The membranes rupture before 37 weeks in 2% of pregnancies - this is called preterm premature rupture of membranes or PPROM. Forty percent of premature deliveries are complicated by PPROM. I understand just how devastating it can be as I ruptured my membranes at 22 1/2 weeks.
The major concern with PPROM is infection, as the protective barrier between baby and all the bacteria in the outside world is lost. This is a big issue because not only does infection trigger labor, but infection is also a major cause of death among premature babies and increases the risk of very serious long-term complications, such as chronic lung disease and cerebral palsy. Premature babies with an infection can get very sick, very quickly.
With PPROM before 32 weeks the risks of prematurity are so great that antibiotics are administered for a week to prevent infection in the hopes of buying more precious time. There is good data to support this course of action. However, for women who rupture their membranes after 32 weeks the recommended timing of delivery has been controversial. Is it better to give antibiotics and sit tight, monitoring closely for infection, or is the risk of infection just too great compared with the risks of prematurity and should labor be induced. And if labor should be induced, what is the best time?
A recent study aims to answer that question. Investigators at the University of Connecticut looked the all the records of women with PPROM between 32 and 36 6/7 weeks and their babies (excluding twins, triplets etc.). What they found was the closer babies got to 35 weeks, the better they did. Babies born at 34 weeks after PPROM spent an average of 14.8 days in the neonatal intensive care unit (NICU) and babies born at 35 weeks spent an average of 4.5 days in the NICU. After 35 weeks there was a small increase in the risk of stillbirth.
So if you have PPROM, the first step is to rule out infection (because then you definitely need to be delivered), get swabbed for group B strep, and give antibiotics for a week to try and prolong the pregnancy. If you develop and infection, you need to be delivered. However, if you are lucky to get to 35 weeks, the risks to staying pregnant with PPROM start to out weigh the risks of prematurity and inducing labor is probably the best option. It’s comforting to know that the average NICU stay in this scenario is 4.5 days.
Remember, this column is not individual medical advice