EARLY RUPTURE OF PREGNANCY MEMBRANES (water bladder)

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If the pregnancy has completed its 37th week, it is called full-term. 24.-37. Pregnancies between weeks are called premature. Rupture of the gestational membranes after the 37th week of pregnancy, but before labor pains begin, is called 'premature rupture of the gestational membranes', and rupture of the gestational membranes before the 37th week of gestation, before labor pains begin, is called 'early rupture in immature pregnancy'. Premature tearing before the 37th week of pregnancy usually does not cause a problem as the baby has completed his term. However, if the membranes rupture early in a pregnancy that has not completed its full term, serious risks may arise due to the small size of the baby.

What is the incidence?

While premature rupture of the membranes is seen in 5-10% of pregnancies, premature rupture in preterm pregnancies is seen in approximately 1% of pregnancies. The biggest risk that may occur as a result of early rupture of the gestational membranes is the infection that may develop in both the membranes and the baby.

What are the main risk factors?

Lower genital tract infections, maternal nutritional disorders, smokingBleeding in early pregnancy, cervical insufficiency, and the mother's previous premature birth can be considered as the main risk factors.

How is the diagnosis made?

The pregnant woman spontaneously states that something liquid flows down her legs and her underwear becomes wet. The most common urinary incontinence can be confused with normal pregnancy discharge and discharge due to infections in the lower genital tract. During the examination, seeing clear fluid coming from the cervix and detecting that the pregnancy fluid has decreased on ultrasonography, makes the diagnosis. If diagnosis cannot be made with these methods, special tests that detect pregnancy fluid (color change of nitrazine paper, amniosure test, etc.) can be used.

How should follow-up and treatment be?

Since the most important risk in these patients is infection, examinations must be performed very meticulously. In order to diagnose the infection that may develop early, some tests should be taken (complete blood count, sedimentation, CRP) and fever should be monitored. If the birth time will be prolonged, an appropriate antibiotic should be started for preventive purposes. Patients were grouped according to their gestational weeks follow-up and their treatments should be planned.

a. Pregnancies that have completed the 37th week of pregnancy: In this case, physicians may take two different approaches. If the cervix is ​​suitable for birth, birth can be achieved immediately by giving artificial pain. Some physicians prefer to wait up to 3 days for labor pains to start spontaneously.

b. 34.-37. Pregnancies between the 34th and XNUMXnd weeks of pregnancy: In pregnancies that have completed the XNUMXth week of pregnancy, there is no need for an approach that will require a long wait, as the baby's chance of survival is very high. It is generally preferred for these pregnant women to be delivered within a few days.

c. 32.-34. Pregnancies between XNUMX weeks and XNUMX weeks: In addition to the risk of infection in these babies, there are risks of respiratory distress, intestinal infection (necrotizing enterocolitis) and brain hemorrhage. To contribute to the baby's lung development, some medications (steroids) may be administered to the mother and she may be kept under close monitoring for a while. Antibiotics are given to the mother during follow-up. This waiting period will increase the baby's chance of survival after birth and reduce the risks mentioned above.

D. Pregnancies under 32 weeks: If the baby in the womb continues to grow and is not in any distress, and if all the pregnancy fluid has not been discharged, the pregnancy is tried to be continued as late as possible until the next gestational week, by close monitoring under hospital conditions.