Prolonged Premature Rupture of Membranes
Rupture of the fetal membranes (ROM) is a normal part of every pregnancy, commonly referred to as “breaking the water.” However, ROM may occur before the onset of labor in certain cases, presenting potential complications for fetal health. Latency refers to the amount of time between PROM taking place and delivery. Any incidence of ROM with a latent period of 24 hours or more is considered prolonged premature rupture of the membrane.
Causes and Risk Factors of PROM
It is not fully understood why prolonged PROM occurs. Choriodecidual infection or inflammation may cause the condition, as well as a decrease in collagen content in the amniotic membrane itself. There is statistical evidence which suggests a link between low BMI, smoking, previous STIs/STDs, vaginal bleeding and uterine distension with prolonged PROM. Women who have had the condition during a previous pregnancy are also at greater risk of it recurring.
- 95% of at-term pregnancies in which PROM occurs will go into labor within 24 hours 1
- PROM is a factor in one third of all preterm pregnancies 2
- Preterm PROM (prior to 37 weeks’ gestation) occurs in 3% of pregnancies, or approximately 150,000 cases a year3 in the United States
- The average latent period of any PROM occurring before 24 weeks’ gestation is six days4
Risks of Prolonged PROM
Prolonged PROM is associated with a number of potential complications and other risks. For at- or near-term pregnancies, it is generally recommended that labor not be delayed any further. When it is not possible to induce labor safely (typically, for any pregnancy at 32 weeks’ gestation or less), complications arising from prolonged premature rupture of membranes can include fetal respiratory distress syndrome, umbilical cord prolapse and placental abruption. These risks are generally managed by supervised care, modified bed rest and the administration of corticosteroids or antibiotics — they can prolong pregnancy and reduce the risk of infection.
Early intervention is essential to maintaining fetal health during cases of prolonged rupture of membranes. Several methods are available for detecting PROM. AmniSure® is a test for PROM that tests for the presence of PAMG-1. PAMG-1 is a protein that regardless of gestational age, is found in high concentrations in amniotic fluid (2,000-25,000 ng/ml) while low concentrations are found in the background vaginal discharge (0.05-0.22 ng/ml).## Unlike older diagnostic tools such as fern or nitrazine testing, AmniSure® is non-invasive and can detect PROM with ~99% accuracy, according to published data..
- Hannah ME et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl. J Med. 1996;334:1005–10.
- ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet. Gynecol. 2007 Apr;109(4):1007-19.
- Caughey AB et al. Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes. Rev. Obstet. Gynecol. 2008;1(1):11–22.
- Schutte MF et al. Management of premature rupture of membranes: the risk of vaginal examination to the infant. Am J Obstet. Gynecol. 1983;146:395–400