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Preterm Premature Rupture of Membranes

Premature Rupture of Membranes (PROM) refers to when the bag of waters (amniotic fluid) surrounding your unborn baby breaks before the onset of labour. Pre-term PROM (PPROM) is the term used when the pregnancy is less than 37 weeks.

PPROM occurs in 3% of pregnancies.

The role of amniotic fluid

• Provides space for the baby's growth and movement
• May protect the baby against external factors such as infection
• Maintains a constant temperature for your baby and provides small amounts of nutrients
• Plays an important part in lung development and maturity of your baby

Risk factors for PPROM

The risk factors are similar to those for preterm labour. However the following factors have the strongest association:

• Previous PPROM
• Infections in the genital tract
• Bleeding in pregnancy
• Smoking

Signs of ruptured membranes

You will notice either a slow trickle or a sudden gush of water from your vagina that you can't control.

Coming into hospital

When you come to the hospital the doctor or midwife will:

• Listen to the baby's heart rate and ask you about movements
• look for amniotic fluid draining into the vagina by using a speculum (like a pap smear test)
• Do some blood tests to look for signs of infection
• Possibly perform an ultrasound scan to see how much fluid remains around the baby.

If you have PPROM you will be admitted to hospital to be monitored and given a course of antibiotics.

Infection

When your waters break early the sterile sac surrounding your baby is broken. This leaves your baby vulnerable to infection. Antibiotics have been shown to reduce this risk and your doctor will usually prescribe these for you.

Your doctor or midwife will ask you to watch for early signs of infection. These include:

• Raised temperature
• Raised heart rate
• Flu like symptoms
• Baby being less active than normal
• Abdominal pain/contractions
• Offensive smelling vaginal loss
• Green coloured vaginal loss

Ways in which you can help prevent an infection include:

• Changing 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/creams

Despite this however approximately one third of women with PPROM will go on to develop an infection.

Preterm Labour

Research shows that the majority of women with PPROM will give birth within one week of membrane rupture.

If you have PPROM earlier than 35 weeks of your pregnancy and you are showing signs of labour, it is likely you will be transferred to Mater Mothers' Private Hospital, located at South Brisbane for ongoing care by your doctor.

If you have PPROM and your pregnancy is beyond 35 weeks, you will be admitted to Mater Private Hospital Redland to be monitored and given a course of antibiotics.

If your condition stabilizes your doctor may discharge you home. You will closely be monitored by visiting either the Mater Private Hospital Redland or your doctor's rooms.

At your first visits you may need blood tests, your baby's heart beat may be monitored and an ultrasound scan may be performed to check your baby's growth, measure fluid remaining around your baby and check blood flow to the placenta.

If you are between 24-34 weeks pregnant you will be offered two steroid injections 12 hours apart. Steroids are given to improve lung maturity in premature babies and take about 24 hours to be effective. This is to reduce breathing difficulties after birth.

The earlier your baby is born the more care they are likely to require.

Whenever possible a specialist neonatal doctor will come and talk to you before the birth of your baby. They will discuss the likely care that your baby will need and the chances of your baby having any long term complications. Mater Mothers' Hospitals at South Brisbane have a Special Care Nursery and an Intensive Care Nursery where, if less than 35 weeks, your baby will be cared for. If your baby is 35 weeks and older Mater Private Hospital Redland will provide the required care.

Going home

Not all women will go into premature labour. Therefore once your condition is stable, your doctor may discharge you home. Follow up care may be provided by:

• Attending the Day Ward up to three times per week
• Visiting your doctor

At your visits you may need blood tests, and your baby's heartbeat may be monitored. We may also perform an ultrasound scan to check your baby's growth, measure the fluid remaining around your baby and check blood flow to the placenta.

If you are at home, you will need to observe the following:

• The date and time
• Your temperature (every four hours while awake)
• Your pulse (every four hours while awake)
• Your baby's movements (expect about 10 or more moments in 12 hours)
• Your vaginal loss (discharge colour, amount and odour)
• Your general wellbeing

Your midwife will give you a sheet to record this information on.

It is very important that you contact the hospital immediately on 07 3821 9443 if any of the following occurs:

Change in colour or amount of vaginal loss, or if your loss has an offensive odour

Vaginal bleeding or spotting

Temperature staying above 37.3 degrees Celsius for at least one hour

Pulse rate rises above 100 beats per minute

Baby is not moving as much as they normally do or the pattern of the baby's movement changes

Flu-like symptoms or you feel generally unwell

Abdominal cramping, pain or contractions

It is important to report any concerns to the hospital. Please call the Birth Suite at any time on 07 3163 7444.

Reference: Milliman CareGuidelines 11th Edition, 2007

Mater Private Hospital Redland

Telephone: 3163 7444

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