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'Premature’ rupture of membranes

This has been mentioned here in case it is a term that has been used by your midwife or doctor. It is in fact an old term which is both inaccurate and misleading. The original meaning of the term was a situation where waters broke before the onset of labor, even at Term. This, as you can see, can create confusion.

It is a term that has been largely abandoned but old habits die hard and old medical habits probably die hardest. You may therefore encounter somebody using it. Here, we shall stick with the currently used terms, i.e. preterm rupture of membranes and pre-labor rupture of membranes, which are self-descriptive.

What to expect when membranes rupture (before labor)

When amniotic membranes break, there is a gush or trickle of fluid from the vagina. The fluid is usually clear and warm. It can be, and often is, confused with urine incontinence, especially when it is only a trickle. The tendency is for the leak to continue and it is normally increased by actions such as laughing, coughing or sneezing. There is usually no pain.

What to do when the ‘waters’ break

Regardless of the gestation, the mother should be seen in a maternity unit promptly. One of the not infrequent statements that obstetricians and midwives hear with a sinking heart is, "Oh, I have been wet for the last three days or so." This may be a product of ignorance or sheer irresponsibility on the part of the mother. The plan of management needs to be put in place immediately after any pre-labor rupture of membranes, regardless of whether it is Term or Pre-term.

‘Waters’ breaking at Term

When membranes rupture at Term, this is usually a labor prelude. However, in some instances, there are immediate concerns. These include cord complications. Pre-labor rupture of membranes could be complicated by prolapse of the cord, which may then be compressed, effectively cutting off the blood supply to the fetus. By the time the mother is alerted by, let's say, loss of fetal movements, it is really too late.

Delayed complications of pre-labor rupture of membranes at Term include infection, especially if labor is delayed for a number of days. The baby may be born in poor health and could suffer from severe pneumonia or other serious forms of infection as a result.

Many obstetric units operate a policy of inducing labor after 24 hours if it has not happened spontaneously. Even those units which observe a more conservative policy will take measures to exclude infection or to monitor for any signs of this, so that timely appropriate action can be taken.

Preterm pre-labor rupture of membranes (PPROM) and what it implies

PPROM is a different ball-game when compared to simple pre-labor rupture. 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 26 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. We discuss these shortly.

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