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Pregnancy is a delicate period where every aspect of health is scrutinised to ensure the well-being of both mother and baby. One condition that can arise during this time is Premature Rupture of Membranes (PROM), also known as ‘water breaking’ before labour begins. This unexpected event can pose risks such as infection, preterm birth, or other complications. Understanding PROM is crucial for expectant mothers and healthcare providers alike, as timely intervention can significantly impact outcomes. Regarding the same, a gynaecologist shared what PROM entails, its risks, and how it is managed to ensure the best possible care during pregnancy.
What Is PROM?
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Premature Rupture of Membranes (PROM), commonly referred to as ‘water breaking,’ occurs when the amniotic sac ruptures before labour begins. The amniotic sac is a protective membrane filled with fluid that surrounds and cushions the baby in the womb. Dr Juhee Jain, Director, Obstetrics and Gynecology, Rainbow Children's Hospital, New Delhi, explains that PROM refers to the rupture of membranes before labour begins. She states: “If this rupture occurs after 37 weeks, it’s considered normal and usually leads to labour. However, if it happens before 37 weeks, it’s termed Premature Rupture of Membranes (PROM) or Preterm PROM (PPROM).”
Key Points About PROM:
- Term PROM: Occurs after 37 weeks and typically requires immediate delivery to prevent infection.
- Preterm PROM (PPROM): Happens before 37 weeks and poses risks such as preterm birth, infection, or complications for the baby’s development.
What Causes PROM?
The exact cause of PROM is not always clear, but several factors may contribute to it:
- Infections: Bacterial infections in the uterus or vagina can weaken the membranes.
- Previous Preterm Births: A history of preterm delivery increases the risk of PROM.
- Lifestyle Factors: Smoking during pregnancy or poor prenatal care may also contribute to membrane rupture.
- Unknown Causes: In some cases, no specific cause is identified.
Risks Associated with PROM
Dr Jain highlights that PROM can be challenging for both doctors and patients: “PROM actually ruins the prognosis for the child in many cases, especially if it happens early in pregnancy.”
Potential Risks Include:
- Infections: Without the protective amniotic sac, both mother and baby are at risk of infections.
- Preterm Birth: Babies born prematurely may face respiratory issues, difficulty maintaining body temperature, or developmental delays.
- Umbilical Cord Compression: Loss of amniotic fluid can lead to cord compression, affecting the oxygen supply to the baby.
A Study on PROM Outcomes
A study published in The American Journal of Obstetrics & Gynecology examined outcomes in women with PPROM. The study found that:
- Early diagnosis and timely intervention significantly improved neonatal outcomes.
- Administering corticosteroids helped accelerate lung maturity in preterm babies, reducing complications like respiratory distress syndrome.
- Conservative management (monitoring without immediate delivery) was effective in cases with minimal fluid leakage and no signs of infection.
- These findings emphasise the importance of individualised care based on the severity and timing of PROM.
How Is PROM Managed?
Management strategies for PROM depend on gestational age and severity of fluid leakage:
- Immediate Delivery: If significant fluid leakage occurs after 37 weeks or there are signs of infection, immediate delivery is recommended to protect both mother and baby.
- Conservative Management: For minimal leakage before 37 weeks, doctors may monitor closely while administering corticosteroids to enhance lung maturity in the baby.
- Hospitalisation: In cases of PPROM, hospitalisation may be necessary for regular monitoring to prevent complications.
Dr. Jain emphasises: “Reaching the hospital promptly is critical when PROM occurs because decisions about conservative management or delivery depend on timely evaluation.”
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Conclusion
Premature Rupture of Membranes (PROM) is a complex condition that requires prompt medical attention to ensure the safety of both mother and baby. As Dr Juhee Jain explains, “The decision to manage conservatively or proceed with delivery depends on factors like gestational age and severity of leakage.” Early diagnosis and timely intervention are key to minimising risks associated with PROM. By staying informed and vigilant during pregnancy, expectant mothers can take proactive steps toward better outcomes for themselves and their babies