Premature rupture of the membranes
Premature rupture of the membranes (PROM) is a spontaneous break or tear in the amniochorial sac before the onset of regular contractions, resulting in progressive cervical dilation. PROM occurs in nearly 10% of all pregnancies over 20 weeks’ gestation, and labor usually starts within 24 hours; more than 80% of these neonates are mature. The latent period (between membrane rupture and labor onset) is generally brief when the membranes rupture near term; when the neonate is premature, this period is prolonged, which increases the risk of mortality from maternal infection (amnionitis, endometritis), fetal infection (pneumonia, septicemia), and prematurity.
Causes
Although the cause of PROM is unknown, malpresentation and contracted pelvis commonly accompany the rupture. Predisposing factors may include:
poor nutrition and hygiene and lack of proper prenatal care
incompetent cervix (perhaps as a result of abortions)
increased intrauterine tension due to hydramnios or multiple pregnancies
defects in the amniochorial membranes’ tensile strength
uterine infection.
Signs and symptoms
Typically, PROM causes blood-tinged amniotic fluid containing vernix particles to gush or leak from the vagina. Maternal fever, fetal tachycardia, and foul-smelling vaginal discharge indicate infection.
