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Spontaneous Rupture of Membranes

Pre-Labour Rupture of Membranes: Pathogenesis and clinical findings Gestational age approaching term (>37 weeks) Authors: Wendy Xu Reviewers: Riya Prajapati Michelle J. Chen Dr. Jadine Paw* * MD at time of publication Intrauterine inflammation Fetal maturation Fetal growth Uterine contractions ↑ Pro-inflammatory cytokine & chemokine release in fetal membranes & amniotic fluid ↑ Stretch forces on fetal membranes ↑ Pro-apoptotic factors induces cellular apoptosis of fetal membranes Changes in collagen and protein composition drive extracellular matrix remodeling in fetal membranes ↓ Tensile strength Structural weakening of fetal membranes Occurs primarily in the focal area of fetal membranes overlying the cervix ↑ Matrix metalloproteinases triggers extracellular matrix degradation in fetal membranes Amnion and choriodecidua separation Amniotic fluid flows from vagina Amniotic fluid pools in posterior fornix on speculum exam Pre-labour rupture of membranes Membranes rupture before onset of uterine contractions Chorioamnionitis (infection of the fetal membranes and amniotic fluid) Neonatal infection Endometritis (infection of the endometrium) Amniotic fluid leaks through the cervix Prolonged rupture of membranes (>18hrs) before delivery Microbes ascend through vaginal canal Low amniotic fluid volume on ultrasound Amniotic fluid (pH 7.0-7.5) mixes with normal vaginal fluid (pH 4.5-6.0) which increases vaginal fluid pH to > 6.5 Positive nitrazine (pH indicator) test Ion- and estrogen-containing amniotic fluid enters vaginal canal Ferning (branching pattern) of vaginal fluid under microscope Accompanies uterine contractions, cervical effacement & cervical dilation Delivery/birth Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Oct 4, 2024 on www.thecalgaryguide.com