Rupture of membranes

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Rupture of membranes (ROM) or amniorrhexis is a term used during pregnancy to describe a rupture of the amniotic sac. [1] 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". [2] A premature rupture of membranes (PROM) is a rupture of the amnion that occurs at full term and prior to the onset of labor. [3] 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. [3] Preterm premature rupture of membranes (PPROM) is when water breaks both before the onset of labor and before the pregnancy's 37 week gestation. [3] [4] 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. [5]

Contents

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. [6]

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 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. [7]

Types

Detection

Detection of rupture of membranes mainly include: [10]

For results to be roughly 90% accurate in infection detection, a combination of both an arborization test and nitrazine paper test may be used. [11] An arborization test assesses the patient's vaginal secretions, while a nitrazone paper test uses the nitrazine paper to examines vaginal pH.

Related Research Articles

<span class="mw-page-title-main">Amniocentesis</span> Sampling of amniotic fluid done mainly to detect fetal chromosomal abnormalities

Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is necessary to conclusively diagnose the majority of genetic disorders, with amniocentesis being the gold-standard procedure after 15 weeks' gestation.

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 membranes that hold a developing embryo until shortly before birth. The inner of these membranes, the amnion, encloses the amniotic cavity, containing the amniotic fluid and the embryo. The outer membrane, the chorion, contains the amnion and is part of the placenta. On the outer side, the amniotic sac is connected to the yolk sac, the allantois, and via the umbilical cord, the placenta.

Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.

Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. It is typically diagnosed by ultrasound when the amniotic fluid index (AFI) measures less than 5 cm or when the single deepest pocket (SDP) of amniotic fluid measures less than 2 cm. Amniotic fluid is necessary to allow for normal fetal movement, lung development, and cushioning from uterine compression. Low amniotic fluid can be attributed to a maternal, fetal, placental or idiopathic cause and can result in poor fetal outcomes including death. The prognosis of the fetus is dependent on the etiology, gestational age at diagnosis, and the severity of the oligohydramnios.

<span class="mw-page-title-main">Amniotic fluid</span> Fluid surrounding a fetus within the amnion

The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products between mother and fetus.

<span class="mw-page-title-main">Umbilical cord prolapse</span> Complication of pregnancy where the umbilical cord slips out of the uterus prior to birth

Umbilical cord prolapse is when the umbilical cord comes out of the uterus with or before the presenting part of the baby. The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby. It usually occurs during labor but can occur anytime after the rupture of membranes.

<span class="mw-page-title-main">Placental abruption</span> Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, and is one of the signs that labor may be imminent. The bloody show may be expelled from the vagina in pieces or altogether and often appears as a jelly-like piece of mucus stained with blood. Although the bloody show may be alarming at first, it is not a concern of patient health after 37 weeks gestation.

Fetal fibronectin (fFN) is a fibronectin protein produced by fetal cells. It is found at the interface of the chorion and the decidua. Fetal fibronectin is found normally in vaginal fluid in early pregnancy prior to 22 weeks due to normal growth and development of tissues at the junction of the uterus and amniotic sac. It may also be found in vaginal fluid after 36 weeks as labor approaches. However, fFN should not be detected between 22 and 36 weeks.

<span class="mw-page-title-main">Prelabor rupture of membranes</span> Medical condition

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

<span class="mw-page-title-main">Cervical effacement</span>

Cervical effacement or cervical ripening refers to the thinning and shortening of the cervix. This process occurs during labor to prepare the cervix for dilation to allow the fetus to pass through the vagina. While this a normal, physiological process that occurs at the later end of pregnancy, it can also be induced through medications and procedures.

<span class="mw-page-title-main">Chorioamnionitis</span> Medical condition

Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes, usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert panel recommended use of the term "triple I" to address the heterogeneity of this disorder. The term triple I refers to intrauterine infection or inflammation or both and is defined by strict diagnostic criteria, but this terminology has not been commonly adopted although the criteria are used.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

<span class="mw-page-title-main">Velamentous cord insertion</span> Velamentous placenta

Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.

