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 either during or at the beginning of labor. 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 (PROM) is a rupture of the amnion 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 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 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. 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 full term. 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: 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 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) or carrying more than one fetus ( multifetal pregnancy)), 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. 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 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 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