Problems During Labor and Delivery
Although labor and delivery usually proceed smoothly, unanticipated problems
sometimes develop. Hospitals are well equipped to deal with these
complications. It is important to be aware of the warning signs of
possible complications so you can alert your doctor immediately any problems.
Premature Rupture of Membranes
For most women, if the amniotic membranes rupture ("the water breaks") early,
labor follows within a few hours. But the earlier in pregnancy this
rupture occurs, the longer it may take for labor to begin the longer it may take
for labor to begin afterward.
Premature rupture of membranes (PROM) is an event that occurs during
pregnancy when the sac containing the developing baby (fetus) and the amniotic
fluid bursts or develops a hole prior to the start of labor.
Conditions that most often cause the
premature rupture of membranes include
Infection of the uterus or cervix- Maternal infection is probably
the most common risk of PROM. Ironically, this complication is the one most
likely to be caused by the doctor and hospital environment. At all gestational
ages, patients who have had only a sterile speculum exam have an average of
11.3 days of latency; whereas those who have had digital vaginal exams only
last 2.1 days before labor starts. Obviously, the risk to the premature
fetus is lessened with each day it can remain in the womb, making digital
exams a definite risk to the baby.
Multiple births- (twins, triplets, etc)
Incompetent cervix - Normally, the cervix remains closed throughout
pregnancy until labor begins. An incompetent cervix gradually opens due to the
pressure from the developing fetus after about the 13th week of pregnancy. The
cervix begins to thin out and widen without any contractions or labor. The
membranes surrounding the fetus bulge down into the opening of the cervix
until they break, resulting in the loss of the baby or a very premature
Premature separation of the placenta (placental
abruption)-Placental abruption is the early separation of a normal placenta
from the wall of the uterus. The placenta is an organ that grows in the uterus
during pregnancy to provide nourishment and oxygen to the baby...
Excess amniotic fluid (polyhydramnios)
Smoking is also a risk factor - Studies have also found the risk of
PROM increased with the number of cigarettes the mother smoked,
regardless of alcohol and caffeine intake.
Certain procedures carry an increased risk of PROM, including
amniocentesis and cervical
If your membranes rupture, you are likely to feel a gush or trickle of fluid
out of your vagina. (Sometimes, a woman thinks her membranes have broken
when, in fact, urine has been pushed out by the weight of the baby on her
bladder.) Your doctor can tell in a pelvic examination if your membranes
have ruptured and if your cervix has started to thin (efface) or open (dilate).
He or she may also take samples of amniotic fluid to evaluate the maturity of
the baby's lungs and to check for infection.
Specific treatment for PROM will be determined by your
physician based on:
Your pregnancy, overall
health, and medical history
Extent of the condition
Your tolerance for specific
medications, procedures, or therapies
Expectations for the course
of the condition
Your opinion or preference
Treatment for premature rupture of membranes may include:
Monitoring for signs of
infection such as fever, pain, increased fetal heart rate, and/or laboratory
Giving the mother medications
called corticosteroids that may help mature the lungs of the
fetus. However, corticosteroids
may mask an infection in the uterus.
Tocolytics - medications used to stop preterm labor.
If the membranes rupture after the 36th week of pregnancy, labor usually
begins in 24 to 48 hours. If it does not, labor will probably be induced.
The risk of infection begins to increase 24 hours after the membranes rupture.
Because of the risk of infection, you should not have intercourse or put
anything into your vagina, including tampons.
Although rate, the membranes can rupture before the 25th week of pregnancy.
When the membranes rupture this early in pregnancy, a doctor will try to delay
the onset of labor for as long as it is safe for the baby. The woman is
usually admitted to the hospital so that her temperature and the baby's heart
rate can be monitored continuously; an increase in either may be an indication
that an infection is developing inside the uterus. Exposure to infection
inside the uterus can significantly reduce a baby's chances of survival.
Only the fourth of babies born before the 25th week of pregnancy survive
outside the uterus. Because they are not fully developed
at birth, those that do survive may have permanent disabilities, including slow
development, mental retardation, inadequate development of their lungs, or
Prevention of premature rupture of membranes:
Unfortunately, there is no way to actively prevent PROM. However, this
condition does have a strong link with cigarette smoking and mothers should stop
smoking as soon as possible.
Dated 26 March 2014