Premature rupture of membranes or PROM is when you break your water before you go into labor. Up to three percent of all PROM occur prior to the 37th week of gestation (preterm PROM or PPROM) and 10% occur at term (term PROM). The majority of women who give birth vaginally are in active labor when the bag of waters or membranes are artificially ruptured by a physician (AROM). According to researchers from the Universite d’Auvergne in France, expectant management may be the best course of action for some women experiencing Preterm Premature Rupture of Membranes (PPROM) prior to the 37th week.
Authors reviewed the current guidelines for management of PROM in pregnancy.
- PPROM < 34 weeks: Prior to the 34th week of gestation, researchers noted corticosteroids, utero transfer and antibioprophylaxis are acceptable treatments.
- Term PROM >37 weeks: After the 37th week of gestation, the pregnancy should be ended and the fetus delivered.
- PPROM 34-37 weeks: There is a grey line between 34 and 37 weeks that leaves doctors without a clear action plan. According to report authors, if there is no underlying infection or imminent dangers to the fetus, doctors can practice expectant management or deliver. Expectant management is a watch and wait phase when the needs of the pregnant patient are met, but natural labor is given time to start before labor is induced.
Source: Blanchon L, Accoceberry M, Belville C, Delabaere A, Prat C, Lemery D, Sapin V, Gallot D. Rupture of membranes: Pathophysiology, diagnosis, consequences and management. J Gynecol Obstet Biol Reprod (Paris). 2013 Feb 5. pii: S0368-2315(13)00004-5. doi: 10.1016/j.jgyn.2012.12.012.