Rupture of membranes (ROM) is a term used during pregnancy to describe a rupture of the amniotic sac at the onset of, or during, labor. This is colloquially known as "breaking water". A premature rupture of membranes (PROM) is a rupture that occurs prior to the onset labor. Maternal risk factors for a premature rupture of membranes include chorioamnionitis or sepsis. Fetal factors include prematurity, infection, cord prolapse, or malpresentation. Assessment of a rupture of membranes involves taking a proper medical history, a gynecological exam using a speculum, nitrazine, cytologic (ferning) tests, and ultrasound. In a term pregnancy where premature rupture of membranes has occurred, spontaneous labour should be permitted. Current obstetrical management includes an induction of labour at approximately 6 hours if it has not already begun, and Group B Streptococcal prophylaxis at 18 hours. Some hospitals, birth centers and private midwives do not induce labor at any point after PROM, but rather watch carefully for any signs of infection and ensure that nothing is introduced into the vagina after the PROM, including sterile vaginal exams. In premature birth premature rupture of membranes, antibiotic therapy should be given to decrease the risk of sepsis. Ampicillin or erythromycin should be administered for 7 days, and antenatal steroids if the gestational age is less than 30 weeks. Tocolysis is also used, though its use in this context is controversial. The mother should be admitted to hospital and put under careful surveillance for preterm labour and chorioamnionitis. Induction of labour should happen at around 36 weeks.
Types
- PROM = prelabor or premature rupture of membranes
- PPROM = preterm, premature rupture of membranes
- AROM = artificial rupture of membranes
- SROM = spontaneous rupture of membranes
