Amniotic fluid, popularly called the baby's water, protects the baby from external trauma, ensures easy movement, development of the respiratory system, and keeps it at a constant temperature. The membranes around this fluid, that is, amniotic membranes, protect the baby from microorganisms that can pass up from the vagina and cervix.
Premature rupture of membranes (EMR); It is when the amniotic sac ruptures before birth and the water begins to break. If the amniotic membrane ruptures before the 37th week of pregnancy, it is called premature PROM (PPROM). It is seen in approximately 10% of all pregnancies.
Expectant mothers talk about a fluid suddenly discharged from the vagina. However, this fluid discharge may not always be very noticeable and may come in small amounts intermittently.
Premature rupture of membranes is one of the leading causes of premature birth.
Although the cause is not clearly understood, some infectious agents ( It may play a role in the urinary tract or vagina. Factors such as malnutrition of the mother, low socioeconomic level, direct trauma to the abdomen, smoking, cervical insufficiency, excessive stretching of the uterus (multiple pregnancy or polyhydramnios), placental abnormalities, amniocentesis, stitching of the cervix (cerclage), uterine anomalies are also included in PROM. are among the possible causes of . The risk is also increased in those who have a history of premature water breaking in previous pregnancies.
Expectant mothers generally notice the rupture of the membranes as sudden fluid discharge. In some cases, when the membrane ruptures from the upper parts of the uterus, there may be slight discharge such as a small amount of urine leakage. Diagnosis is made by observing fluid leakage from the cervix during vaginal examination in pregnant women with such complaints.
Risks:
One of the most important risks is the birth of EMR. It is a starter suffix. In most patients, although not always, labor pains begin 24 hours after the waters break. Therefore, breaking of waters may cause premature birth. Premature birth will also cause other problems such as respiratory distress in the baby.
The second important risk is that the fetus and the uterus become vulnerable to infection as the membranes protecting the fetus are ruptured. Infection often does not develop, so the mother is closely monitored and taken to prevent Necessary antibiotics are given. The infection that occurs as a result of EMR is called chorioamnionitis. On the one hand, this infection can spread to the uterus and from there to the blood of the expectant mother, causing serious infections in the mother. On the other hand, it can spread directly to the fetus and the blood of the fetus, causing serious infections in the fetus. Pregnancy is terminated when any infection is confirmed.
In case of sudden and abundant water loss, the cord may prolapse and the cord may become compressed. This is a very urgent situation and may even cause the death of the baby. After the water breaks, the baby's partner (placenta) may experience premature separation (placental abruption).
As the baby's water will decrease due to water breaking, related risks may develop. A baby with low water may develop a number of anomalies and deformities on the face and limbs, and lung development may be delayed.
Diagnosis:
To make the diagnosis of EMR, what the patient explains Apart from the history of water breaking, it is important to see water coming from the cervix during vaginal examination. Apart from this, some tests performed on the fluid seen in the cervix or vagina, such as the Ferning test and the nitrazine test, allow us to understand whether this fluid belongs to the baby. Tests looking for AFP or fetal fibronectin in vaginal fluid can also help in this distinction. Watching the baby's water decrease on ultrasound also supports the diagnosis.
Treatment:
In pregnancies less than 34 weeks, treatments are applied to accelerate the baby's lung maturation and, if the pregnancy condition is suitable, to help the baby mature. It can be waited for a while, but since the baby's lungs are mature in pregnancies over 34 weeks, the risks of water breaking are generally not taken into consideration and birth is aimed. If the pain does not start within 24 hours, antibiotic treatment is started and artificial pain is given to initiate labor.
The most important element in the treatment is the prevention of infection with antibiotics.
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