An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.

Placental alpha microglobulin-1 (PAMG-1) is a human protein that was first isolated in 1975 from amniotic fluid. PAMG-1 is an important biomarker for the detection of premature rupture of fetal membrane (PROM) The high concentration of PAMG-1 in amniotic fluid means it can be used to detect if this fluid is present in the cervico-vaginal discharge of pregnant women; the presence of PAMG-1 in the discharge suggests that amniotic fluid is present, and therefore suggests that PROM has occurred. PAMG-1 was originally referred to as specific alpha-1 globulin of placenta.

<span class="mw-page-title-main">Fetal membranes</span> Amnion and chorion which surround and protect a developing fetus

The fetal membranes are the four extraembryonic membranes, associated with the developing embryo, and fetus in humans and other mammals. They are the amnion, chorion, allantois, and yolk sac. The amnion and the chorion are the chorioamniotic membranes that make up the amniotic sac which surrounds and protects the embryo. The fetal membranes are four of six accessory organs developed by the conceptus that are not part of the embryo itself, the other two are the placenta, and the umbilical cord.

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

Amnioinfusion is a method in which isotonic fluid is instilled into the uterine cavity.

<span class="mw-page-title-main">Fern test</span> Medical 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 low-power microscope. The fern test is most commonly used to provide evidence of the presence of amniotic fluid and is used in obstetrics to detect preterm premature rupture of membranes and/or the onset of labor. It also may provide indirect evidence of ovulation and fertility, although it does not predict the time of ovulation.

References

  1. ↑ "amniorrhexis" "at Dorland's Medical Dictionary
  2. ↑ Harris, Nicole. "If You're Tempted to Break Your Own Water, Read This First". Parents. Retrieved 10 November 2023.
  3. 1 2 3 Obstetrics and gynecology. Charles R. B. Beckmann, American College of Obstetricians and Gynecologists (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 2010. ISBN   978-0-7817-8807-6. OCLC   298509160.{{cite book}}: CS1 maint: others (link)
  4. ↑ Medina, Tanya (February 15, 2006). "Preterm Premature Rupture of Membranes: Diagnosis and Management". American Family Physician. 73 (4): 659–664. PMID   16506709.
  5. ↑ Mercer, Brian (January 2003). "Preterm premature rupture of the membranes". Obstetrics & Gynecology. 101 (1): 178–193. doi:10.1016/s0029-7844(02)02366-9. PMID   12517665. S2CID   31817519 – via Science Direct.
  6. ↑ American Pregnancy Association > Inducing Labor Last Updated: 01/2007
  7. ↑ McDonagh, Marian; Skelly, Andrea C.; Hermesch, Amy; Tilden, Ellen; Brodt, Erika D.; Dana, Tracy; Ramirez, Shaun; Fu, Rochelle; Kantner, Shelby N. (2021). Cervical Ripening in the Outpatient Setting. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID   33818996.
  8. ↑ kiwifamilies.co.nz > Birth > Spontaneous Rupture of Membranes Archived 2012-02-27 at the Wayback Machine By Paula Skelton, midwife
  9. ↑ Medina TM, Hill DA (February 15, 2006). "Preterm premature rupture of membranes: diagnosis and management". Am Fam Physician. 73 (4): 659–64. PMID   16506709 . Retrieved 26 July 2022.
  10. ↑ Bennett, S.; Cullen, J.; Sherer, D.; Woods Jr, J. (2008). "The Ferning and Nitrazine Tests of Amniotic Fluid Between 12 and 41 Weeks Gestation". American Journal of Perinatology. 10 (2): 101–104. doi:10.1055/s-2007-994637. PMID   8476469.
  11. ↑ Davidson, Kim (December 1991). "Detection of Premature Rupture of the Membranes". Clinical Obstetrics and Gynecology. 34 (4): 715–722. doi:10.1097/00003081-199112000-00007. PMID   1778013.
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