It is estimated that 8-10% of pregnancies will be affected by PROM. Approximately 25%-35% of all preterm deliveries occur due to PPROM.

PROM may be due to a natural thinning of the membranes or the power of contractions. Infection of the uterine wall is a common cause of PPROM. Possible additional causes include:

• Low socioeconomic status
• Sexually transmitted diseases (STDs) such as chlamydia and gonorrhea
• History of premature delivery
• Vaginal bleeding
• Smoking during pregnancy

Each pregnancy may present with slightly distinct symptoms. Those may consist of the following:

• Sudden discharge of vaginal fluid;
• Fluid leakage from the vagina
• A sensation of wetness in the vagina or underwear

Diagnosing PROM can be done in several ways, including the following:

• Cervical exam (may show fluid leaking from the cervical opening);
• Fluid’s pH. Most of the time, the pH of amniotic fluid is between 7.1 and 7.3, while the pH of normal vaginal secretions is between 4.5 and 6.0.

Based on the above evaluation, it can be hard to know if someone has PROM. Other tests could help figure out what’s wrong.

• Analysis of the dried fluid under a microscope (may show a characteristic fern-like pattern)
• Ultrasound. 

If the diagnosis is still not clear after a full checkup, ultrasound-guided application of indigo carmine dye can be used to see if the membrane has broken by seeing if the dyed fluid has gone through the vaginal canal (using a tampon or pad). The membranes have broken if the blue dye shows up on the tampon or pad.

Treatment

Symptoms, pregnancy, and health determine the treatment course. PROM’s severity also matters.

In case of hospital admission, doctors and nurses will watch out for the following:

• Contractions and other symptoms of labor
• Monitoring the baby’s heart rate, movements, and other indicators
• Manifestations of a disease or infection where symptoms include heat and soreness. Babies’ heart rates may also rise.

It is also possible to provide medications, including tocolytics and antibiotics. However, doctors may prescribe medication to induce labor. In other words, they may advise you to stop using tocolytics. Until a woman reaches week 34 of pregnancy, it is quite unlikely that she will be induced. In the event of complications, this may need to be done sooner. Such indications for delivery include the presence of chorioamnionitis and nonreassuring fetal status.

Furthermore, women with preterm PROM should be hospitalized and monitored regularly for complications such as infection, placental abruption, umbilical cord compression, fetal well-being, and labor.

Most cases of PPROM have an unknown cause. In the majority of pregnancies, this is not preventable.

It’s very important to look after yourself while pregnant. This includes an early visit to the doctor once pregnancy is confirmed and regular checkups. Smoking should be stopped immediately, and ask a professional for advice. However, a study by Ghomian et al. (2013) found that if a woman has a history of PPROM, she may benefit from taking vitamin C supplements after the 14th week of pregnancy to prevent PPROM from recurring. 

References

Dayal S, Hong PL. Premature Rupture Of Membranes. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532888/

Ghomian, N., Hafizi, L., & Takhti, Z. (2013). The role of vitamin C in prevention of preterm premature rupture of membranes. Iranian Red Crescent medical journal, 15(2), 113–116. https://doi.org/10.5812/ircmj.5138

Children’s Hospital of Philadelphia (2022). Premature Rupture of Membranes (PROM)/Preterm Premature Rupture of Membranes (PPROM). Retrieved November 6, 2022, from https://www.chop.edu/conditions-diseases/premature-rupture-membranes-prompreterm-premature-rupture-membranes-pprom#

University of Rochester Medical Center (2022). Preterm Premature Rupture of Membranes (PPROM). Retrieved November 6, 2022, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02496