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What are the risks of
premature rupture of membranes
in pregnancy?
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To address this issue is
essential a division of the different
periods of gestation, which can
calculate the risks of the decision
taken in terms of weeks of gestation of
the patient.
The preterm period is too long and in
which the prognosis is very different
depending on whether a pregnancy of 26
or 27 weeks that one of 35 or 36 weeks.
The frequency of premature rupture of
membranes (PROM) in pregnancy is very
variable (4-25%), although most studies
place it between 6 and 12%.
Approximately one third of preterm
deliveries are due to the RPM with what
frequency ranges from 2 to 3%, this low
frequency should not make us unconcerned
that is responsible for 10% of perinatal
mortality mainly as great cause of
prematurity.
The RPM is a risk in any period of
pregnancy to occur. First there is the
risk of infection by contamination from
the vagina, although it is believed that
a rate of thirty percent infection
existed before the RPM and is therefore
because of this, more so in the absence
of clinical symptoms of infection, if
the risk of infection inside the uterus
represents a risk to the mother if not
treated properly. Also for the fetuses
is of great severity and should be
treated according to the time of
pregnancy, taking into account that it
is more dangerous, if prolongation of
pregnancy or the risk of infection.
There is a risk of increased operations,
starting with inductions in poor
condition and obstetric interventions to
address anesthesia and its associated
complications.
A significant risk to the fetus's
gestational age at PROM occurs,
prematurity leads to respiratory
complications, infectious, ventricular
hemorrhage of the brain, intestinal
necrosis, retrolental fibrodysplasia
(damage of vision)
The lack of fluid caused by the RPM
anmiótico can lead to fetal hypoxia
(lack of oxygen) by umbilical cord
compression, fetal deformities,
pulmonary pseudohipoplasia latter is
highly associated with fetal death if
the fetus is 26 weeks gestation or less.
We also saw the presentation of abruptio
placenta represents an extremely high
risk for both mother and fetus,
increased cord prolapse (umbilical cord
exit before the fetus)
The infection of the uterus during
pregnancy (corioanmionitis = fever,
uterine tenderness, foul smelling liquid
anmiótico, elevated white blood cells),
does not usually occur without premature
rupture of membranes (PROM), but even in
the absence of these signs, some
patients tend to have positive cultures
of fluid anmiótico.
Both these germs that operate within the
uterine cavity and fluid anmiótico as
those found in the vagina, by the action
of certain enzymes, could weaken the
membranes, as well as prostaglandin
production during this process would
lead to the weakening of the membranes
and uterine contractions that increase
pressure inside the uterus, promoting
the breakdown of them.
In the RPM before term
there is the option to remove the fetus
or attempt to prolong pregnancy,
provided no signs of infection occur in
utero or fetal distress. In the presence
of risk of illness or fetal mortality is
not very convenient to extract fetuses
under 31 weeks, but seem to have lung
maturity. From this gestational age, if
it is found that the fetus has mature
lungs and will weigh between 1,500 and
2,500 grams extract would be less risky
to wait for spontaneous onset of labor.
The use of corticosteroids to accelerate
lung maturity is indicated, because if
it is true that the fact that RPM, in
itself, and mature the fetal lung, the
corticosteroid is increasing fetal lung
maturity and decrease the frequency of
cerebral hemorrhages intestinal necrosis
and premature fetus
Antibiotics are indicated and
eliminating any infection process of the
mother and fetus and thus prolongs the
gestation
The RPM is a risk of maternal-fetal and
fetal distress in all groups.
From week 31 to 32, the risk of
prolonging pregnancy is higher,
especially if it is established fetal
lung maturity, which are useful for
steroids and antibiotics.
tc. have been associated with outbreaks
of P.P.
