Premature rupture of amniotic sacs (PROM): What happens next?

Premature rupture of membranes, abbreviated as PROM, is the breaking of amniotic sac before completion of 37 weeks of gestation. This is commonly known as 'water breaking.' The water surrounding the baby in the womb is called amniotic fluid and it is covered by a layer of tissue called amniotic sac. Under normal circumstances, the amniotic sac ruptures at the end of the first stage of labour but in case of premature rupture most women go into labour within 24 hours of water breaking. Are there any complications? The seriousness of the situation is dependent on how early the water breaks. PROM is associated with certain complications as mentioned below but the medical advancement enables doctors to manage most of them.

• Premature birth of the baby who is not fully developed, known as pre-term delivery
• Before delivery, placenta may detach  from the uterus, known as placental abruption
• Umbilical cord may get compressed between the baby and the pelvis, known as pro-lapsed umbilical cord
• Uterine infection (high fever is the symptoms)
• Infection to the baby
• Miscarriage

If you suspect that your water has broken, call your doctor right away . Why does it happen? Though exact causes are still not clearly understood but possible factors are

• Infections of the uterus, cervix or vagina
• Weight of the baby and placenta putting lot of pressure of cervix
• Improper eating or drinking
• Smoking and alcohol
• Surgery or biopsies of the cervix
• PROM in earlier pregnancies
• Bleeding during the second and third trimester
• Lung disease during pregnancy
• Low body mass index

Most women whose water breaks never witnessed had any risk factor. How do I know when my water breaks? There will be fluid leaking from the vagina. You'll experience either a sudden gush of water or slow trickles going down.  If it trickles down slowly, don't confuse it with urine. Instead, use a pad to absorb it and then look and smell it. Amniotic fluid has no color or smell. How will doctor diagnose it? Doctors will diagnose PROM with the following tests:

• Microscopic screening
• Visual exam - doctors will check the trickle of fluid through the cervix, or a pool of fluid collected behind the cervix
• Nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
• Ultrasound—using sound waves, the doctor examines the baby and amniotic sac to see if there is plenty of fluid and the baby is doing well.
• Checking the baby for any signs of distress and mother for fever and any other signs of infection.

How will it be treated? Treatment of PROM depends on when it occurs in the pregnancy. Doctors will monitor you for cervical dilation and

After 37 weeks

Your baby is ready to be born. Soon you'll find yourself in labour either on your own or you can be induced.

Between 34 and 36 weeks

Doctors will suggest that you be induced into labour soon to avoid even the slightest chance of infection which could prove risky for you and your baby. He may monitor the baby's heart rate and give you antibiotics.

Before 34 weeks

It is a serious condition. Doctors will provide treatment with - steroids to help the baby's lungs grow quickly and antibiotics to prevent any infection. Bed rest will be advised and baby will be closely monitored to check the growth of lungs. Once the lungs are grown enough, doctor will induce labour. If you break your water, don't panic. Your doctor will tell you what the safest thing to do is. Even if there are risks in giving birth early, nowadays hospitals have good pre-term/neonatal units with best-in-class facilities to ensure best treatment and care.  The two best things that you can do to prevent premature rupture of amniotic sac are quit smoking and consume nutritious diet. Stay alert. Stay safe!