Pregnancy—preterm pre labour rupture of membranes
Pre-term pre labour rupture of membranes (PPROM) refers to when the bag of waters containing the amniotic fluid surrounding your baby breaks before the onset of labour and the pregnancy is less than 37 weeks. This occurs in two per cent of pregnancies.
When your waters break early the sterile sack surrounding your baby is broken. This leaves both you and your baby vulnerable to infection. Antibiotics have been shown to reduce this risk and to prolong the pregnancy; and your doctor will usually prescribe these for you.
You will be observed for early signs of infection, which include:
- raised temperature
- raised heart rate
- flu like symptoms
- baby being less active than normal
- abdominal pains/contractions
- offensive smelling vaginal loss
- green coloured vaginal loss.
There are several ways in which you can help prevent an infection, including:
- changing your sanitary pads at least every four
hours. Personal hygiene is very important to reduce
the risk of infection
- not using tampons
- wiping from front to back after going to the toilet
- not going swimming
- not having baths or using a spa—please shower
- not taking part in any form of sexual activity
- not using any vaginal medications or creams.
However, despite these measures, approximately one third of women with PPROM will go on to develop an infection.
Management of PPROM
Research shows that the majority of women with PPROM will give birth within one week of membrane rupture. If you are between 24 to 34 weeks pregnant you will be offered two steroid injections 12 hours apart. Steroids are given to reduce the seriousness of breathing difficulties for premature babies and help reduce the likelihood of other complications faced by babies who are born very early. Steroids take about 24 hours to be effective.
The earlier your baby is born the more likely it is that they will require care in the Neonatal Critical Care Unit. Whenever possible, a specialist neonatal doctor will come and talk to you before the birth of your baby. They will discuss the possible care that your baby will need and the chances of your baby having any long term complications.
Not all women will go into preterm labour. Therefore, once your condition is stable, your doctor may discharge you home. If you have been transferred to our service from another hospital, you may be able to stay locally with family or friends or assistance may be offered to arrange alternative local accommodation.
Follow-up care may be provided by:
- attending the Pregnancy Assessment and
- telephone consultation with the hospital
- visiting your doctor.
At your visits, you may need blood tests and your baby’s heart beat will be monitored. We may also perform an ultrasound to check your baby’s growth, and take swabs from your vagina to make sure there is no further infection.
If you are at home you will need to record the following observations in the booklet given to you by your doctor. It is important to record the date and time of each set of the following observations:
- your temperature every four hours while awake
- your pulse rate every four hours while awake
- your baby's movements (expect about 10 or
more movements in 12 hours)
- your vaginal discharge—colour, amount
- your general wellbeing.
Timing of the birth of your baby
It is usual to continue to monitor you and your baby until closer to your due date. If there are signs of infection, or any other concerns about you or your baby, the doctor will discuss delivery with you at that time. If this does not occur, we usually recommend continuing your pregnancy until 37 weeks and then arranging for the birth of your baby at around that time. The way your baby is born will not usually be affected by the membranes having ruptured early, so if your plan was for a vaginal birth, an induction of labour will be offered. If there was a reason to recommend caesarean section this would be offered. From 33 weeks a vaginal swab is taken each week to look for the presence of a specific bacteria (Group B streptococcus), that is found in one third of healthy women, as the presence of this bacteria is considered to be an indication to offer delivery at 34 rather than 37 weeks.
It is very important that you contact the Pregnancy Assessment and Observation Unit on 07 3163 1379 or 07 3163 2785 immediately if you have any of the following symptoms:
- temperature staying above 37.5ºC
- pulse rate above 100 beats per minute
- change in colour or odour of vaginal discharge
- vaginal bleeding or spotting
- abdominal cramping, pain or contractions
- flu-like symptoms or you feel generally unwell
- decreased fetal movements.
© 2014 Mater Misericordiae Ltd. ACN 096 708 922
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 18/11/2015.