Common Obstetric Problems

Premature rupture of the membranes (PROM)
The membranes around the baby provide protection during pregnancy and the early stages of labour. In about 2% of women the membranes will rupture early. Sometimes the membranes rupture because there is infection, but often there is no obvious reason for this. As with preterm labour (see above), the earlier the membranes rupture the greater the risk to the mother and baby. If the membranes rupture before 20 weeks, the chances of survival are very poor, as the fetus needs fluid around its lungs at this stage for proper development. After 20 weeks, the chances of normal lung development in the presence of PROM improve, but are at best 50:50 until after 24 weeks. The other problem with PROM is that the fetus has nowhere to move its body and develop its limbs. Finally PROM usually results in preterm delivery, which carries its own risks (see above). If there is evidence of womb infection with PROM, it is imperative that the fetus is delivered as soon as possible, because of the risk of chorioamnionitis (see Infection).

Haemorrhage
Haemorrhage (bleeding) remains a very serious complication of pregnancy, accounting for a third of maternal deaths in childbirth around the world. (continued next page)