{"id":15827,"date":"2022-10-07T11:22:18","date_gmt":"2022-10-07T16:22:18","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=15827"},"modified":"2024-12-20T14:39:25","modified_gmt":"2024-12-20T20:39:25","slug":"rupture-prematuree-des-membranes-pprom","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/preterm-premature-rupture-of-membranes-pprom\/","title":{"rendered":"Rupture pr\u00e9matur\u00e9e des membranes (RPM) : Que se passe-t-il lorsque vous perdez les eaux trop t\u00f4t ?\u00a0"},"content":{"rendered":"\n

Given the recent overturn of Roe v Wade<\/em> and the frightening headlines<\/a> that have followed, now more than ever, American women are questioning the medical care and information they receive during pregnancy. Many pregnant women have heard or read that they won\u2019t be able to receive proper medical care if they have a miscarriage (we addressed this misconception here<\/a>), or an ectopic pregnancy<\/a>, or if they develop an infection if their water breaks too early. Today, we are going to discuss premature rupture of the fetal amniotic sac of membranes (commonly known as having your water break too early), and the truth about whether pregnant women can still receive the treatment they need if this happens, even in a post-Roe <\/em>America. <\/p>\n\n\n\n

Normally, a woman\u2019s water breaks during<\/em> labor<\/h2>\n\n\n\n

Most of the time, a pregnant woman\u2019s bag of water will break during labor. The American College of Obstetricians and Gynecologists (ACOG) notes<\/a> that about 8% of the time, women who are 37 weeks pregnant or beyond will have their water break before<\/em> they go into labor, and this is known as premature or prelabor rupture of membranes (PROM). In these circumstances, labor usually starts on its own within 24 hours. A woman whose water breaks but then does not<\/em> go into labor spontaneously within 24 hours may be recommended for induction by her doctor, due to the risk of developing an infection when the baby\u2019s infection-prevention \u201cbubble\u201d has essentially popped. <\/p>\n\n\n\n

But some women will experience their water breaking before (even long before) 37 weeks (which is when the baby is considered \u201cearly term,\u201d and ready to be born). This situation is called preterm premature rupture of membranes (PPROM), and it affects thousands of women each year. PPROM is a concern primarily because, like I wrote above, labor typically soon follows. In fact, more than half of women experiencing PPROM will go into labor within one week of the event. This is a medically challenging situation because a baby born too early has a higher risk of death, and is prone to potentially life-long health problems. Fortunately, thanks to modern advancements in medicine, even extremely premature babies have a chance at life, and many can lead healthy lives<\/a> despite very rocky beginnings [1].   <\/p>\n\n\n\n

How long after PPROM will labor start?<\/span><\/h2>\n\n\n\n

While old studies with small sample sizes consistently found that more than half of women went into labor within one week of PPROM, the length of time between membrane rupture and labor is inversely correlated with how early membrane rupture occurred, according to ACOG\u2019s guidelines [2]. This means that the earlier a woman\u2019s water breaks, the longer it may be before she goes into labor. The further along she is in her pregnancy, the shorter the time frame may be between her water breaking and labor beginning. <\/p>\n\n\n\n

Sometimes women whose waters break before 24 weeks may carry their babies for an additional two to five weeks, and others may go even longer. One study of 174 babies found<\/a> that half of women who had membrane rupture before 24 weeks carried their babies for at least 6 additional weeks, with one woman staying pregnant for an additional 17 weeks and her baby surviving until hospital discharge (the end of the study timeframe) [2]. The PPROM Foundation<\/a> notes that gestational age at birth, not at the time that PPROM occurred, is \u201cthe key predictor of survival.\u201d <\/p>\n\n\n\n

What are your treatment options with PPROM? <\/h2>\n\n\n\n

The American College of Obstetricians and Gynecologists has a set of clinical guidelines<\/a> that physicians can follow when this complication arises. The two options for treatment are expectant management or labor induction (early birth). The type of medical care ACOG recommends depends largely on gestational age, though other complications must be considered too. Generally, the later PPROM happens during pregnancy, the better the outcome, because the unborn baby has had more time to develop in the womb.<\/p>\n\n\n\n

Expectant management involves monitoring the health of the mother and her unborn baby at home or, as is often the case, in a hospital setting. There, she may receive medications such as antibiotics to ward off infection, or corticosteroid injections to help her preborn baby\u2019s lungs mature more quickly. The goal with expectant management is to allow babies more time in the womb, while balancing any risks (like life-threatening infection) posed to mothers. If any additional complications arise, induction is typically recommended to preserve the life of the mother.  <\/p>\n\n\n\n

Expectant management often a superior option for PPROM between 24 and 37 weeks gestation, study finds<\/h2>\n\n\n\n

For pregnant women who experience PPROM between 24 and 37 weeks without any additional complications, expectant management was linked to better outcomes for mother and baby compared with immediately inducing labor, as found<\/a> by a 2017 meta-analysis [3]. This type of study combines data from multiple studies to detect an effect (which can be tricky to identify in individual research studies if you\u2019re studying a rare complication) and is considered the strongest level of scientific evidence. The results were published in Cochrane Database of Systematic Reviews<\/em>, a prestigious and respected journal. <\/p>\n\n\n\n

The researchers reached this conclusion by analyzing the outcomes for mothers and babies from 12 clinical trials, 7 of which were done in the United States. The trials collectively included 3,617 pregnant women who had membrane rupture between 24 weeks and 37 weeks gestation. Women were randomly assigned treatment with either early birth by inducing labor, or expectant management.  <\/p>\n\n\n\n

24 weeks was the gestational age cutoff for the studies because babies have long been considered viable, or able to survive outside of the womb, starting at 24 weeks. Some consider viability to start sooner, around 22 or 23 weeks, given that babies born at that age have survived<\/a> (the world\u2019s most premature baby<\/a> was born in 2020 at just 21 weeks and 1 day). <\/p>\n\n\n\n

All but one measured health outcome was better in expectant management vs. early birth group<\/span><\/h3>\n\n\n\n

The researchers found that, compared with immediate birth via induction, when mothers with PPROM were expectantly managed: <\/p>\n\n\n\n

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