Premature rupture of membranes (kpd): causes, signs and risks of complications

The rupture of the amniotic fluid is a signal that the body that the pregnant woman is showing signs of wanting to give birth. However, some mothers actually experience premature rupture of membranes long before their time. In the medical world, premature rupture of membranes (PROM) is a condition called preterm premature rupture of membranes (PPROM). Approximately, what can cause this condition?

What is premature rupture of the amniotic sac (PROM)?

Premature rupture of membranes (PROM) is a condition when your membranes break prematurely. Quoting from the Children Hospital of Philadelphia (CHOP), premature rupture of membranes is divided into two conditions.

First, the membranes break prematurely at term or premature rupture of membrane (PROM) after 37 weeks of gestation. Meanwhile, premature rupture of the membranes or less preterm premature rupture of membrane (PPROM) occurs before 37 weeks of gestation.

This condition occurs in about 10 percent of pregnancies. When the membranes have broken but the baby is not delivered immediately, it is feared that an infection will occur which can also endanger the mother and baby.

A rupture of membranes when you are pregnant is not too dangerous because babies born at 37 weeks of gestation or more are ready to “live alone” so there is no problem if they are born immediately.

Statistics from Medscape show that in 90 percent of pregnant women who experience premature rupture of membranes, labor will occur within 24 hours.

Based on data from The PPROM Foundation, PROM that occurs less than 37 weeks occurs in 2-4 percent of single pregnancies and 7-20 percent occurs in multiple pregnancies.

PROM is a potentially dangerous pregnancy complication. Premature rupture of membranes can cause the mother to give birth to a baby prematurely.

The function of the amniotic sac is to hold, protect from damage, and help regulate the baby's body temperature. The amniotic fluid contains water, hormones, antibodies and nutrients for the fetus.

Not only that, amniotic fluid also has bacteriostatic properties which help prevent amniotic infections.

What causes premature rupture of membranes (PROM)?

Rupture of the amniotic fluid before birth (at term) can be caused by the weakening of the membranes from contractions. The premature rupture of the membranes is caused by an infection in the uterus.

The following are the causes of premature rupture of membranes that need attention:

• Sexually transmitted infections (chlamydia and gonorrhea)
• Have had premature birth before
• Smoking during pregnancy
• Bleeding in the vagina for more than one trimester
• Inflammation or infection of the amniotic membrane
• Early activation of enzymes in membranes
• Low levels of collagen in the amniotic sac tissue
• Too much amniotic fluid volume
• Breech baby position
• Have had amniocentesis in early pregnancy
• Doing strenuous exercise or putting too much stress on the body
• Poor diet and nutrition
• Lack of copper, vitamin C, or zinc intake

Premature rupture of the membranes is a complicating factor in one-third of preterm births.

What are the signs and symptoms of PROM?

The symptoms of PROM are the same as the rupture of the water as a sign of childbirth, namely the leakage of fluid from the vagina. The amniotic fluid may leak, leak, drain, or spray strongly like urine.

The bigger the tear in the sac, the more amniotic fluid that comes out of the vagina. Amniotic fluid will continue to drain 600-800 milliliters (about 2-3 glasses) from the initial tear.

However, a hallmark of KPD is the timing of its occurrence. Premature rupture of membranes (under 37 weeks) is a complication preterm premature rupture of membrane (PPROM).

If the gestational age is still too young, for example in the middle of the second trimester of pregnancy and your membranes have broken, this is not normal and you should immediately see a doctor for further treatment.

Distinguish amniotic fluid, urine, and vaginal discharge

Many people find it difficult to distinguish between amniotic fluid, urine, and vaginal discharge because they are all considered to have the same shape.

If you see discharge from the vagina, use a bandage to accommodate it temporarily. After that, touch, look, and smell the smell to be able to tell the difference.

The amniotic fluid is usually warm, colorless (pale translucent), and has no strong odor. The scent smelled much sweeter and less urine. Usually amniotic fluid when it comes out can not be held, in contrast to urine that can still be held.

On the other hand, the amniotic fluid can also contain a little blood as a sign that the time for delivery is near.

If the discharge looks like mucus and is milky white, it could be a whitish discharge. While the liquid that comes out is yellowish and smells of urine is urine, not because of PROM.

How is the diagnosis of premature rupture of membranes?

The doctor's test is the most accurate way of diagnosing PROM. Doctors can diagnose premature rupture of membranes using the following two methods:

Putting the speculum into the vagina

Placing a speculum (duck cocor) into the vagina is done to check for puddles of amniotic fluid. The doctor can also collect a sample and check whether there is infection or not.

