17.1 Premature rupture of membranes
Premature rupture of membranes (PROM) is defined as a spontaneous leakage of amniotic fluid from the amniotic sac where the baby swims; the fluid escapes through ruptured fetal membranes, occurring after 28 weeks of gestation and at least one hour before the onset of true labour. PROM can occur before or after 40 weeks’ gestation, so the word ‘premature’ does not mean that the gestational age of the fetus is preterm.
Premature here refers to the premature rupture of fetal membranes before the onset of labour. PROM is of concern because rupture of fetal membranes before the onset of labour is not normal and is associated with many complications (described later in this session). In a normal labour, the fetal membranes usually rupture after the labour has progressed for some time, when the fetal head is deeply engaged and the cervix is near to full dilatation, with no complications in most labouring women. (You will learn in detail about labour progress in the next Module, Labour and Delivery Care.)
You need to know that the majority of people in Ethiopia don’t think of PROM as a problem. Rather, they consider the leakage of fluid as a good symptom about the coming labour. As you will see later in this study session, many serious complications can occur as a result of PROM. Therefore, you need to counsel the woman, her husband/partner and her family very clearly about the actions they should take if her membranes rupture and fluid leaks from her vagina before labour begins. Tell them about the dangers of waiting at home after the rupture of fetal membranes. We begin by describing how you classify cases of PROM, which determines how you handle each case.