Rupture of membranes (ROM) or amniorrhexis is a term used during

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

to describe a rupture of the

amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of biological membrane, membranes that hold a developing embryo (and l ...

. Normally, it occurs spontaneously at

full term Pregnancy is the time during which one or more offspring gestates inside a woman's uterus. A multiple pregnancy involves more than one offspring, such as with twins. Conception usually occurs following vaginal intercourse, but can also ...

either during or at the beginning of

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

. Rupture of the membranes is known colloquially as "breaking (one's) water," especially when induced rather than spontaneous, or as one's "water breaking". A

premature rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labour. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Compl ...

(PROM) is a rupture of the

amnion The amnion (: amnions or amnia) is a membrane that closely covers human and various other embryos when they first form. It fills with amniotic fluid, which causes the amnion to expand and become the amniotic sac that provides a protective envir ...

that occurs at full term and prior to the onset of labor. In cases of PROM, options include expectant management without intervention, or interventions such as oxytocin or other methods of labor induction, and both are usually accompanied by close monitoring of maternal and fetal health. Preterm premature rupture of membranes (PPROM) is when water breaks both before the onset of labor and 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 pregn ...

. 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 is a piece of membrane that can cover a newborn's head and face. Birth with a caul is rare, occurring in less than 1 in 80,000 births. The caul is harmless and is immediately removed by the attending parent, physician, or midwife upon birt ...

birth.

Effects

When the amniotic sac ruptures, production of

prostaglandins Prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids that have diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...

increases and the cushioning between the fetus and uterus is decreased, both of which are processes that increase the frequency and intensity of

uterine contraction Uterine contractions are muscle contractions of the uterine smooth muscle that can occur at various intensities in both the non-pregnant and pregnant uterine state. The non-pregnant uterus undergoes small, spontaneous contractions in addition to ...

s.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 In Placentalia, placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord i ...

may

prolapse In medicine, prolapse is a condition in which organ (anatomy), organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is al ...

. A

cord prolapse Cord or CORD may refer to: Common meanings * String (structure), String * Thin rope * Twine * Cord (unit) used for measuring wood * Power cord * Umbilical cord Cord or CORD may also refer to: Places * Cord, Arkansas People * Alex Cord ( ...

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 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. Rupture of membranes can affect ongoing labor management. Certain methods of labor induction or augmentation such as balloon catheters are relatively contraindicated after ROM.

Types

*SROM: spontaneous rupture of membranes. This term describes the normal, spontaneous rupture of the membranes at

. The rupture is usually at the bottom of the

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

, over the

cervix The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...

, 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:

. 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 Black is a color that results from the absence or complete absorption of visible light. It is an achromatic color, without chroma, like white and grey. It is often used symbolically or figuratively to represent darkness.Eva Heller, ''P ...

patients are at increased risk), low

socioeconomic status Socioeconomic status (SES) is a measurement used by economics, economists and sociology, sociologsts. The measurement combines a person's work experience and their or their family's access to economic resources and social position in relation t ...

, history of

sexually transmitted disease A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, or ...

, 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 clini ...

) or carrying more than one fetus (

multifetal pregnancy Pregnancy is the time during which one or more offspring gestates inside a woman's uterus. A multiple pregnancy involves more than one offspring, such as with twins. Conception usually occurs following vaginal intercourse, but can also oc ...

)), and

tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or released from the mouth, as is generally done with pipes and cigars. The practice is believed to hav ...

. *AROM:

artificial rupture of membranes Artificial rupture of membranes (AROM), also known as an amniotomy, is performed by a midwife or obstetrician and was once thought to be an effective means to induce or accelerate labor. The membranes can be ruptured using a specialized tool, such ...

. This term describes a rupture of the membranes by a third party, usually a

midwife A midwife (: midwives) is a health professional who cares for mothers and Infant, newborns around childbirth, a specialisation known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughou ...

obstetrician Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

, 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), American musician * Labor induction Labor indu ...

or accelerate labor.

Detection

Detection of rupture of membranes mainly include: *''Pooling test'': visualization of amniotic fluid pooling in the vagina *

Nitrazine Nitrazine or phenaphthazine is a pH indicator dye often used in medicine. More sensitive than litmus, nitrazine indicates pH in the range of 4.5 to 7.5. Nitrazine is usually used as the disodium salt. Use *This test is done to ascertain the natu ...

paper test *

Fern test The fern test is a medical laboratory test used in obstetrics and gynecology. The name refers to the detection of a characteristic "fern like" pattern of vaginal secretions when a specimen is allowed to dry on a glass slide and is viewed under a ...

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 centimetres) given to the amount of amniotic ...

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 the membranesVideo: Amniotic Sac: What Happens When Your "Water Breaks"
{{DEFAULTSORT:Rupture Of Membranes Obstetrics Midwifery