Rupture of membranes (ROM) or amniorrhexis is a term used during
pregnancy to describe a rupture of the
amniotic sac. Normally, it occurs spontaneously at
full term either during or at the beginning of
labor. Rupture of the membranes is known colloquially as "breaking the water" or as one's "water breaking." A
premature rupture of membranes (PROM) is a rupture of the
amnion
The amnion is a membrane that closely covers the human and various other embryos when first formed. It fills with amniotic fluid, which causes the amnion to expand and become the amniotic sac that provides a protective environment for the develo ...
that occurs prior to the onset of labor. This typically occurs before the pregnancy's 37 week
gestation
Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...
. In the United States, more than 120,000 pregnancies per year are affected by a premature rupture of membranes, which is the cause of about one third of
preterm deliveries.
Sometimes, a child is born with no rupture of the amniotic sac (no rupture of membranes). In such cases, the child may still be entirely within the sac once born; such a birth is known as an
en-caul
A caul or cowl ( la, Caput galeatum, literally, "helmeted head") is a piece of membrane that can cover a newborn's head and face. Birth with a caul is rare, occurring in fewer than 1 in 80,000 births. The caul is harmless and is immediately removed ...
birth.
Effects
When the amniotic sac ruptures, production of
prostaglandins increases and the cushioning between the fetus and uterus is decreased, both of which are processes that increase the frequency and intensity of
uterine contractions.
[American Pregnancy Association > Inducing Labor]
Last Updated: 01/2007
On occasion, with the rupture of membranes, particularly if the head is not engaged, the
umbilical cord may
prolapse. A
cord prolapse is an
obstetrical emergency, as the descending head may block fetal-placental circulation.
Once the membranes are ruptured, bacteria may ascend and could lead to
amnionitis
Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes (amnion and chorion), usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert p ...
and fetal infection.
A premature rupture of membranes can have multiple effects on the fetus such as increasing their risk of prematurity and facing neonatal or perinatal complications.
Types
*SROM: spontaneous rupture of membranes. This term describes the normal, spontaneous rupture of the membranes at
full term. The rupture is usually at the bottom of the
uterus, over the
cervix
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
, causing a gush of fluid. This gush may be quite small (such as 50ml), or it can be significantly large (200-300ml) depending upon amount of fluid in the amniotic sac, and to what extent the fetal head is plugging the hole and retaining fluid in the sac.
[kiwifamilies.co.nz > Birth > Spontaneous Rupture of Membranes]
By Paula Skelton, midwife A spontaneous rupture that occurs early in labor may actually be related to other complications resulting in delayed labor. These complications may include a contracted pelvis, breech presentation, or occipito-posterior position.
*PROM:
premature rupture of membranes. This term describes a rupture of the membranes that occurs before the onset of labor.
**PPROM: preterm, premature rupture of membranes. This term describes a rupture of the membranes that occurs before 37 weeks gestation, and it can have multiple effects on the fetus such as increasing their risk of prematurity and facing neonatal or perinatal complications. Risk factors of pregnancies with PPROM include race (
black patients are at increased risk), low
socioeconomic status
Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...
, history of
sexually transmitted disease, distension of the uterus (which may result from factors such as excessive amniotic fluid (
polyhydramnios
Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.
There are two clin ...
) or carrying more than one fetus (
multifetal pregnancy
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
)), and
tobacco smoking.
*AROM:
artificial rupture of membranes. This term describes a rupture of the membranes by a third party, usually a
midwife or
obstetrician, in order to
induce
Induce may refer to:
* Induced consumption
* Induced innovation
* Induced character
* Induced coma
* Induced menopause
* Induced metric
* Induced path
* Induced topology
* Induce (musician)
Ryan Smith, better known by his stage name Induce, i ...
or accelerate labor.
Detection
Detection of rupture of membranes mainly include:
*''Pooling test'': visualization of amniotic fluid pooling in the vagina
*
Nitrazine paper test
*
Fern test
*
Amniotic fluid index
Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. It is a separate measurement from the biophysical profile.
AFI is the score (expressed in cm) given to the amount of amniotic fluid seen ...
For results to be roughly 90% accurate in infection detection, a combination of both an arborization test and nitrazine paper test may be used.
An arborization test assesses the patient's vaginal secretions, while a nitrazone paper test uses the nitrazine paper to examines vaginal pH.
References
External links
Merck ManualPremature rupture of membranes
{{DEFAULTSORT:Rupture Of Membranes
Obstetrics
Midwifery