Understanding Premature Rupture of Membranes (PROM)

Premature Rupture of Membranes (PROM)

Premature rupture of membranes (PROM) is a condition where the amniotic sac ruptures before labor begins. This condition can occur either before the fetus matures in the womb (before the 37th week of pregnancy), or after the fetus matures. The earlier the membrane rupture occurs during pregnancy, the more serious the condition. These danger signs of pregnancy need to be treated as soon as possible to avoid complications for the mother and baby. It is said that premature rupture of membranes occurs if the amniotic sac ruptures before the labor process begins, or before entering the active phase.

Characteristics of Premature Rupture of Membranes

Pregnant women will feel amniotic fluid coming out of the vagina when the membranes break. The water that comes out can flow slowly or come out heavily. Unlike urine, leaking amniotic fluid cannot be controlled so it will continue to flow out even if you try to hold it in. To further determine whether the fluid is urine or amniotic fluid, pregnant women can use a sanitary napkin to absorb the fluid that comes out. Next, look and smell the sanitary napkin. Amniotic fluid is colorless and does not smell like urine, but tends to have a sweet smell.

Apart from leaking amniotic fluid, premature rupture of membranes can be accompanied by the following symptoms:

1. The pelvis feels compressed.
2. Vaginal discharge or vagina feels wetter than usual.
3. Bleeding through the vagina.

Immediately consult a doctor or midwife if a pregnant woman feels these symptoms.

Causes of Premature Rupture of Membranes

Premature rupture of membranes is very important for pregnant women to be aware of. Because, this condition can cause serious complications that endanger the lives of pregnant women and their fetuses. Therefore, it is important to know the causes of premature rupture of membranes so that pregnant women can anticipate the dangers of this pregnancy. During pregnancy, the fetus is protected and surrounded by membranes containing amniotic fluid. This fluid is produced about 12 days after the fertilization process or after the amniotic sac is formed.
Some time before the fetus is born, the amniotic sac will rupture and amniotic fluid will exit through the vagina. Within approximately 24 hours after the membranes rupture, the baby will usually be born. If the membranes rupture before 37 weeks of gestation, the condition can be said to be premature rupture of the membranes.

A pregnant woman is said to have premature rupture of membranes if:

1. Fluid leaks before the pregnancy reaches 37 weeks. The earlier the membranes rupture, the more dangerous it is for the mother and baby.
2. The membranes rupture when the gestational age is approaching the due date, but labor does not occur within 24 hours afterward.

Premature rupture of membranes usually causes preterm labor, which is a condition where the baby is forced to be born prematurely.
This condition is generally more at risk of occurring in the following conditions:

1. Infection in the uterus, amniotic sac, cervix, or vagina.
2. Twin pregnancy.
3. The amniotic sac stretches excessively, because there is too much amniotic fluid (polyhydramnios).In certain cases, premature rupture of membranes can also occur in pregnant women who experience a lack of amniotic fluid (oligohydramnios).
4. Pregnant women who are underweight or have malnutrition.
5. The habit of smoking or using drugs during pregnancy.
6. History of premature rupture of membranes in a previous pregnancy.
7. Vaginal bleeding during pregnancy in the second and third trimesters of pregnancy.
8. Low body mass index of pregnant women.
9. High blood pressure and uncontrolled blood sugar levels.
10. The distance between births is too close or too far.
11. Have had surgery and cervical biopsy.
12. Have given birth to a premature baby.Diagnosis dan Pengobatan Ketuban Pecah Dini.

Doctors can diagnose premature rupture of membranes from the patient’s complaints and through physical examination. In the physical examination, the doctor will mainly examine the inside of the cervix to confirm the rupture of the membranes.
If necessary, the doctor will also carry out additional examinations in the form of:

1. pH test, to check the acidity level of vaginal fluids. If the amniotic fluid has ruptured, the acidity level of the vaginal fluid will be higher (it should be more alkaline).
2. Ultrasound, a pregnancy ultrasound examination can be done to check the condition of the fetus and uterus, as well as see the amount of amniotic fluid remaining.

After the membranes break, the doctor will check whether the fetus is ready to be born, because delaying birth after the membranes break risks causing infection. If there are no signs of labor, the obstetrician will recommend induction to speed up labor.
However, if premature rupture of membranes occurs before the gestational age reaches 34 weeks, the fetus’ lungs are not yet fully formed so it is not ready to be born. In this condition, the doctor will give corticosteroid medication to speed up the maturation of the fetus’ lungs, so that it can be born as soon as possible. To prevent infection, the doctor will also give antibiotics. Once the fetus is felt to be ready to be born, the doctor will carry out the induction procedure.

Complications of Premature Rupture of Membranes

Premature rupture of membranes can cause a number of complications. The following are some complications that can occur:

1. Infection of the membranes covering the fetus or chorioamnionitis.
   Chorioamnionitis carries the risk of causing serious infections in the mother and fetus, such as pneumonia, meningitis, and sepsis.
2. Depressed umbilical cord or compression of the umbilical cord.
   Lack of amniotic fluid due to premature rupture of membranes can put pressure on the umbilical cord by the fetus. In some cases, the umbilical cord even comes out of the uterus and descends into the vagina. Umbilical cord compression can cause serious brain injury and even death.
3. The baby was born premature.
   Babies born prematurely are at risk of experiencing neurological disorders, respiratory problems and learning difficulties later in life. Although rare, premature rupture of membranes can occur before 24 weeks of pregnancy and can cause fetal death. Babies born before the 24th week and who survive are at risk of developing developmental disorders, chronic lung disease, hydrocephalus and cerebral palsy.

4. Uterine infection.
   This condition is characterized by symptoms such as fever, unusual vaginal discharge, unpleasant vaginal odor, fast pulse, pain in the lower abdomen, and the fetus’ heart rate is faster than normal. If left untreated, infections in the uterus can cause dangerous sepsis in the baby.
5. Retained placenta.
   Premature labor due to premature rupture of membranes increases the risk of placental retention, which is a condition where part or all of the placenta is left in the uterus. This condition can cause postpartum hemorrhage which is characterized by heavy bleeding from the vagina within 24 hours to 6 weeks after delivery.
6. Placental abruption.
   Placental abruption, which is the detachment of part or all of the placenta from the uterine wall before labor occurs. This condition can trigger premature labor or even death of the fetus.
7. Brain injury to the fetus.
   When amniotic fluid is lost, the umbilical cord can become trapped between the fetus and the uterine wall. As a result, the fetus can experience brain injury or even death.
8. Death.
   If the membranes rupture before 23 weeks of gestation, the fetus’ lungs may not develop properly and cause the fetus not to survive. Even if the fetus survives, it is very likely that it will experience physical and mental defects when it is born. Babies are also at risk of experiencing several problems, such as chronic lung disease, hydrocephalus, cerebral palsy, and growth and development disorders.

Prevention of Premature Rupture of Membranes

There is nothing special that can be done to prevent premature rupture of membranes. However, because of the link between smoking during pregnancy and premature rupture of membranes, pregnant women are advised not to smoke and always adopt a healthy lifestyle and maintain health during pregnancy. Don’t forget to have regular pregnancy check-ups to monitor the growth and development and health of the fetus.