The rupture of fetal membranes (water breaks) before the beginning of labor is considered a complication of pregnancy known as premature rupture of membranes. This can happen at any gestational age, even full term. Despite what movies may depict, this sudden gush or steady trickle of fluid only occurs in about 10% of term pregnancies and 4% of preterm pregnancies. When the membranes rupture prior to 37 weeks gestation, it is considered preterm premature rupture of membranes (PPROM). Regardless of gestational age, when the membranes rupture, the protective barrier between the vagina and the fetus is lost and increases the risk of maternal and fetal infection.
There is no specific cause, but there are many factors that may increase the risk of PROM. Maternal or intra-amniotic infection and chronic disease, such as systemic lupus erythematosus, direct abdominal trauma, nutritional deficiencies, smoking and placenta abruption all increase the risk of PROM. Multiple pregnancy (twins or more) and a history of previous PROM also indicate an increased risk.
Patient will be free from infection (maternal and fetal); viable birth
Assess for signs of infection
Maternal and fetal infection may prompt PROM and must be treated quickly to avoid fetal compromise.
Perform single digital or sterile speculum vaginal exam
Vaginal exam may be required to confirm diagnosis, but avoid multiple digital vaginal exams to reduce the risk of infection. Reserve these exams for when delivery is imminent.
Obtain history from patient regarding complications and status of pregnancy.
Initiate fetal monitoring
PROM may be an indicator of fetal distress. Monitor for signs of fetal compromise to include changes in fetal heart rate.
Administer medications and IV fluids as appropriate
Prepare patient for induction of labor and delivery
If indicated, labor will likely be induced if it does not spontaneously begin within 12-24 hours. Explain process to patient to reduce fears.
Provide patient education if preterm
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