Definition of "Rupture of membranes"

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Rupture of membranes (ROM, aka amniorrhexis, water breaking) is a rupture of the amniotic sac, releasing amniotic fluid (aka waters, Latin liquor amnii).

Patient information

What does it mean that your waters break? Is that the same thing as giving birth?
Not really. Childbirth requires there to be contractions, as well as opening up of the cervix. These things are required for the baby to pop out. You need to have something to push it. And you need to have a hole for it to pop out of. But waters breaking is one of the things which can help stimulate contractions. So it's sort of part of the "giving birth" process.

Physiology
  • When the amniotic sac ruptures, production of prostaglandins increases, and the cushioning between the fetus and uterus is decreased, both of which increase the frequency and intensity of contractions

Patient information

How does breaking of waters, cause contraction?
When the amniotic sac ruptures, prostaglandins are produced. Also, the amniotic fluid acts as a cushion between the fetus and uterus, so with that gone now, there's more pressure on the uterus, which increases both frequency and intensity of contractions.

Wait... can't prostaglandins be used to induce labor? PGE1 and PGF2alpha, right? They are the alternatives to synto, right?
That's correct! You're talking about the drugs. That's artificial. We're talking about the natural stuff your body produces here though. But you're right ! It's all the same game.

Complications
  • Cord prolapse, particularly if the head is not engaged, the umbilical cord may prolapse. It is an obstetric emergency, as the decsending head may block fetal-placental circulation
  • Amnionitis and fetal infection, as once the membranes are ruptured, bacteria may ascend
Types
  • SROM (Spontaneous rupture of membranes), which is normal spontaneous rupture of membranes at full term, either during or at the beginning of labor. The rupture is usually at the bottom of the uterus, over the cervix, causing a gush of fluid, which may be as small as 50mL, or as large as 300mL, depending on the amount of fluid in the amniotic sac, and the extent the fetal head is plugging the hole and retaining fluid in the sac
  • PROM (premature rupture), PPROM (premature and preterm rupture)
  • ARM (artificial rupture)
Ix
  • Confirm amniotic fluid, with vaginal exam, followed by:
    • Pooling test, which is where a collection of amniotic fluid is seen in the back of the vagina, sometimes with leakage seen when the Pt coughs or does the valsalva maneuver
    • Nitrazine [paper] test, which is where a cotton swab is used to collect fluid from the vagina, and placed on nitrazine (phenaphthazine) paper. Amniotic fluid is mildly basic (pH 7.1-7.3) compared ot normal vaginal secretions which are acidic (pH 4.5-6). Therefore, amniotic fluid (basic) will tunr nitrzine paper form orange to dark blue
    • Fern test, which is where a cotton swab is used to collect fluid from the vagina, which is viewed on microscopy. After drying, amniotic fluid will form a crystallization pattern, resembling leaves of a fern plant under microscopy
See also

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Definition of Rupture of membranes | Autoprac


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