Premature rupture of membranes

Definition
Premature rupture of membranes (PROM) is defined as the membranes rupture prematurely gave birth. This can occur in late pregnancy or childbirth long before his time. KPD KPD preterm is before 37 weeks gestation. KPD KPD stretching is occurring more than 12 hours of giving birth prematurely.
KPD incidence ranging 5-10% of all births, and preterm PROM occurs in about 1% of all pregnancies. KPD 70% of cases occur in term pregnancies. KPD is a cause of premature births by 30%.

Figure 1. Broken membranes
Cause
In most cases, the cause has not been found. Mentioned factors have a connection with the KPD history of preterm birth, smoking, and bleeding during pregnancy. Some risk factors of the KPD:

   1. Cervical incompetence (cervical)
   2. Polyhydramnios (excess amniotic fluid)
   3. KPD history of previous
   4. Abnormality or damage to membranes
   5. Twin pregnancy
   6. Trauma
   7. Cervix (cervical) are short (<25mm) at 23 weeks gestation
   8. Infections such as bacterial vaginosis in pregnancy

Figure 2. Rahim cervical incompetence
Signs and Symptoms
Signs that happens is the amniotic fluid seeps out through the vagina. The smell of sweet-smelling amniotic fluid and do not like the smell of ammonia, the liquid may still seeping or dripping, with a characteristic pale colors and stripes of blood. This fluid will not stop or dry as it continues to be produced until the birth. But when you sit or stand, head of the fetus which is usually located under the "prop" or "clogging" leak for a while.
Fever, vaginal spotting a lot, abdominal pain, increased fetal heart rate quickly is a sign of infection occurs.
Investigations
Direct examination of the fluid that seeps can be done with nitrazine paper, this paper measures the pH (acid-base). normal pH of the vagina is 4 to 4.7 while the pH of amniotic fluid is 7.1 to 7.3. The test can have false positive results if there is involvement of trichomonas, blood, semen, cervical mucus, and urine. Examination by ultrasonography (USG) can be used to confirm the amount of amniotic fluid contained in the womb.
Complications KPD
Complications most often occurs in the KPD before 37 weeks' gestation is respiratory distress syndrome, which occurs in 10-40% of newborns. The risk of infection increases the incidence of KPD. All pregnant women with preterm PROM should be evaluated for possible occurrence of chorioamnionitis (inflammation of the chorion and amnion). Besides events umbilical cord prolapse or discharge may occur in the KPD.
The risk of disability and increased fetal mortality in preterm PROM. Pulmonary hypoplasia is a fatal complication that occurs in preterm PROM. It happened nearly 100% when preterm PROM occurs at gestational age less than 23 weeks.
Figure 3. Rope discharge Navel
Handling Membranes in Glass Houses

   1. If there is seepage or flow of fluid from the vagina, immediately contact your doctor or health care workers and be prepared to go to the Hospital
   2. Use sanitary napkins (not tampons) for absorption of water coming out
   3. Vaginal area should be as clean as possible to prevent infection, do not sexual intercourse or bath
   4. Always clean from front to back to avoid infection from the rectum
   5. Do not attempt to perform the checks in his own

Therapy
In the event of rupture of membranes, then immediately go to the hospital. The obstetrician will discuss the treatment plan that will be done, and it depends on how gestational age and signs of infection occur. The risk of preterm birth is the second biggest risk of infection due to premature rupture of membranes. Examination of the fetal lung maturity should be performed primarily at 32-34 weeks of gestation. The end result of the ability of the fetus to live very decisive steps to be taken.
Contractions will occur within 24 hours after rupture of membranes if pregnancy has entered the final phase. The more premature rupture of membranes occurred then the longer the distance between the rupture of the membranes with contractions. If the actual date of delivery has not arrived, the doctor usually will induce labor with oxytocin (stimulating contraction) in 6 to 24 hours after rupture of membranes. But if it had entered the date of delivery doctor will not wait that long to give the induction of the mother, due to delayed induction may increase the risk of infection.
If the baby's lungs are immature and there is no incidence of infection after KPD, then rest and delay birth (if not yet time to give birth) using magnesium sulfate and tocolytic drugs. If the fetal lung is mature or have an infection after the KPD, the induction to delivery may be needed.
Use of steroids for fetal lung maturation is still a controversy in the KPD. Recent research found the advantages as well as the absence of increased risk of infection in the mother and fetus. Steroids are useful for mature fetal lung, reducing the risk of respiratory distress syndrome in the fetus, as well as bleeding in the brain.
The use of antibiotics in the case of KPD has two reasons. The first is the use of antibiotics to prevent infection after the occurrence of preterm PROM. And the second is based on the hypothesis that KPD can be caused by infection and preterm KPD vice versa can cause infection. The advantages obtained in pregnant women with PROM who received an antibiotic that is, the birth process is slowed up to 7 days, reduced the incidence of chorioamnionitis and neonatal sepsis (infection in the newborn).
Prevention
Some precautions can be done but no one has proven quite effective. Reduced activity or rest at the end of the second quarter or early third trimester is recommended.