Using the amnicator test

Later, the doctor will wet the amniotic fluid sample with a yellow nitrazine pH detecting dye.

The color of nitrazine changes from yellow to blue-yellow or dark blue if the fluid is amniotic. If not amniotic fluid, nitrazine will not change color.

If the two tests above are unsuccessful, pregnant women need to wait for more fluid to come out to be tested a sample.

What to do when your water breaks prematurely?

As soon as the water breaks prematurely, consult a gynecologist. PROM is a condition that could indicate labor.

If the test result is correct it indicates preterm premature rupture of membrane (premature rupture of membranes less than months), the doctor will consider the next steps. One of them, if the age is still less than months, the lungs will be matured first. The doctor can first check the uterus to make sure there is no infection in the uterus and give antibiotics.

If the amniotic sac breaks more than 3 weeks before the day of delivery, the doctor may immediately induce or even immediately perform a cesarean section.

This step will indeed make the baby born prematurely, but it needs to be done so that the baby avoids the risk of further infection.

If the amniotic sac breaks within 3 weeks before birth, the doctor will wait for the mother's body to contract to trigger labor on its own. The doctor may also be able to suggest an induction process to speed up the birth.

If labor can be delayed, the doctor may give antibiotics to prevent infection and help prolong the pregnancy. Of course, as long as this is considered safe for pregnant women and future babies.

The risk of complications and danger of premature rupture of the membranes for the fetus

In the fetus, prematurely rupture of the membranes can pose various health risks such as:

Susceptible to infection

The greatest risk of premature rupture of the amniotic sac is infection of the fetus. The amniotic sac and fluid serve as a protection to prevent bacteria and other germs from infecting the fetus in the womb.

When the membranes tear and break prematurely, that protection is destroyed. Therefore, this condition generally makes the fetus more susceptible to disease during the womb and when it is born later.

The damaged amniotic sac will be a consideration for the doctor regarding the next steps that will be taken. The reason is that the longer the amniotic sac is allowed to rupture, the greater the risk of the baby getting infected.

Therefore, doctors will usually promptly advise patients to undergo compulsory examinations in the hospital. After that, it is only decided whether the baby should be born immediately or not.

However, if your water breaks prematurely while the tear is small and there is still enough fluid left over, you probably won't need to go into labor early. This is because the body will continue to produce amniotic fluid to protect itself.

Susceptible to lung problems at birth

Before 23 weeks of gestation, babies need amniotic fluid so that their lungs can develop normally.

If the amniotic fluid breaks prematurely, the fetus will lose enough amniotic fluid to prevent the development of its lungs.

This can increase the risk of lung disease in infants, one of which is pulmonary hypoplasia.

Lungs of babies born prematurely due to premature rupture of membranes or PROM is a condition that generally makes babies have fewer lung cells, airways, and alveoli.

This makes the baby have to be immediately treated in a special room or NICU (Neonatal Intensive Care Unit) as soon as he was born.

How can you prevent premature rupture of your membranes?

To prevent premature rupture of your membranes, there are a number of things that should be done, namely:

Take vitamin C.

In several reports published in the Iranian Red Crescent Medical Journal in 2013, consumption of vitamin C can prevent premature rupture of membranes.

This means that consuming enough vitamin C can also reduce the risk of preterm birth due to the rupture of the amniotic sac prematurely.

In this study, it was stated that one of the risk factors for PROM is collagen metabolism.

Researchers found that consumption of vitamin C during pregnancy can change collagen metabolism, which strengthens the amniotic membrane and amniotic membrane of pregnant women.

Diligently taking vitamin C also increases the results of the baby's Apgar score and increases the baby's weight. Taking 100 mg of vitamin C after 20 weeks of gestation can greatly reduce the risk of premature rupture of your membranes.

These findings still need further investigation into the relationship between vitamin C and its benefits in preventing PROM.

Avoid smoking

Some cases of premature rupture of membranes have no known cause. However, there is nothing wrong with maintaining a pregnancy by adopting a healthy lifestyle.

One of the things that need to be avoided so that pregnancy can avoid complications is cigarette smoke. Avoid smoking or inhaling secondhand smoke during pregnancy because it can harm the fetus in the womb and trigger premature rupture of the membranes.

Routinely check with the doctor

In addition, don't forget to always check with your obstetrician regularly every month. Examination of the womb can provide warning signs of pregnancy hazards, including problems with amniotic fluid.

If doctors suspect a problem, they are also able to plan treatment and treatment. The doctor can prescribe several prenatal vitamins that can maintain the health of the mother and the fetus in the womb.

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