Water Breaking in Pregnancy – Causes and Treatment of Premature Rupture of Membranes
The end stage of pregnancy usually covers two aspects; the joy of giving birth and the fear of complications during labor. No matter you have been successfully going through the phase of pregnancy with ease; still, there are chances of severe complications at the finish line. Let’s discuss one such condition that can prove life-threatening for the baby.
Premature Rupture of Membranes
Often abbreviated as PROM, premature rupture of membranes means that the amniotic sac breaks or leaks before the woman goes into labor. This condition is most commonly known as water breaking. In majority of the cases, the water breaks at some point of time during the labor but not before that.
Though despite the term ‘premature’, PROM is common after 37 weeks, which isn’t harmful, as the baby will no longer be considered as premature. But on the other hand, in about 3 percent of pregnancies, the membranes ruptures or water breaks before 37 weeks which can result in severe complications. Premature rupture of amniotic membranes often occurs in twin or multiple pregnancies.
Why is water breaking considered risky?
Normally, ruptured membranes cause the mom to go into labor. This isn’t a problem after 37 weeks as mentioned. But if water breaks earlier than 37 weeks, it means preterm labor and the baby will be born prematurely resulting in life-threatening complications.
Secondly, if doctors want to postpone the delivery due to prematurity of the baby, there would be an increased risk of infection. Other complications include umbilical cord compression, a baby born with neurological or learning disabilities and respiratory problems.
What causes premature rupture of membranes?
It is often hard to exactly identify the cause of preterm PROM, but certain types of infections are associated with this condition. Researchers till date consider following cause or risk factors of PROM:
- Uterine infection
- Overstretching of the uterus
- Multiple pregnancies
- Sexually transmitted diseases
- History of water breaking
- History of premature delivery
- Too much amniotic fluid (polyhydramnios)
- Incompetent cervix
Symptoms of premature rupture of membranes
The most classic sign of PROM is the leakage of fluid from the vagina. It could leak slowly or gush out. Unfortunately, many women mistake this fluid for urine. Usually, amniotic fluid is colorless and it shouldn’t smell like urine. Other signs might include:
- Inability to stop urinating
- Bleeding from vagina
- Wetness or vaginal discharge that seems more than normal
- Pressure on the pelvis
- If you are experiencing any of the symptoms, call your doctor right away.
Diagnosis of premature rupture of membranes
If you suspect premature rupture and have timely intimated the doctor, she might confirm it by first examining your symptoms. After that, the doctor would be conducting some tests. The test would usually involve examining the vaginal secretion.
- pH level – Normally, vaginal pH or acidity level lies between 4.5-6.0. Amniotic fluid has higher pH anywhere between 7.1 and 7.3. If membranes are ruptured, the pH level would be above 7.1.
- Nitrazine test – A drop of vaginal fluid will be placed on a strip containing Nitrazine dye. If the strip turns blue in color, then it is considered that pH is more than 6.0. However, this test is likely to create a false positive result. This is because if the vaginal fluid is contaminated with blood or infection or you have been recently indulged in sex, then the test might show increased pH level.
- Ferning – This test involves dropping of vaginal fluid on a microscope slide to observe ‘fern-like’ pattern. If the membranes are ruptured, the fluid mixed with estrogen will produce a ‘fern-like’ pattern. This is due to salt crystallization.
Other tests –
- Dye test – A dye will be injected through the abdomen into the amniotic sac. If the membranes are ruptured, the color of the fluid will change after 30 minutes.
- Tests for the presence of chemicals – There are certain chemicals such as prolactin, alpha-fetoprotein and diamine oxidase found in the amniotic fluid, but not in the vaginal fluid. Presence of these chemicals in high levels indicates that the membranes are ruptured.
- AmniSure ROM Test – This is a newer non-invasive technique to diagnose PROM. This rapid test involves taking a sample of vaginal fluid via sterile swab. The test checks for Alpha Microglobulin-1 (PAMG-1) protein present in the amniotic fluid. Within minutes, a clear Yes or No can be read.
If the condition is confirmed, the doctor will further conduct additional tests to check for infection, lung development and heart rate of the baby.
Is it possible to manage or treat premature rupture of membranes?
The treatment will depend on the stage of the pregnancy.
- If the condition occurs after 37 weeks and the mother does not go into labor naturally, the doctor will be inducing labor. In this case, no treatment would be required and the baby might be born without any complications.
- If PROM occurs before 37 weeks, the doctor would be administering antibiotics for treating strep B bacteria and then delivering the baby. Babies born in between 34-36 weeks, would not face any serious problems. Although, both the mother and the baby might need to stay for a few days or weeks in the hospital for special care.
- If PROM occurs before 34 weeks, the woman might be hospitalized. The doctor will then postpone the delivery until the lungs of the baby are matured enough. For lung development, steroids might be used subsequently with anti-biotics for countering infection. But if the infection occurs in the uterus, the baby might be delivered without delay.
- Although labor can be postponed by medications, still the majority of the women will deliver babies within a week. And depending on the time of the delivery, there is an increased risk of infant death. According to American Family Physician, fetal death occurs in 1-2 percent of cases. This is the reason why many doctors opt for delivering the baby right away if PROM occurs between 32-34 weeks.
- PROM rarely occurs before 24th week and the survival rate is much lower. Delivery happening after 24 weeks does have chances of survival but the odds of complications are much higher.
Sometimes, it’s a two-way sword. However, the team at the hospital will be closely watching both the mother and the baby. So seek immediate help from your gynecologist if you see any of the symptoms mentioned above.