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PRE-TERM PRE-RUPTURE OF MEMBRANES (PPROMM)

November 1, 2024 Lifestyle 1

What is PPROM?

Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks’ gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks’ gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.

Medina, T. M., & Hill, D. A. (2006, February 15). Preterm premature rupture of membranes: Diagnosis and management. American Family Physician. https://www.aafp.org/pubs/afp/issues/2006/0215/p659.html

This was our story, at nineteen weeks and 4 days gestation, my water broke while at work and it was the most confusing and scary moment of my life. She was my second pregnancy as my first was stillborn due to IUGR (intrauterine Growth Restriction) and she was our hopes and dreams just as our son was. Both conceived via IVF. Our son a singlet pregnancy, our sweet girl was a twin pregnancy. At 7 weeks I miscarried her sibling, at 14 weeks I started to have contractions and bleeding a lot every day. I continued to go to the doctor in which she dismissed by concerns. At 15 weeks the pain became too much and blood clots began to pass, in the emergency room I delivered a clot the size of a football. The doctor automatically diagnosed me with a miscarriage but wanted to confirm with an ultrasound. There she was turning flips and the ultrasound technician reassured that she had a strong heartbeat and asked if I wanted to know her gender, I said yes please! In that moment I found out I was having a little girl. After three days, I stopped bleeding and had a normal pregnancy until at 19 weeks 4 days, sitting at my desk as work, I began to feel wet and I just new it wasn’t normal. Emergency doctor tested the liquid and it was positive for amniotic fluid. The doctor recommended I terminate the pregnancy but I had hope since she had a heartbeat, he informed me about all the doom and gloom of a baby in utero without amniotic fluid.

Complications of PPROM

One of the most common complications of preterm PROM is early delivery. The latent period, which is the time from membrane rupture until delivery, generally is inversely proportional to the gestational age at which PROM occurs. For example, one large study3 of patients at term revealed that 95 percent of patients delivered within approximately one day of PROM, whereas an analysis of studies4 evaluating patients with preterm PROM between 16 and 26 weeks’ gestation determined that 57 percent of patients delivered within one week, and 22 percent had a latent period of four weeks. When PROM occurs too early, surviving neonates may develop sequelae such as malpresentation, cord compression, oligohydramnios, necrotizing enterocolitis, neurologic impairment, intraventricular hemorrhage, and respiratory distress syndrome. Complications of preterm PROM are listed in Table 1.2,5–10

TABLE 1

Complications of Preterm PROM

Complications Incidence (%)
Delivery within one week 50 to 75
Respiratory distress syndrome 35
Cord compression 32 to 76
Chorioamnionitis 13 to 60
Abruptio placentae 4 to 12
Antepartum fetal death 1 to 2
PROM = premature rupture of membranes.Information from references 2 and 5 through 10.

The majority of patients will deliver within one week when preterm PROM occurs before 24 weeks’ gestation, with an average latency period of six days.15 Many infants who are delivered after previable rupture of the fetal membranes suffer from numerous long-term problems including chronic lung disease, developmental and neurologic abnormalities, hydrocephalus, and cerebral palsy. Previable rupture of membranes also can lead to Potter’s syndrome, which results in pressure deformities of the limbs and face and pulmonary hypoplasia. The incidence of this syndrome is related to the gestational age at which rupture occurs and to the level of oligohydramnios. Fifty percent of infants with rupture at 19 weeks’ gestation or earlier are affected by Potter’s syndrome, whereas 25 percent born at 22 weeks’ and 10 percent after 26 weeks’ gestation are affected.32 Patients should be counseled about the outcomes and benefits and risks of expectant management, which may not continue long enough to deliver a baby that will survive normally.

Physicians caring for patients with preterm PROM before viability may wish to obtain consultation with a perinatologist or neonatologist. Such patients, if they are stable, may benefit from transport to a tertiary facility. Home management of patients with preterm PROM is controversial. A study33 of patients with preterm PROM randomized to home versus hospital management revealed that only 18 percent of patients met criteria for safe home management. Bed rest at home before viability (i.e., approximately 24 weeks’ gestation) may be acceptable for patients without evidence of infection or active labor, although they must receive precise education about symptoms of infection and preterm labor, and physicians should consider consultation with experts familiar with home management of preterm PROM. Consider readmission to the hospital for these patients after 24 weeks’ gestation to allow for close fetal and maternal monitoring.

Medina, T. M., & Hill, D. A. (2006, February 15). Preterm premature rupture of membranes: Diagnosis and management. American Family Physician. https://www.aafp.org/pubs/afp/issues/2006/0215/p659.html

HOPE & PRAYER-A MIRACLE RECEIVED

Although I was aware of the complications of PPROM, I started to research to advocate for our baby and do the best I can to keep her in utero as long as possible. I went on bed rest and i drank as much water as I possible could throughout the day. I sat in a wheelchair whenever I had to go to appointments. I avoided baths and showered every other day to minimize getting infections. I prayed everyday and spoke positive affirmations to myself and our child. At 24 weeks and 2 days I was in labor and she arrived. We had a 10 month NICU/PICU stay and she has chronic lung disease developmental delays, and health challenges respiratory wise, but our girl is conquering and thriving at her pace. She was ventilator/oxygen dependent at birth but not longer by two years of age. She has a tracheostomy still due to airway issues from intubation in infancy, but she shall overcome with medical intervention. She loves to play the piano, and loves music in general, she enjoys reading, taking things apart and putting them back together, and anything else that her Dad enjoys doing. I’m so thankful for our daughter, my choice, and her resiliency. I’m just grateful to be blessed with my own miracle!

1 thought on PRE-TERM PRE-RUPTURE OF MEMBRANES (PPROMM)

  • The AlthemistNovember 2, 2024 at 4:59 pm

    That’s was absolutely amazing article. Thanks for sharing such a valuable information

    Reply

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