Premature rupture of membranes (PROM) is a condition where the amniotic sac breaks before labour begins, posing significant risks to both mother and baby. While PROM is not entirely avoidable, certain preventive measures can reduce its likelihood. Vaginal infections, in particular, play a crucial role in the development of PROM and can have fatal consequences for pregnancy if left untreated. An expert shared the importance of treating vaginal infections promptly to minimise the risk of PROM. Read ahead to explore how PROM can be managed and the impact of vaginal infections on pregnancy outcomes.
Understanding Premature Rupture of Membranes (PROM)
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PROM can occur at any stage of pregnancy but is categorised into two main types: term PROM (after 37 weeks) and preterm PROM (before 37 weeks). Preterm PROM is associated with higher risks of neonatal morbidity and mortality due to prematurity.
Vaginal infections are a significant risk factor for PROM. Dr Juhee Jain, Director, Obstetrics and Gynecology, Rainbow Children's Hospital, New Delhi, notes, "If there is any vaginosis or bacterial or fungal infection in the vagina, it should be treated accordingly." Studies have shown that vaginal infections can lead to adverse pregnancy outcomes, including preterm birth and PROM. A recent study highlighted that women with vaginal infections had higher rates of preterm birth, low birth weight, and PPROM compared to those without infections.
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Study: Impact of Vaginal Infections on Pregnancy Outcomes
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A retrospective cohort study found that vaginal infections significantly increased the risk of preterm birth, low birth weight, and PPROM. The study emphasised the importance of timely detection and treatment of vaginal infections to prevent adverse outcomes. Mixed vaginitis showed a stronger association with these adverse outcomes, underscoring the need for comprehensive infection management.
Dr Juhee Jain advises that patients with a history of PROM should be closely monitored for vaginal infections. She recommends using blood tests or high vaginal swabs to diagnose infections early and administering prophylactic antibiotics or appropriate treatment as needed. The expert says, "PROM is not avoidable by 100%, but to quite an extent by the advertent use of treatment of infections in the vagina and the patients being little alert if they feel that it is wet they better consult a doctor rather than keep watching it will settle on its own."
Preventive Measures and Management
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Preventing PROM involves addressing risk factors such as smoking, urinary tract infections, and previous preterm labour. Regular prenatal care and prompt treatment of vaginal infections are crucial. For preterm PROM, expectant management may be considered if there are no contraindications, involving corticosteroids for fetal lung maturity and antibiotics to prevent infection. Below are a few key strategies:
- Expectant Management: Administer corticosteroids for fetal lung maturity and antibiotics to prevent infection if no contraindications.
- Antibiotic Therapy: Use antibiotics like ampicillin and erythromycin to prevent infection.
- Corticosteroids: Given between 24-31 weeks to reduce perinatal mortality and respiratory distress syndrome.
- Intrapartum Chemoprophylaxis: Prevent group B streptococcus transmission.
- Facility Transfer: Transfer to a NICU-equipped facility for optimal neonatal care.
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Conclusion
While PROM cannot be completely avoided, managing risk factors and treating vaginal infections can significantly reduce its occurrence. The expert’s advice highlights the importance of vigilance and proactive treatment in minimising the risks associated with PROM. By understanding the role of vaginal infections and taking preventive measures, expectant mothers can reduce the likelihood of adverse pregnancy outcomes.