Membrane rupture time

It is not good if the amniotic membrane ruptures too early or too late, as it may cause the birth of a premature baby. Generally speaking, premature babies are more difficult to survive than ordinary fetuses. Therefore, try not to let this happen to you, otherwise you can only rely on oxygen supply to maintain the life of the fetus. In addition, sometimes when the cervix itself is traumatized, it will also cause the amniotic membrane to rupture.

Rupture of membranes is one of the important causes of premature birth and neonatal complications, and the fetus often needs to be sent to the NICU (neonatal intensive care unit) for monitoring. Misdiagnosis of PROM may result in the failure of obstetrics to take early measures and may lead to dangerous conditions such as infection, premature delivery, fetal distress, umbilical cord prolapse and placental abruption. [1]

Trauma; relaxation of the internal cervical os; mechanical stimulation or membrane inflammation caused by sexual intercourse in late pregnancy; lower genital tract infection, which may be caused by bacteria, viruses or Toxoplasma; increased pressure in the amniotic cavity (such as multiple pregnancy, polyhydramnios); failure of the fetal presenting part to connect well with the pelvic entrance (such as cephalopelvic disproportion, abnormal fetal position, etc.); poor development of the fetal membrane to the point of being thin and fragile, etc.

When abdominal pressure increases, such as by coughing, snoring, or weight bearing, the amniotic fluid will flow out. During rectal examination, if an increase in the amount of fluid flowing out is seen when the fetal presenting part is pushed up, the diagnosis can be confirmed.

1. Vaginal fluid pH test: Normally the pH value of vaginal fluid is 4.5-5.5, the pH value of amniotic fluid is 7.0-7.5, and the pH value of urine is 5.5-6.5. When tested with nitrazine paper, vaginal fluid is alkaline, and a pH value of ≥7.0 is considered positive, tending to be amniotic fluid, and the possibility of premature rupture of membranes is very high.

2. Vaginal fluid smear examination: If fern-like crystals appear on the dried vaginal fluid smear, it is amniotic fluid. When the smear is stained with 0.5‰ methylene blue, light yellow or unstained fetal skin epithelium and vellus hair can be seen; when stained with Sudan III, orange-yellow fat granules can be seen, and when stained with 0.5% Nile blue sulfate, yellowish fetal epithelial cells can be seen. The result is more reliable than measuring the pH value with test paper and can be confirmed as amniotic fluid.

3. Amnioscopic examination allows direct visualization of the fetal presenting part, and if the anterior amniotic sac is not visible, the diagnosis can be confirmed.

Actively prevent and treat lower reproductive tract infections, pay attention to hygiene guidance during pregnancy; prohibit sexual intercourse in the late pregnancy; avoid weight bearing and abdominal impact; those with loose cervical os should rest in bed, and perform cervical cerclage at around 14 weeks of pregnancy, and the cerclage site should be as close to the level of the internal cervical os as possible. Regarding whether antibiotics should be given prophylactically after rupture of membranes, most scholars believe that preventive medication has little effect on reducing maternal morbidity and does not reduce perinatal morbidity and mortality. In addition, antibiotics can pass through the placenta and make the newborn resistant to drugs in the future, so active treatment after delivery is advocated. Better than prophylactic antibiotics.