Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Maternal and Neonatal Complications of Term PROM

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Term PROM is defined as the spontaneous rupture of the amniotic membranes prior to the onset of labor in a term gestation. It is a well established risk factor for maternal and neonatal infection.

Interventions to hasten birth are often undertaken to reduce the risk of infection, however the duration of rupture is not the only risk factor and multiple variables may interact in a synergistic fashion to result in inflammation, infection or both.

“The primary argument for immediate induction has always been reducing neonatal infections, which the American College of Obstetricians & Gynecologists (ACOG) acknowledges it DOES NOT DO [emphasis mine], and as can be seen…with optimal care the other [perceived] benefits are likely to be smaller than they currently appear.” Henci Goer 

Term PROM is considered a labor and birth complication, your healthcare provider’s primary management decision is an assessment of the risk of complications determining whether the pregnancy should be allowed to continue or if immediate labor and birth should be initiated via labor induction.

Although between 77-95% of women will begin labor spontaneously within 24 hours of rupture, expectant management in term PROM is an uncommon management approach today. However, it is a reasonable evidence based option that should be presented to women along with induction.

Unfortunately, because of the perceived risk of infection the medical world still considers birth to be the best option, in spite of the best evidence, labor will most likely be induced if contractions do not begin shortly after rupture.

There are several complications that have been associated with term PROM and PPROM, the most established being that of infection and therefore that perceived risk drives the whole medical protocol surrounding the management of term PROM pregnancies.

So let’s discuss the other less likely complications first.