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]

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.

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. ^ a b c 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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