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PROM – DEFINITION, SIGNS, AND CHANCES OF SURVIVAL BABY BORN AT 23 WEEKS GESTATION DUE TO PROM

DEFINITION

Premature rupture of membranes (PROM), or pre-labor rupture of membranes, is a condition that can occur during pregnancy. It is defined as ruptures of membranes (breakage of the amniotic sac, more than 1 hour before the onset of labor. The sac (consisting of 2 membranes, the chorion, and amnion) contains amniotic fluid, which surrounds and protects the fetus in the womb. After rupture, the amniotic fluid leaks out of the uterus, through the vagina.

Women with PROM usually experience a painless gush of fluid leaking out from the vagina, but sometimes a slow steady leakage occurs instead.

When premature rupture of membranes occurs at or after 37 weeks’ completed gestational age (full-term or term), there is minimal risk to the fetus and labor typically starts soon after.

If rupture occurs before 37 weeks, it is called preterm premature rupture of membranes (PPROM), and the fetus and mother are at greater risk for complications. PPROM causes one-third of all preterm births, and babies born preterm (before 37 weeks) can suffer from the complications of prematurity, including death.

SIGNS

The main symptom of PROM is fluid leaking from the vagina. It may be a sudden, large gush or fluid, or it may be a slow, constant trickle of fluid. The complications that may follow PROM include premature labor and delivery of the fetus, infections of the mother and/or the fetus, and compression of the umbilical cord (leading to oxygen deprivation in the fetus).

CHANCES OF SURVIVAL BABY BORN AT 23 WEEKS GESTATION DUE TO PROM

Increased gestational age at ROM (rupture of membrane) is associated with advanced age at delivery. However, 60% of surviving infants between 21-26 weeks had serious complications, such as chronic pulmonary disease or retinopathy.

Recent advances in obstetric care have included the use of antepartum antibiotics, which may prolong latency to delivery in pregnancies with PPROM. Concurrent developments in perinatal care have included administration of antenatal corticosteroids and use of surfactant in premature infants, which have contributed to decreasing the gestational age limit of viability and improving outcomes in premature infants. Since the mid-1980 s, there has been a concomitant trend toward consideration of conservative management in early PROM patients. 

In 2017, a review of watchful waiting vs the early birth strategy was conducted to ascertain which was associated with a lower overall risk. “Cochrane Pregnancy and Childbirth’s Trials Register”, concluded that “In women with PROM before 37 weeks’ gestation with no contraindications to continuing the pregnancy, a policy of expectant management with careful monitoring was associated with better outcomes for the mother and baby”. There is believed to be a correlation between volume of amniotic fluid retained and neonatal outcomes before 26 weeks’ gestation. Amniotic fluid levels are an important consideration when debating expectant management vs clinical intervention. Additionally, labor and infection are less likely to occur when there are sufficient levels of amniotic fluid remaining in the uterus.

SOURCES

https://en.wikipedia.org/wiki/Premature_rupture_of_membranes

https://medical-dictionary.thefreedictionary.com/PROM+(medical)

https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/premature-rupture-of-membranes-prom

https://www.nature.com/articles/7211163

 

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