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By Dr Joe Kabyemela, MD
When "waters" go prior to reaching term (thirty-seven weeks and beyond), the event can cause acute anxiety and even panic.
There is little doubt that nature meant the membranes to rupture either just before the onset of labour or during labour.

The further from term the event occurs, the higher the risk of complications for both mother and baby. In fact, if this happens at or around twenty weeks of gestation (the halfway mark), the prognosis for the baby is, in all honesty, quite dire. On the other hand, if this takes place closer to term - let us say at around thirty-four weeks - unless the cause was something very serious, the baby will usually emerge relatively unscathed. This is regardless of whether delivery follows a few days after or much later.

You will see in the following section that there are areas where obstetricians do not appear to agree on the best strategy when membranes rupture. Mothers, quite understandably, hate this. Unfortunately, this is one area where you do not have a clear black and white picture. The apparent dithering is because there is, in reality, no scientific evidence to say which strategy is superior to the other.

It is therefore not unusual to hear one advising immediate delivery because it is his or her preferred strategy, while the other advises conservative management "to await events". This is usually the case when "waters" rupture in the so-called gray period between thirty-four and thirty-seven weeks. There is virtual consensus when it is before this, as we shall see in the following section.

Rupture of membranes at term, even before the onset of labour is not regarded as a problem. It just means labour is imminent, even though the waiting for the actual event may stretch from less than an hour to two or even three days. This is unless the doctors decide to intervene to encourage things along, as they might do, with the mother's consent.



29. Preterm rupture of membranes

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