Rupture of membranes (ROM) or amniorrhexis is a term used during pregnancy to describe a rupture of the amniotic sac at the onset of, or during, labor. This is colloquially known as "breaking water." A premature rupture of membranes (PROM) is a rupture that occurs prior to the onset of labor.
Maternal risk factors for a premature rupture of membranes include chorioamnionitis or sepsis. Fetal factors include prematurity, infection, cord prolapse, or malpresentation.
Assessment of a rupture of membranes involves taking a proper medical history, a gynecological exam using a speculum, nitrazine, cytologic (ferning) tests, and ultrasound. It can also involve a test called "Amnisure".
In a term pregnancy where premature rupture of membranes has occurred, spontaneous labor can be permitted. Current obstetrical management includes an induction of labor at approximately 4-6 hours if it has not already begun though many physicians believe it to be safe to induce labor immediately, and consideration of Group B Streptococcal prophylaxis at 18 hours. Some hospitals, birth centers and private midwives do not induce labor at any point after PROM, but rather watch carefully for any signs of infection and ensure that nothing is introduced into the vagina after the PROM, including sterile vaginal exams.
In preterm premature rupture of membranes (PPROM), antibiotic therapy should be given to decrease the risk of sepsis. Ampicillin or erythromycin should be administered for 7 days, and antenatal steroids if the gestational age is less than 32 weeks. Tocolysis is also sometimes used, though its use in this context is controversial. The mother should be admitted to hospital and put under careful surveillance for preterm labor and chorioamnionitis. Induction of labor should happen at around 34 weeks.
Types
- PROM = prelabor or premature rupture of membranes
- PPROM = preterm, premature rupture of membranes
- AROM = artificial rupture of membranes
- SROM = spontaneous rupture of membranes
Resources
Placental_alpha_microglobulin-1_(PAMG-1)
External links
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