset of labor, therefore of preterm birth. The earlier the gestational period at delivery, unfortunately the greater the risk of complications.

Complications

Complications for the baby are primarily dictated by the gestational period to birth and are common to all premature babies; Respiratory complications are typical since in the absence of amniotic fluid the maturation of the lungs is insufficient (pulmonary hypoplasia). The possible complications for the mother, on the other hand, are represented by infections, an increased risk of caesarean section or haemorrhage.

You hesitate

Unfortunately, the neonatal prognosis is severe: only half of children affected by pProm between the 20th and 24th week of gestation survive, and of these, in half of the cases, the long-term outcomes in the neuro-cognitive area are complex.

Management

The management of pPROM in the earliest gestational periods is based on a delicate evaluation of risks and benefits in the continuation of pregnancy. In some cases, regardless of the gestational age, delivery is indicated for specific maternal or fetal conditions; in other cases spontaneous birth is inevitable and we can only intervene in reducing the infectious, respiratory and neurological complications to which the severely preterm baby is exposed.

If spontaneous labor does not occur and maternal-fetal conditions allow it, a waiting behavior can be implemented and time can be gained towards gestational periods that are more favorable for the survival and health of the baby.

After giving birth

Even if unfortunately a precise identification of the causes is not always reached, it is essential to have more tests (microbiological and histological tests) to understand the origin of the rupture of the membranes. There is the possibility, for those who have had a pProm, that the pPROM also occurs in a subsequent pregnancy so the risk factors of the woman must be investigated and, where possible, removed.

This article is dedicated to all the mothers who have passed by CiaoLapo to deal with the loss of their babies born too early and passed away too soon, due to premature rupture of the membranes.

This article is dedicated to all the mothers who have waited, motionless, the passing of days, hoping to be able to give days to the lives of their children.

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