How to prevent and treat premature rupture of membranes

The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Obstetrics & Gynecology - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital

Premature rupture of membranes is the rupture of the amniotic sac after or at the same time as labor, before the cervix is ​​fully dilated.
Premature rupture of membranes is a spontaneous rupture of the membranes and chorion at any point prior to labor.
Amniotic fluid is produced continuously until the 16th week of pregnancy, after the 16th week, the amount of amniotic fluid largely depends on the amount of urine and fetal lung fluid produced. The role of amniotic fluid in pregnancy:
Amniotic fluid helps the fetus avoid compression of the umbilical cord, infections and possible injuries when the baby is still in the womb. The right amount of amniotic fluid helps the baby move better while in the mother's womb. Amniotic fluid also plays a very important role in breathing, the balanced development of the limbs, thorax and especially the lungs of the fetus.

Causes of premature rupture of membranes in pregnant women:
Women have lower genital tract infections such as vaginitis, vulvovaginitis, cervicitis,... Sexually transmitted diseases such as syphilis, gonorrhea, genital herpes ... are also the main causes of premature rupture of membranes in pregnancy. Premature rupture of membranes can occur if the fetus is abnormal, transverse, breech, placenta previa, polyhydramnios, multiple pregnancies, and narrow pelvis of the pregnant woman. Maternal smoking during pregnancy is also a risk factor for rupture of membranes in pregnancy, the rate of premature rupture of membranes is twice as high as that of pregnant women who do not smoke. Some other causes of premature rupture of membranes during pregnancy include a short cervix of less than 35 cm, a cleft palate, poor maternal nutritional status, poor nutrition, etc.

Premature birth is a common consequence when pregnant women have premature rupture of membranes, it causes babies to be underweight, susceptible to some respiratory diseases such as pneumonia, bronchitis or some birth defects such as blindness, deaf, mute,...
Early rupture of membranes causes a series of complications for the fetus such as:
Amniotic fluid infection, fetal infection or sepsis,... Children with respiratory distress syndrome, hemorrhage ventricles, thrombocytopenia bleeding, intestinal necrosis,... There are abnormalities in motor and nerve function in the fetus when the mother has premature rupture of membranes.

4.1 From the 22nd to the 31st week of pregnancy: Pregnant women need to try to maintain the pregnancy During the nursing process, the doctor can prescribe the drug to mature the fetal lung by injecting Betamethasone 12mg/24 hours x2 days or Dexamethasone 6mg/12 hours x 2 days, however, this drug can cause weight loss, head circumference and body length of the fetus if used more than 2 times. Managing Infections Infection is one of the main causes of premature rupture of membranes. Therefore, during this period, it is necessary to strictly control the problem of infection for pregnant women by:
During gynecological examination, it is necessary to use speculum clamps, avoid using hands to examine except in special cases. Cervical, vaginal and anal cultures for pregnant women. Vaginal cultures 1-3 times/week. Indication of broad-spectrum antibiotics to prevent infection for both pregnant women and fetuses. Broad-spectrum antibiotics also help reduce the rate of early labor, prolong pregnancy for pregnant women with premature rupture of membranes to stimulate fetal lung maturity. However, antibiotics should not be used for more than 7 days because prolonged use of antibiotics can increase the resistance of bacteria. Pregnant women need to rest, during pregnancy need to monitor vital signs 4 times/day, blood count, white blood cell count, CRP . Regularly monitor the fetus by ultrasound assessment of the fetus, placenta and amniotic fluid, perform obstetric monitoring 3 times/day. Administer spasmolytics when necessary.

4.2 Pregnancy 32 - 33 weeks In this stage, it is necessary to conduct:
Monitor fetal heart rate, check the development of the fetus in the uterus. Indication of a group of corticosteroids to stimulate the maturation of the fetal lungs. Good control of infection for pregnant women When there is enough evidence of lung maturity, infection, fetal distress, it is necessary to initiate labor. 4.3 Pregnancy 34 - 36 weeks During this period, corticosteroids are not recommended. Within 24 hours of your water breaking, most women will go into labor spontaneously. Premature rupture of membranes: Increases the risk of uterine infection, peritonitis, oligohydramnios, limb deformity, placental abruption, fetal distress or oliguria if the pregnancy is prolonged. Induction of labor, termination of pregnancy immediately if there is sufficient evidence of fetal lung maturity. If the decision is made to keep the pregnancy, it is important to manage the infection problem well. Indication of spasmolytic drugs when necessary, note that this drug should not be prescribed for pregnancy greater than 36 weeks. 4.4 Pregnancy > 37 weeks Carrying out pregnancy termination for fetuses older than 37 weeks with premature rupture of membranes, note that it should not wait for 12 to 24 weeks to minimize possible complications for both mother and fetus.
The termination of pregnancy depends on the condition of the cervix, the position of the fetus, the status of the fetus and the presence of an infection, conduct:
Caesarean section if abnormal position is detected or there is evidence that The fetus cannot tolerate labor Give antibiotics to induce labor immediately for clinical infections and no contraindications for vaginal delivery. Induction of labor by infusion of oxytocin if the cervix is ​​favorable. In case the cervix is ​​not favorable, it is necessary to ripen the cervix.

Prevention is the best measure to help reduce the risk of rupture of membranes for pregnant women. Prevent premature rupture of membranes by:
Well control and treat vaginal infections, cervicitis before and during pregnancy. During pregnancy, pregnant women need to have a reasonable diet and rest, supplement with adequate nutrients, and should not smoke. It is necessary to transfer pregnant women to a level with a low birth weight preterm infant care unit for special care and monitoring. Induction of labor at the right time, neither too early nor too late. Use broad-spectrum antibiotics under the guidance of medical staff, do not arbitrarily buy drugs without a doctor's prescription. Vinmec International General Hospital offers a Package Maternity Care Program for pregnant women right from the first months of pregnancy with a full range of antenatal check-ups, periodical 3D and 4D ultrasounds and other routine tests to ensure that the mother is healthy and the fetus is developing comprehensively.
Pregnant women will be consulted and checked for health under the close supervision of experienced and specialized Obstetricians, helping mothers have more knowledge to protect their health during pregnancy as well as reduce reduce complications for mother and child.