MANAGEMENT OF PREGNANCY WITH PREMATURE RUPTURE OF MEMBRANES (PROM)
M. Velemínský1, P. Sák2
Abstract Amniotic fluid fulfils a lot of significant functions in pregnancy and birth. The membrane sac together with the amniotic fluid protect the foetus particularly against external insults and against penetration of infection into the ovum.The membrane sac usually bursts during birth, most often in the 1st birth stage, which appears in form of discharge of amniotic fluid. Premature rupture of membranes (PROM) occurs, according to different literature sources, in 4-14% of pregnancies. In dependence on the pregnancy stage, this is considered the beginning of birth or miscarriage. The sooner in the pregnancy course the PROM occurs, themore serious are its consequences. About 30-40% of premature births start by premature rupture of membranes that has therefore substantial share on perinatal and infant morbidity and mortality. The article describes the approach to PROM pregnancy in the Czech Republic. Key words: PROM – pPROM – premature birth - management
Premature rupture of membranes (PROM) is an importanttopic in perinatology and proper management can affect pregnancy outcome. Incidence of premature rupture of mebranes varies from 4% to 14%. In about 30% to 40% of cases it is a cause of preterm delivery, and therefore it contributes substantially to perinatal and infant mortality and morbidity. This article provides oveview of theoretical knowledge and recommended procedures in pregnancy complicatedby PROM and its management in Czech Republic. Premature (PROM) rupture membranes membranes is often termed with the abbreviation PROM. This term is used by some authors only for the discharge of amniotic fluid after the 37 th pregnancy week finished. When the amniotic fluid drains away before the 37th pregnancy week, this condition is often called pPROM (Preterm Premature Rupture of the Membranes).Epidemiology The incidence of PROM stated in literature oscillated between 4-14% of pregnancies. As for pPROM in the concrete, i.e. premature rupture of membranes before 37 th pregnancy week, the pPROM incidence is stated between 2-3%. 30-40% of premature births start with premature rupture of membranes. The different data are caused primarily by different methods used to diagnose the PROM, bydemographic characteristics of the population researched or by the type of studies. Clinical picture Premature rupture of membranes usually shows in form of continuous light aqueous discharge from the vagina, that can but need not be very abundant. Sometimes blood ribbons
Definition We call premature rupture of membranes the condition when the amniotic fluid drains away spontaneously before thebirth starts, i.e. without presence of uterus contractions. The premature rupture of
Department of Obstetrics and Gynecology, Hospital, a.s., Èeské Budìjovice, 2 University of South Bohemia, Faculty of Health and Social Studies, Èeské Budìjovice, Czech Republic.
Journal of Health Sciences Management and Public Health
can be present in the amniotic fluid draining away. Uteruscontractions are not present. When the amniotic fluid is turbid, rank or bloody, it can signalize a serious associated complication. After the amniotic fluid is drained away, a differently long latent stage comes on, lasting until the start of active birth stage. Contact of the adjacent part of the foetus and the area of the os uteri internal originates. This leads to increase of secretion ofendogenous prostaglandins and, by activation of Frankenhauser ganglion, to Fergusson reflex that provokes increased secretion of oxytocin from hypophysis, and so to uterus contractions. Risk factors Risk factors of premature rupture of membranes include: - Infection of the woman’s genital tract (nonspecific vaginosis, Trichomonas vaginalis, Mycoplasma hominis, Chlamydia trachomatis, Neisseria gonnorhoe,...