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What happens in cases where membranes rupture before labour at term?
If the gestation is over 37 weeks, it means the pregnancy is effectively at term. If the waters break before the onset of labour in this period, most obstetricians advise a waiting approach, as labour will ensue in well over 80 per cent within 24 hours. Because of this fact, most units operate a policy where induction of labour is done for the few who have not gone into labour after twenty-four hours. There is evidence that leaving such cases for longer than 48 hours increases the risk of infection for both the mother and the baby.
Others, however, have a more interventionist approach, where assessment is made at the time the mother first presents. If the neck of the womb (cervix) is found not to be favourable for labour, the process of induction of labour is commenced immediately.
If, on the other hand, the cervix is favourable, nothing is done. This is on the assumption that spontaneous labour onset is likely to happen in a matter of hours.
There is no scientific evidence to suggest that one approach is superior to the other.
In rupture of membranes before term, are there any additional measures to improve the outcome?
The main measure is a close surveillance to detect the development of infection at the earliest possible stage. These measures will include monitoring the mother's own vital signs, including temperature and serial blood tests. Some will add vaginal swabs every few days, but this is controversial.
The other measure is monitoring the fetal well-being.
Is there room for outpatient management of this problem?
It is being increasingly accepted that women with preterm rupture of membranes can be managed on an outpatient basis and that admission until delivery is not an absolute necessity for every one. Of-course each case is carefully assessed for suitability to this approach.
Is there room for use of antibiotics to prevent infection in such cases?
It is now accepted that antibiotics in preterm rupture of membranes are beneficial and every woman finding herself in this situation is prescribed a course of Erythromycin. A substitute is used in the rare case of allergy to this antibiotic.
A therapeutic course of appropriate antibiotics is also necessary in cases where there is already evidence of infection, where treatment is commenced, together with putting delivery plans under way. In such a situation, there is no time to waste.
Are there any likely complications after delivery?
Yes; the most important one is the oft-mentioned problem of infection.
Also, there is increased incidence of excessive haemorrhage (blood loss).
What causes these complications?
The causes are poorly understood. In some cases, they have been associated with vaginal infection. Cigarette smoking is considered a risk factor.
In the vast majority, no cause or associated factor can be identified. This is one area where medical research is very active.
Does preterm rupture of membranes recur?
Yes. In just over 20 per cent of women (1 in 5), the problem will recur in a subsequent pregnancy.
Do membranes ever re-seal if they rupture early in pregnancy?
This probably never happens. There is certainly no hard evidence that such an occurrence has ever taken place.