What is PPROM and how should doctors manage it?
Preterm premature rupture of membranes (PPROM) is a subtype of Premature Rupture of Membranes (PROM). PROM is a condition in which a mother’s ‘water breaks’ (the amniotic sac and chorion rupture) more than an hour before the onset of labor. PPROM refers to when this happens before 37 weeks gestation – that is, before the baby is at term. PROM is concerning because the amniotic fluid serves as a protective environment for the baby, and PPROM is particularly dangerous because of how vulnerable premature babies are. Without the protection of the amniotic fluid, the baby becomes significantly more prone umbilical cord compression issues, infection, and a large number of other complications.
How Common Is PPROM?
PROM occurs in about 8-10% of pregnancies, and PPROM occurs in about 3% of pregnancies. It is the cause of about 30-40% of premature births.
What Are The Causes of PPROM?
PPROM often occurs due to infections such as herpes simplex virus (HSV), Group B Strep (GBS), bacterial vaginosis (BV), a urinary tract infection (UTI), or maternal sepsis, though infection isn’t always the cause. It can also happen when the mother has had previous cervical surgery, has had or is having multiples (e.g. twins or triplets), or has too much amniotic fluid (polyhydramnios).
What Are The Signs and Symptoms of PPROM?
Several signs can indicate that PPROM occurred. The most prominent is pale yellow or clear fluid leaking from the vagina, either in a steady trickle or all at once.
Because PPROM and infections co-occur in a significant number of cases, physicians can look for signs of infection in the baby as well. These include:
- Increase in fetal heart rate (fetal tachycardia)
- Increase in maternal heart rate (maternal tachycardia)
- Uterine tenderness
- Foul-smelling vaginal discharge
- Increased white blood cell count or change in relative quantities of white blood cell type in the mother
If these signs are present, a physician can:
- Use a speculum to see if fluid is leaking from the cervix
- Take a sample and verify it is amniotic fluid
- Order an ultrasound to see how much fluid is left
- Take a thorough medical history
What Are Some Of The Complications Associated With PPROM?
Some of the complications associated with PPROM are similar to those that occur with PROM. These include:
- Chorioamnionitis: Chorioamnionitis is a maternal infection that affects the placenta and fetal membranes. A woman can get chorioamnionitis when bacteria move upward through her vagina and into her uterus. This infection can cause early labor, as well as interrupt the exchange of nutrients and gases between the mother and baby.
- Infections passed from mother to baby: Chorioamnionitis and other maternal infections can spread to the baby, potentially resulting in neonatal sepsis and meningitis. These conditions can have permanent and serious effects on the baby’s brain development.
- Umbilical cord compression: After a premature rupture of membranes, the umbilical cord is no longer cushioned by the amniotic fluid, and can become compressed (or flattened). In some cases, the umbilical cord may also slip out of the birth canal in front of the baby, becoming compressed between the presenting part of the baby (usually the head) and the mother’s vaginal canal. This is known as cord prolapse. Cord prolapse and other forms of compression are dangerous because the flow of oxygen-rich blood to the baby is interrupted, and the baby may experience dangerous complications like hypoxic-ischemic encephalopathy (HIE).
- PPROM can also increase the chance of premature birth, which is associated with a number of issues for the baby. The following are just a few examples of ways in which PPROM and premature birth can put an infant at risk:
- If a mother’s membranes rupture early and she delivers the baby prematurely, the baby’s brain and lungs might not be fully developed. If mismanaged by physicians, this can lead to respiratory distress syndrome (RDS), apnea of prematurity, and overventilation injuries.
- Mismanaged respiratory issues can then lead to conditions such as hypoxic-ischemic encephalopathy, neurodevelopmental impairments, intraventricular hemorrhage (IVH), and cerebral palsy (CP).
- If the infant is particularly small or premature, the risk of developing periventricular leukomalacia (PVL) as a result of respiratory mismanagement also increases.
- In some cases, these complications can result in infant death
How Are Medical Professionals Obligated To Care For PPROM?
Physicians may follow different standards of care depending on how many weeks’ gestation the fetus is. However, because PPROM can be either the cause or the result of an infection, they should give mothers antibiotics to avoid passing infection from mother to baby.
A C-section might be necessary to protect the baby from infection, because the longer the time period between the rupture of membranes and delivery, the likelier an infection will happen (especially if more than 12 hours elapse between rupture and delivery).
Once the baby is born, physicians should follow standards of care, including respiratory management, which can require the use of surfactant or ventilation.
Note: A premature baby with an infection is at greater risk for injury, death, or disability than a premature baby. Ideally, the baby should be delivered at the first signs of potential infection. This is occasionally difficult to predict, so close monitoring is essential, and signs of infection or changes in the baby’s testing (even subtle ones) should be relied upon.
For more detailed information on managing this condition, please see our general FAQ page on PROM.
What Are The Long-Term Outcomes Associated With PPROM?
Many infants that are born as a result of properly managed PPROM do well, as most complications tend to arise from mismanagement of the condition. Because PPROM has the added risk factor of prematurity, it’s very important that physicians be exceedingly careful in their treatment of the baby. Good outcomes stem from proper management of care.
PPROM And Medical Malpractice
If you had PPROM and suspect that your child has experienced long-term impacts from medical staff’s mishandling of the complication, you may want to consider seeking compensation through a birth injury case. This can provide your child with the resources necessary for treatment, therapy, and other types of support they may need.
About ABC Law Centers
The attorneys at ABC Law Centers have exclusively handled birth injury cases since the firm’s inception in 1997. Our firm has a network of renowned medical, economic, and forensics experts on our side. Our attorneys have been consistently recognized for their work in birth injury. We are available 24/7 for a free consultation, and we do not charge any fees for the entire legal process unless we win.
We are one of only a few select firms that exclusively handle birth injury. We are also one of the few to employ in-house medical staff, who apply their knowledge to exhaustively interpret your medical records and determine if medical malpractice occurred. Our attorneys have won numerous multi-million dollar settlements for our clients, and have received many awards for their work.
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- Preventing Premature Birth
- Premature Birth and Brain Injuries
- PROM: Overview
- PPROM: Case Study
- NICU Overview
- Little Heartbeats: PPROM Support Group (Facebook)