Preterm Prelabour Rupture of Membranes
What is preterm pre-labour rupture of membranes (PPROM)?
PPROM occurs when you break your water bags before you go into labour and you are less than 37 weeks pregnant. Water bag is the term used for the amniotic fluid surrounding your baby.
How do I know that I might have PPROM?
You might feel a sudden gush of fluid coming down from your vagina or excessive dampness or vaginal discharge. The fluid could be clear, pinkish or mixed with blood. If you are unsure you should go and check with your doctor or nearest clinic / hospital immediately.
What should I do if I think I have PPROM?
Wear a sanitary pad (not a tampon) and take note of the colour, smell and amount of the fluid. You should go and seek medical attention from your doctor as soon as possible to confirm the diagnosis.
How is PPROM diagnosed?
Your doctor will need to do an internal examination. A speculum will be inserted into your vagina to visualize your vagina and cervix. It will be noted whether there was any obvious leaking liquor and dilatation of your cervix. If there is no obvious liquor seen, a simple test could be done by taking a swab to confirm whether there is any PPROM or not.
What is the cause of PPROM?
There are many reasons for PPROM including:
- Vaginal infections
- Too much amniotic fluid (polyhydramnios)
- Cigarrette smoking
What treatment will be given for PPROM?
- After confirming that you have PPROM, you will most likely be asked to be admitted into hospital for further monitoring
- Several tests will be done to find out the cause of PPROM especially to rule out any underlying infection (vagina or urine)
- An ultrasound and CTG will be done to measure the growth, weight of your baby, the amount of amniotic fluid and hear the baby’s heart beat.
- You will be given antibiotics (erythromycin) to cover for any underlying infection. This will not be harmful to your baby.
- Corticosteroids injection will be given to fasten the maturity of your baby’s lung incase you go into preterm labour
- A ventilator will be booked after liason with the Paediatrician for your baby.
- Monitoring of the leaking and any evidence of possible infection via monitoring your pad, blood pressure, heart rate, temperature and blood investigation.
Further management will depend on what gestation you are, whether you have stopped leaking, any evidence of uterine infection (chorioamnionitis) and the presence of contractions. You should discuss this with your doctor.
What does this means for me and my baby?
- You might go into preterm labour and have a preterm vaginal delivery with premature baby. Outcome depends at how far along you are in pregnancy.
- Prolonged hospital stay for further monitoring. You may either be discharge home later or induced for labour.
- Increased risk of infection of the womb (chorioamnionitis) When your water breaks, the protective barrier is broken and there is an increased risk of infection going into the womb and infecting the baby. Signs to look out for including an increased in temperature, heart rate, change in the colour and smell of the liquor from clear and odourless to green and foul smelling. There could be also changes in your blood indicating infection. When this happens your doctor may deliver you earlier.
- If you went into labour and the baby’s position is not head down, you may require an emergency C-section.
What will happen to my baby after delivery?
The main problem will be prematurity and risk of infection. This depends on how far along you are and if there was any evidence of infection in your baby. Your baby may be taken care of at the Neonatal Intensive care Unit (NICU) post delivery due to prematurity and risk of infection. Every case is different. Talk your doctor about it.
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