Premature rupture of membranes: what to do if the amniotic sac bursts?

When the waters break before labor begins, it is called premature rupture of membranes. The further procedure then depends on your week of pregnancy and the degree of maturity of the child’s development.

Premature rupture of membranes is not a problem as long as the child is mature and the most important organs are already fully developed. Normally, labor will come on by itself, allowing for a spontaneous birth. In a few cases, labour-inducing drugs are used to speed up the process . However, if the baby is not yet mature, a decision is made as to whether to continue waiting or to be delivered. Because after a ruptured membrane, it is easier to get a dangerous infection. Waiting, however, would give the baby more time for organ maturation and thus improve its chances of starting.

Premature rupture of membranes: causes

  • Genital infection is one of the most common causes of premature rupture of membranes. The vaginal infection can rise and thus damage the egg membrane. This reduces the stability of the amniotic sac and causes it to burst prematurely.
  • A weakness in the connective tissue of the fetal membrane can mean that it does not stretch properly during pregnancy and then tears prematurely without labor occurring.
  • Premature labor can also massively increase the pressure on the amniotic sac and thus lead to premature rupture of membranes.
  • Amniocentesis can cause premature rupture of membranes In most cases, however, the resulting opening closes again within a short time and the pregnancy can continue as normal.

Premature rupture of membranes: symptoms

The symptoms of a ruptured membrane are clear. After the amniotic sac ruptures, a gush of amniotic fluid is released . After the first gush, the amount of fluid decreases significantly, since there is now less amniotic fluid and the child’s head sits lower, preventing further amniotic fluid from escaping. The first gush is usually so strong that it cannot be confused with urinary leakage.

If you notice the leakage of amniotic fluid, or you are unsure if it is amniotic fluid, assume a recumbent position as much as your circumstances allow. Make yourself comfortable so as not to unnecessarily endanger your baby. Then contact a maternity facility, your doctor or midwife to discuss how to proceed. As a rule, you will then be asked to visit the practice or clinic.

The doctor will use the ultrasound to check the amount of amniotic fluid and use a quick test to determine whether the escaping fluid is really amniotic fluid. A swab is then taken to rule out infection. Your temperature and pulse will be checked. The CTG is used to check whether the child is doing well and whether the first contractions can already be observed.

Premature rupture of membranes: consequences

  • Infections : After a premature rupture of membranes, germs can more easily enter the uterus and lead to inflammation of the membranes or infection of the child. Premature labor can also be a consequence. If an infection occurs, immediate delivery of the child by caesarean section is often advised.
  • Umbilical cord complication : If the umbilical cord is in front of the cervix when the membranes rupture, a prolapsed umbilical cord can occur. This means that the umbilical cord is pinched. The pressure on the umbilical cord is additionally increased by the decreasing amount of amniotic fluid, it is no longer properly supplied with blood and can no longer care for the child as before. If there is a supply problem here, the child must be delivered.
  • Disturbance of the child’s lung development: If the child is already mature at the time of the premature rupture of the bladder, the lungs are already functional at a premature birth. If a child then only has to remain in the uterus for a few days without amniotic fluid, this does not have any major consequences for the development of the child. However, if the baby has to go four to six weeks without amniotic fluid, in many cases the lungs can no longer develop normally. In such a case, the doctor will monitor closely in order to be able to identify and treat problems early.
  • Hand, foot and head deformities : The absence of amniotic fluid over a long period of time can also cause deformities of the hands, head and especially feet. This risk can also be controlled and minimized through careful preventive medical check-ups.

How is premature rupture of membranes treated?

The treatment for premature rupture of membranes depends on the time of pregnancy. There are two approaches to choose from: Either you wait to allow the child to mature longer. Or labor is induced or the child is delivered by caesarean section to minimize the risk of infection. Which of these two options you choose depends on the progress of the pregnancy and thus the child’s maturity:

  • After the 38th week of pregnancy , premature rupture of membranes usually does not cause any problems, because contractions usually start within a short time and the baby is born naturally. At this point, the development of the child is so complete that no negative effects are to be expected. If contractions do not start and there is a risk of infection, the birth can also be initiated with medication .
  • Between the 33rd and 37th week of pregnancy , no major medical help is required either, because the child’s lungs are almost fully mature by the 32nd week. If the contractions don’t start here either, the birth will be induced.
  • 24th and 32nd week of pregnancy : If the membranes rupture before the child’s lungs have matured, most doctors try to wait as long as possible. The condition of the child is closely monitored with ultrasound and CTG . The pregnant woman is given a drug to support the child’s lung maturation and an anti-infectious antibiotic. The child is only delivered when there are signs of infection. At this point, the delivery is usually by caesarean section, since the cervix is ​​usually not yet ready for a natural birth.
  • Up to the 24th week of pregnancy : Unfortunately, at this early stage of development, the chances of the baby surviving are very poor. In most cases, this leads to a miscarriage .

When is the caesarean section done?

As a rule, nothing stands in the way of a natural birth, even if there is a premature rupture of membranes. However, if the child’s heartbeat drops during the birth or other signs of a health impairment of the child are observed, it may be safer to deliver the child with a caesarean section. A caesarean section may also be necessary at the first signs of infection if the cervix is ​​not yet ready for the induction of a natural birth.

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