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Pregnancy and Childbirth: The answers

Pre-term Pre-labor Rupture of Membranes (PPROM)

 

When the amniotic membranes or ‘waters’ break prior to reaching Term (37 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 labor or during labor itself.

 

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 20 weeks of gestation (the halfway mark), the prognosis for the baby is quite bleak. On the other hand, if this takes place closer to Term – let’s say around 34 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 membranes rupture in the so-called grey period between 34 and 37 weeks. There is consensus when membranes break before 34 weeks, as we shall see in the following section.

 

Rupture of membranes at Term, even before the onset of labor is not regarded as a problem. It just means labor is imminent, even though the waiting for the actual event may stretch from a matter of minutes 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.

 

Pre-term rupture of membranes: How common

This is fairly common in the sense that it affects about 8% of all pregnancies. Overall, 10% of all pregnancies will be affected by membranes rupturing before labor. The difference (2%) is accounted for by rupture at term but before the onset of labor.

 

 

Pre-term rupture and pre-labor rupture: What is the difference?

If membranes rupture before the onset of labor then this is termed "pre-labor rupture of membranes", regardless of the gestation. If this occurs before 37 weeks of gestation, then it is further qualified by the term "preterm pre-labor rupture of membranes" (PPROM). The significance is in the prematurity in the latter case.

 

Ideally, amniotic fluid membranes (or "waters", in popular terms) should stay intact until the onset of labor. The waters will go at any stage of labor. This may be spontaneous or they may be artificially ruptured (if this is seen to be useful or necessary). This is what happens in 90% of all pregnancies.

 

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