Rupture of membranes (ROM) or amniorrhexis is a term used during

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

to describe a rupture of the

amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shor ...

. Normally, it occurs spontaneously at

full term Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can ...

either during or at the beginning of

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

. Rupture of the membranes is known colloquially as "breaking the water" or as one's "water breaking." A

premature rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complicati ...

(PROM) is a rupture of the

amnion The amnion is a membrane that closely covers the human and various other embryos when first formed. It fills with amniotic fluid, which causes the amnion to expand and become the amniotic sac that provides a protective environment for the develo ...

that occurs prior to the onset of labor. This typically occurs before the pregnancy's 37 week

gestation Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...

. In the United States, more than 120,000 pregnancies per year are affected by a premature rupture of membranes, which is the cause of about one third of preterm deliveries. Sometimes, a child is born with no rupture of the amniotic sac (no rupture of membranes). In such cases, the child may still be entirely within the sac once born; such a birth is known as an en-caul birth.

Effects

When the amniotic sac ruptures, production of

prostaglandins The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...

increases and the cushioning between the fetus and uterus is decreased, both of which are processes that increase the frequency and intensity of

uterine contraction Uterine contractions are muscle contractions of the uterine smooth muscle that occur during the menstrual cycle and labour. Uterine contractions occur throughout the menstrual cycle in the non-pregnant state and throughout gestation. Throughout m ...

s.American Pregnancy Association > Inducing Labor
Last Updated: 01/2007 On occasion, with the rupture of membranes, particularly if the head is not engaged, the

umbilical cord In placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologic ...

may

prolapse In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes call ...

. A

cord prolapse Umbilical cord prolapse is when the umbilical cord comes out of the uterus with or before the presenting part of the baby. The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby. It usuall ...

is an obstetrical emergency, as the descending head may block fetal-placental circulation. Once the membranes are ruptured, bacteria may ascend and could lead to amnionitis and fetal infection. A premature rupture of membranes can have multiple effects on the fetus such as increasing their risk of prematurity and facing neonatal or perinatal complications.

Types

*SROM: spontaneous rupture of membranes. This term describes the normal, spontaneous rupture of the membranes at

. The rupture is usually at the bottom of the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

, over the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

, causing a gush of fluid. This gush may be quite small (such as 50ml), or it can be significantly large (200-300ml) depending upon amount of fluid in the amniotic sac, and to what extent the fetal head is plugging the hole and retaining fluid in the sac.kiwifamilies.co.nz > Birth > Spontaneous Rupture of Membranes
By Paula Skelton, midwife A spontaneous rupture that occurs early in labor may actually be related to other complications resulting in delayed labor. These complications may include a contracted pelvis, breech presentation, or occipito-posterior position. *PROM:

. This term describes a rupture of the membranes that occurs before the onset of labor. **PPROM: preterm, premature rupture of membranes. This term describes a rupture of the membranes that occurs before 37 weeks gestation, and it can have multiple effects on the fetus such as increasing their risk of prematurity and facing neonatal or perinatal complications. Risk factors of pregnancies with PPROM include race (

black Black is a color which results from the absence or complete absorption of visible light. It is an achromatic color, without hue, like white and grey. It is often used symbolically or figuratively to represent darkness. Black and white have o ...

patients are at increased risk), low

socioeconomic status Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...

, history of

sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...

, distension of the uterus (which may result from factors such as excessive amniotic fluid (

polyhydramnios Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. There are two clin ...

) or carrying more than one fetus (

multifetal pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

)), and

tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...

. *AROM:

artificial rupture of membranes Artificial rupture of membranes (AROM), also known as an amniotomy, is performed by a midwife or obstetrician and was once thought to be an effective means to induce or accelerate labor. The membranes can be ruptured using a specialized tool, such ...

. This term describes a rupture of the membranes by a third party, usually a

midwife A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...

obstetrician Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

, in order to induce or accelerate labor.

Detection

Detection of rupture of membranes mainly include: *''Pooling test'': visualization of amniotic fluid pooling in the vagina *

Nitrazine Nitrazine or phenaphthazine is a pH indicator dye often used in medicine. More sensitive than litmus, nitrazine indicates pH in the range of 4.5 to 7.5. Nitrazine is usually used as the disodium salt. Use *This test is done to ascertain the natu ...

paper test *

Fern test The fern test is a medical laboratory test used in obstetrics and gynecology. The name refers to the detection of a characteristic "fern like" pattern of vaginal secretions when a specimen is allowed to dry on a glass slide and is viewed under a lo ...

Amniotic fluid index Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. It is a separate measurement from the biophysical profile. AFI is the score (expressed in cm) given to the amount of amniotic fluid seen ...

For results to be roughly 90% accurate in infection detection, a combination of both an arborization test and nitrazine paper test may be used. An arborization test assesses the patient's vaginal secretions, while a nitrazone paper test uses the nitrazine paper to examines vaginal pH.

References

External links

Merck ManualPremature rupture of membranes
{{DEFAULTSORT:Rupture Of Membranes Obstetrics Midwifery