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Pregnancy Bliss | Reproductive Health Hub

Talipes (club-foot) can result from prolonged membrane rupture. It is relatively easy to correct after the birth

Frequency Effects of PPROM Steroids role Progesterone hormone Late PPROM Pre-labour rupture

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What about preterm pre-labour rupture of membranes?

This is a different ball-game. There is the added dimension of prematurity as a problem to contend with. The outlook for the pregnancy will therefore be heavily dependent on the gestation, i.e. the degree of prematurity.

It is important to be aware that once waters break, four out of five pregnancies (80%) will conclude within a week, whatever measures are instituted. In cases where the membranes rupture before twenty-six weeks of gestation, the outlook is challenging. For the 20% where pregnancy continues successfully, there are still other problems which might plague the mother and baby. These are discussed below.

How the mother and baby are affected by PPROM

If the pregnancy continues after preterm pre-labour rupture of membranes (PROM), what are the potential risks to the mother?

For the mother, the feared complication is infection, a condition called "chorioamnionitis". It simply means "inflammation of the membranes". This is a potentially serious problem and can even lead to septicaemia (infection of the blood).

It is estimated to affect up to a third of all pregnancies with prolonged rupture of membranes, the vast majority of cases being only mild and treated in time.

It is now an accepted practise to start any mother confirmed to have pre-term pre-labour rupture of membranes on a course of antibiotics. Erythromycin is the antibiotic normally used unless the person is allergic to it. In such a case, a substitute safe antibiotic will be used. The aim is to minimise the risk of infection. Studies have shown that this strategy is very effective in this regard.

Preterm rupture of membranes also increases the chance of a caesarean delivery.

We should not forget that this complication of pregnancy is managed wholly in hospital and the prolonged hospitalization, sometimes lasting several weeks, could be severely disruptive on the home front.

How is the baby affected by preterm rupture of membranes?

This depends on the extent or degree of prematurity. Again, remember, once the waters break, delivery will occur within a week in 80 per cent of cases. If the rupture occurs as early as around twenty-four weeks, one is facing a spectre of delivering a tiny baby with hardly any lung development. The outlook is then very poor indeed, unless the pregnancy can be prolonged for several weeks. Even when this is achieved, it is not all light and sunshine.

These babies face multiple problems as a result of developing in the womb where there is no water. If the rupture occurred very early, lung development - which is dependent on the presence of adequate fluid - will be severely impaired.

This may be a difficult problem to overcome even after delivery- and the baby may face a battle to survive.

Other problems caused by lack of fluid in the womb include limb deformities. These are positional and correctable.

There may also be facial deformities (usually mild) and growth restriction. In any case of prolonged rupture of membranes, there is the ever-present risk of infection, which will normally force delivery. Once infection is detected, there is no option but to deliver the baby.

Can anything be done about the feared poor lung development?

Precious little, if any. If the membranes rupture relatively late - let's say after twenty-eight weeks - the problem is either mild or does not occur. If it is as early as 22 to 24 weeks, it is potentially very serious. One management strategy which is not quite established in mainstream practice and whose value has yet to be fully established is the so-called "ammo-infusion". In this, sterile fluid is infused into the womb every few days to try to create a "normal" environment for the fetus. Results so far have been variable but the procedure is still in its infancy. page