Premature Rupture of Membranes: Causes, Risks and Treatment

Your water is suppose to break when you go into labor, as the rupturing of the amniotic sac means that it will soon be time to give birth. But what does it mean if your water breaks well before your due date?

Known as premature rupture of membranes, this complication can be quite serious and requires quick attention.

Defining PROM
Premature rupture of membranes, also known as PROM, refers to when a pregnant women's amniotic membrane, which surrounds the fetus, either bursts or suffers a hole to it. The amniotic membrane is an enclosed sac consisting of amniotic fluid, the fetus and the placenta.

Amniotic fluid is important because it surrounds the fetus, protecting it from viruses and bacteria; it also allows the umbilical cord to float, providing the fetus with oxygen and nutrients. The membrane is also central to the development of the fetus' lungs.

PROM is used in reference to a pregnant woman either at or beyond 37 weeks of gestation who experiences PROM prior to the onset of labor; preterm premature rupture of membranes (PPROM) refers to when the amniotic membrane bursts or is ruptured during the period of between 24 to 37 weeks of pregnancy.

PROM occurs in 10% of pregnancies, 20% of which are cases of PPROM. Signs of PROM include a gush of blood-tinged fluid, as well as fever and foul-smelling vaginal discharge.

Why PROM Occurs
While uncertainties exist as to the exact cause of PROM, it is generally believed that it occurs due to infection during pregnancy or due to impending labor. It is believed that programmed cell death and the activation of catabolic enzymes, such as collagenase, can also result in the rupture of the membrane. Having sex during the latter stages of pregnancy is not considered a risk factor.

Who is Most at Risk of Experiencing PROM?
Pregnant women most at risk for PROM are those who smoke, have a low body mass index, have poor nutrition and hygiene, and those who have a history of preterm labor. Pregnant women with excess amniotic fluid are also at risk.

Other important factors to problems during pregnancy include whether pregnant women have had a history of infection, women who have had multiple pregnancies previous to the current pregnancy, as well as those experiencing vaginal infection during pregnancy. Babies in a breech position particularly pose a risk to complications during pregnancy.

Procedural factors also play a role in the risk of PROM; amniocentesis, as well as cerclage (when the uterus is sewn shut due to an incompetent cervix) can result in the rupture of a pregnant woman's amniotic membrane. PROM is also identified with women who had a pelvic exam in the last three months of their pregnancy.

Controllable preventions are therefore limited to abstaining from smoking during pregnancy, maintaining a healthy diet, and keeping up personal hygiene.