Symptoms may include:. If you notice any symptoms of PROM, be sure to call your doctor as soon as possible. The symptoms of PROM may resemble other medical conditions.
Consult your doctor for a diagnosis. In addition to a complete medical history and physical examination, PROM may be diagnosed in several ways, including the following:. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
Ultrasounds are used to view internal organs as they function, and to assess how much fluid is around the baby. Expectant management in very few cases of PPROM, the membranes may seal over and the fluid may stop leaking without treatment, although this is uncommon unless PROM was from a procedure, such as amniocentesis, early in gestation.
Another meta-analysis 24 found a decrease in neonatal intraventricular hemorrhage and sepsis. A number of antibiotic regimens are advocated for use after preterm PROM. The regimen studied by the National Institute of Child Health and Human Development trial 25 uses an intravenous combination of 2 grams of ampicillin and mg of erythromycin every six hours for 48 hours, followed by mg of amoxicillin and mg of erythromycin every eight hours for five days.
Women given this combination were more likely to stay pregnant for three weeks despite discontinuation of the antibiotics after seven days. It is advisable to administer appropriate antibiotics for intrapartum group B streptococcus prophylaxis to women who are carriers, even if these patients have previously received a course of antibiotics after preterm PROM.
Limited data are available to help determine whether tocolytic therapy is indicated after preterm PROM. As described above, corticosteroids and antibiotics are beneficial when administered to patients with preterm PROM, but no studies of these therapies combined with tocolysis are available.
Tocolytic therapy may prolong the latent period for a short time but do not appear to improve neonatal outcomes. Long-term tocolytic therapy in patients with PROM is not recommended; consideration of this should await further research. Preterm PROM is not a contraindication to vaginal delivery. There are few data to guide the care of patients without documented pulmonary maturity. No studies are available comparing delivery with expectant management when patients receive evidence-based therapies such as corticosteroids and antibiotics.
Physicians must balance the risk of respiratory distress syndrome and other sequelae of premature delivery with the risks of pregnancy prolongation, such as neonatal sepsis and cord accidents. Physicians should administer a course of corticosteroids and antibiotics to patients without documented fetal lung maturity and consider delivery 48 hours later or perform a careful assessment of fetal well-being, observe for intra-amniotic infection, and deliver at 34 weeks, as described above.
Consultation with a neonatologist and physician experienced in the management of preterm PROM may be beneficial. Patients with amnionitis require broad-spectrum antibiotic therapy, and all patients should receive appropriate intrapartum group B streptococcus prophylaxis, if indicated. Physicians should advise patients and family members that, despite these efforts, many patients deliver within one week of preterm PROM.
Physicians should administer a course of corticosteroids and antibiotics and perform an assessment of fetal well-being by fetal monitoring or ultrasonography. In addition, the physician should observe closely for fetal or maternal tachycardia, oral temperature exceeding Corticosteroid administration may lead to an elevated leukocyte count if given within five to seven days of PROM.
Evidence suggests that prolonged latency may increase the risk of intra-amniotic infection. Delivery is necessary for patients with evidence of amnionitis. If the diagnosis of an intrauterine infection is suspected but not established, amniocentesis can be performed to check for a decreased glucose level or a positive Gram stain and differential count can be performed.
The incidence of this syndrome is related to the gestational age at which rupture occurs and to the level of oligohydramnios. Physicians caring for patients with preterm PROM before viability may wish to obtain consultation with a perinatologist or neonatologist. Such patients, if they are stable, may benefit from transport to a tertiary facility. Home management of patients with preterm PROM is controversial. A study 33 of patients with preterm PROM randomized to home versus hospital management revealed that only 18 percent of patients met criteria for safe home management.
Bed rest at home before viability i. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Medina completed a fellowship in family practice obstetrics at Florida Hospital, Orlando. Address correspondence to D. Ashley Hill, M.
Reprints are not available from the authors. Causes of low birth weight births in public and private patients. Am J Obstet Gynecol. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. This is called an artificial rupture of the membranes.
You may feel a large gush of fluid after the membranes rupture. The uterus keeps making amniotic fluid until the baby's birth. So you may still feel some leaking, especially right after a hard contraction tightening of the muscles of the uterus. Sometimes it can be hard to tell if your membranes have ruptured. As you get closer to your due date, your uterus puts more pressure on your bladder. A strong Braxton Hicks contraction or sneeze can cause some urine to leak.
You might mistake this for a rupture of the membranes. If you are lying down when your membranes break, you are more likely to feel a gush of liquid. If the membranes break when you are standing up, you are more likely to feel just a trickle. That's because the baby's head gets pushed down against the cervix and acts like a cork when you stand.
You can also go to the hospital or birthing center. The health professionals there will test the drainage to see if it is amniotic fluid. Amniotic fluid is normally a cloudy-white to an amber-straw color. Let your health professional know if the leaking fluid:. As soon as the membranes have ruptured, a woman should contact her doctor or midwife.
Usually, the fluid-filled membranes containing the fetus rupture during labor. But occasionally in normal pregnancies, the membranes rupture before labor starts—prelabor rupture. Prelabor rupture of the membranes may occur near the due date at 37 weeks or later, when pregnancy is considered full term or earlier called preterm prelabor rupture if it occurs earlier than 37 weeks.
If rupture is preterm, delivery is also likely to be too early preterm Preterm Labor Labor that occurs before 37 weeks of pregnancy is considered preterm. Babies born prematurely can have serious health problems. The diagnosis of preterm labor is usually obvious. Measures such Intra-amniotic infection Intra-Amniotic Infection Intra-amniotic infection is infection of the tissues around the fetus, such as the fluid that surrounds the fetus amniotic fluid , the placenta, the membranes around the fetus, or a combination Presentation refers to the part of Early detachment of the placenta placental abruption Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy.
Infection of the uterus can cause a fever, a heavy or foul-smelling vaginal discharge, or abdominal pain. If prelabor rupture results in a preterm delivery, the premature newborn Premature Newborn A premature newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, premature newborns have underdeveloped organs, which may not be ready to function outside When there is bleeding in the brain, the brain may not develop normally, causing problems such as cerebral palsy Cerebral Palsy CP Cerebral palsy refers to a group of symptoms that involve difficulty moving and muscle stiffness spasticity.
It results from brain malformations that occur before birth as the brain is developing If the pregnancy is less than 24 weeks when the membranes rupture, the fetus's limbs may be deformed. After the membranes rupture, contractions usually begin within 24 hours when the woman is at term but may not start for 4 days or longer if rupture occurs between 32 and 34 weeks of pregnancy.
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