During pregnancy, a baby is surrounded and cushioned by a fluid-filled membranous sac called the amniotic sac. Typically, at the beginning of or during labour, the pregnant woman’s membranes will rupture — also known as water breaking. Water breaking is a normal part of going into labour, but if it happens before your baby’s ready to be born, the condition is called premature rupture of the membranes (PROM), which affects up to 10 per cent of pregnant women. The longer it takes for labour to start after your water breaks, the greater the risk of the mother and the baby to develop an infection, says Dr Iba Mayele. Mayele, a gynaecologist/ obstetrician operating at Galien Clinic in Kimironko, says that in a routine labour, contractions begin before the water breaks. In premature rupture of membranes, the sac ruptures and begins leaking before the contractions and labour begins. “PROM often occurs very unexpectedly and the cause may not be determined in each case. However, some of the risk factors for water breaking too early may include having a history of preterm premature rupture of membranes in a prior pregnancy, inflammation of the foetal membranes (intra-amniotic infection), vaginal bleeding during the second and third trimesters, and smoking or using illicit drugs during pregnancy,” he says. What happens when water breaks prematurely? Mayele says that having PROM or preterm PROM can lead to complications and may cause the mother to be hospitalised, but it doesn’t necessarily mean the baby will be born right away. PROM can occur at any time during a pregnancy. If it occurs before 37 weeks of gestation, it will usually lead to preterm labour. If PROM occurs after 37 weeks of gestation and the woman does not go into labour on her own, medical intervention may be necessary to induce labour or she may need a caesarean section (C-section). “Premature rupture of the membranes provides a path for bacteria to enter the womb and puts both the mother and foetus at risk for life-threatening infection. A significant risk of PPROM is that the baby is very likely to be born within a few days of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis, which can be very dangerous for mother and baby,” he says. Mayele adds that other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, caesarean birth, and postpartum (after delivery) infection. The chance of chorioamnionitis, uterine infection, or neonatal sepsis, increases when PROM occurs. This can be really serious since it can be hazardous to the health of both the woman and the baby. He recommends women to promptly seek medical support once they notice any symptoms of PROM. The doctor might take a complete medical history and physical examination, including an ultrasound to see how much fluid surrounds the baby, or examination of the cervix which may show fluid leaking from the cervical opening, and testing of the pH (acid or alkaline) of the fluid among others . All these tests will determine how to protect the mother and child. Dr John Muganda, a gynaecologist at Polyclinique La Medicale, says that if a woman is experiencing PROM and is near her due date (more than 34 weeks), she might go into labour on her own, or the doctor might decide to induce labour to minimise the risk of infection, especially if there are signs of abruption, chorioamnionitis, or foetal compromise. “If the water breaks before 34 weeks, the doctor will probably give the mother antibiotics to fend off potential infections, plus steroids to help the baby’s lungs develop. She may have to stay in the hospital to be monitored for signs of labour. Once she reaches 34 weeks, the doctor will check to see if the baby’s lungs are mature, and if they are, it will most likely be delivered then,” says Muganda. Unfortunately, medics says that there is no way to actively prevent PROM. However, they say this condition does have a strong link with cigarette smoking and women should desist from doing so. editorial@newtimes.co.rw
