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Premature rupture of membranes

Maternal pregnancy complications


Description

In about 3% of pregnancies, the amniotic membranes break and release amniotic fluid before 37 weeks of amenorrhea (the absence of menstruation). Premature rupture of membranes is not necessarily accompanied by contractions but remains responsible for 30% of premature deliveries.

Complications associated with premature rupture of the membranes are:

  • Chorioamnionitis causing premature labour and preterm birth.
  • Chorioamnionitis causing fetal distress and perinatal death.
  • Cord injury secondary to severe oligohydramnios (low amniotic fluid) or cord prolapse
  • Placental detachment causing premature labour.
  • Pulmonary hypertension and pulmonary hypoplasia, which cause severe breathing difficulties in preterm infants if membrane rupture occurs during the 2nd trimester of pregnancy.

These complications are avoided by close medical supervision and by the administration of treatments specific to these conditions.


Causes

The cause of membrane rupture is not always identifiable. It may, however, be the result of medical interventions (e.g. amniocentesis), genital infection of the mother, or the amniotic fluid itself. Certain pregnancy complications leading to overdistention of the uterus (e.g. polyhydramnios, which is an excess of amniotic fluid) may also be associated with premature rupture of the membranes.


Symptoms

An obvious loss of clear or lightly coloured liquid – whether abundant or dripping repeatedly from the vagina – before term should be promptly reported to a member of your medical team. Sometimes a pregnant woman has urinary leakage, but the difference is usually identifiable by its color and odour.


Tests and procedures

When a premature rupture of the membranes is suspected, the doctor will carry out certain tests to confirm this is the case:

  • Fern-test (microscopic examination)
  • Nitrazine paper test
  • AmniSure
  • Ultrasound

If the tests are conclusive, blood and vaginal samples will be taken from the mother to look for a cause and to eliminate the possibility of chorioamnionitis (intra-amniotic infection).

The exam includes the tests below to ensure fetal well-being:

  • Ultrasound fetal reactivity assessment (non-stress test (NST))
  • Biophysical profile (BPP) as needed
  • Listening to fetal heart with portable monitor when pregnancy is under 23 weeks.

Treatment and follow-up care

When the membranes rupture prematurely, an evaluation by a doctor is necessary.

Proposed treatment is chosen according to:

  • Gestational age
  • Fetal well-being
  • Signs of infection
  • Whether labour has begun (contractions)

According to the observations:

  • In about 50% of cases, labour sets in and delivery occurs within 24 to 48 hours (Nelson L)
  • In more than 40% of cases, delivery occurs after 48 hours
  • In about 10% of cases, there is prolongation of pregnancy for a week or more

When the membranes are broken, but there is no labour or infection:

  • If the gestational age is less than 23 weeks, there will be an investigation by a doctor. If the patient’s condition is stable, he or she will prescribe bed rest at home with antibiotics and bi-weekly medical visits that include an ultrasound.
  • At 23 weeks of pregnancy and over, hospitalization for at least one week is ordered, along with blood tests and ultrasounds and the administration of antibiotics. To prevent the risk of respiratory distress in the baby, 2 injections of betamethasone are given 24 hours apart. Finally, the doctor will ask for a weekly NST and request that her temperature is taken regularly and that she is on strict bed rest.

Because lung immaturity in the baby is a major problem related to prematurity, maintaining the pregnancy is considered more beneficial than the risk of infection. Delivery will still be expected early, or between 34 and 37 weeks of pregnancy, depending on the evolution of the condition and the results of the analyses.

In some hospitals, such as CHU Sainte-Justine, after minimum hospitalization, the continuation of a pregnancy can be maintained at home despite premature rupture of the membranes. This is done under the supervision of a nurse specialized in at-risk pregnancies who visits 3 times a week. The care provided is based on the well-being of the unborn child, the health of the mother, and the involvement of the family, which is key for at home care since the pregnant woman must remain resting. The nurse does not replace the necessity of medical visits every two weeks.


Resources and useful links

  • Nelson L, Anderson R, O’Shea M et Swain M. Expectant management of preterm premature rupture of Membranes. Am J Obstet Gynecol 1994 171 : 350-8.
  • G. Kayem, F. Maillard. Gynécologie Obstétrique & AMP ; Fertilité, volume 37, numéro 4, pages 334-341 (avril 2009)
Fiche par

Nancy Morris, inf. clinicienne et Dre Lucie Morin

About this page
Updated on 12/19/2017
Created on 12/19/2017
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