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Membrane rupture: Effect on mother and baby

 

Following preterm pre-labor membrane rupture, 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 septicemia (infection of the blood). This 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. The role of antibiotics is discussed below.

 

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 domestically.

 

Preterm rupture of membranes: The baby

Effect on the baby depends on the degree of prematurity. Again, remember, once the ‘waters’ break, delivery will occur within a week in 80% of cases. If the rupture occurs as early as around 24 weeks, one is facing a specter of delivering a tiny baby with hardly any lung development. The outlook is then very poor indeed. This is so 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 little or 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 prove to 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.

 

Dealing with poor fetal lung development

If the membranes rupture relatively late - let's say after 28 weeks - the lung development 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.

 

 

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Clubfoot may result from prolonged PPROM

Talipes (clubfoot) could result from prolonged membrane rupture as the cushion effect of the fluid is lost. These are  relatively easily corrected after delivery