Preterm Premature Rupture of Membranes (PPROM) during Pregnancy

Rupture of membranes is the rupture of the amniotic sac that happens at the onset of labour after the full pregnancy term has passed. It is more commonly known as “water breaking”. However, in many cases, water breaking can happen a few hours before labour, leading to a condition known as premature rupture of membranes (PROM). This condition is harmless and does not cause any complications. However, membrane rupture occurring earlier than this can lead to severe problems. This article will help you understand the causes, risks, and treatments for this condition.

What Is PPROM?

If the amniotic sac breaks or ruptures before the 37th week of pregnancy, it leads to preterm premature rupture of membranes (PPROM). This can lead to severe problems such as miscarriage, premature birth, stillbirth, and infections.

How Common It Is?

PPROM in pregnancy is very unlikely, occurring in less than five per cent of all pregnancies. However, those who experience it will need to contact their obstetrician immediately.

Who Is at Risk of PPROM?

There are several factors that increase the likelihood of developing PPROM. Some of them are: 

• Smoking in any trimester of pregnancy.
• History of experiencing premature amniotic rupture.
• Suffering chronic bleeding from the vagina during pregnancy.
• Pregnancy involving two or more foetuses due to distension of the uterus.
• Contracting infectious diseases, such as bacterial vaginosis or certain sexually transmitted illnesses.
• Having gone through premature labour prior.
• Experiencing a placental abruption.
• Physical traumatic events, such as accidents.

Signs and Symptoms

The symptoms of PPROM are hard to miss, but to be on the safe side, you must consult with your gynaecologist for a proper diagnosis. Some symptoms may include:

• Suddenly emerging vaginal fluid.
• Fluid with a sweet aroma; if it has an ammoniacal odour, it is urine.

• Experiencing a wet or moist feeling in your underclothing.

Diagnosis and Tests

Your gynaecologist is well equipped to identify PPROM. They will first question you about your pregnancy and any symptoms, following which they will examine you for leaking fluid. There are three main tests available to confirm the diagnosis of PPROM.

pH Balance Testing

Your doctor will test the pH of the leaking fluid (pH is a measure of the level of acidity). This will tell them if you are leaking urine, vaginal fluid, or amniotic fluid, as they all differ in terms of acidity. The fluid will be placed on a pH balance strip, which will provide the information required. The sample can also be observed under a microscope, as dried amniotic fluid is fern-shaped and can be easily recognised.

Ultrasonography

If the pH balance tests are inconclusive, your doctor might schedule you for an ultrasound exam which will help identify if your membranes are intact or ruptured and measure the amount of amniotic fluid in your body.

Amniocentesis

However, if ultrasound results are still unclear, and if you have a history of membrane rupture or preterm labour, an amniocentesis might be recommended. This procedure will give you a certain answer.

Complications

In a large number of preterm deliveries, the cause is PPROM. There are several other complications that can arise from this condition, such as:

• Placental abruption, in which the uterus and placenta get torn away from each other.
• Infections in the amniotic sac, placenta or uterus.
• Umbilical cord prolapse, where the umbilical cord descends into the birth canal before the baby.
• Increased likelihood of a Caesarean section.

Treatment and Management

There are several PPROM guidelines that are employed in treatment and management methods:

Standard Treatment

The standard PPROM treatment involves corticosteroid medications, which are employed to make the foetal lungs develop faster in case of premature delivery. These medicines are prescribed around the 34th week of pregnancy. Antibiotics are also provided to combat any developing infections.

Other Treatments

Alternative treatment methods include observation of the situation, followed by amniocentesis to test for diseases or if the baby’s lungs are ready for birth. Induction of labour is also employed if it does not happen naturally. This shortens the delivery time, thereby lowering the likelihood of infections.

Controversial Treatment

Tocolytic medicine is often used as a last-minute attempt. It can delay the premature delivery, allowing time for the antibiotics and antenatal corticosteroid medications to work. This time delay can also be used to rush to a hospital with a dedicated neonatal intensive care unit.

Preventive Measures

There are no known preventive measures for PPROM. However, if you have experienced a preterm delivery before, progesterone supplements are recommended to prevent it from occurring again.

Difference Between PROM and PPROM

• While PROM happens in 7-10 per cent of all pregnancies, PPROM only occurs in about 3 per cent.

• PROM occurs right before birth, while PPROM occurs before the 37th week of pregnancy.

• PROM is much easier to manage than PPROM, causing two per cent and twenty per cent of perinatal fatalities, respectively.

• The complications from PROM can be avoided by labour induction before delivery, whereas in PPROM, it must be ensured that the foetus is ready for premature birth.

As mentioned earlier, the chances of suffering from PPROM are very low. However, ensure you consume a balanced diet and avoid smoking and strenuous exercise that will help reduce the likelihood of going through PPROM. Remember to carefully note down what your doctor tells you to have a healthy, happy pregnancy.

Also Read: 

Preterm Labour and Birth
How to Prevent Preterm Labour
Common Causes of Premature Birth