If you are experiencing PPROM, you and your doctor must work together to answer the question, Is it better to deliver the baby early or try to prolong the pregnancy? The first step in answering this question is evaluation by your obstetrician.
During this evaluation, your doctor performs a vaginal exam to:
- Verify that your membranes are ruptured. When your vagina is held open by a speculum, your doctor can see if amniotic fluid is leaking from the cervical os (the mouth of the uterus that opens into the vagina). If no fluid can be seen, diagnostic tests such as a pH test or Nitrazine test can help determine if the membrane has ruptured. Your doctor avoids performing a digital exam (that is, with her hands) to check for fluid leaving the os because of the risk of infection. If a digital exam is not performed and a speculum exam is performed only once, the chance of infection is low.
- Collect amniotic fluid to test your baby's lung maturity.This fluid can be collected from the vagina during the speculum exam or by amniocentesis.
- Determine whether labor has begun. Viewing the cervix with the speculum can help your doctor determine whether the cervix has begun to dilate-and, if so, how much. Dilation indicates that labor has begun and the degree of dilation indicates how far the labor has progressed.
If labor has begun, your doctor will monitor you for contractions. At most hospitals, your care providers will monitor your contractions and the baby's heart rate by placing two electronic monitors on your abdomen: one assesses your baby's heart rate and the other records the frequency, intensity, and duration of your contractions. Your nurse or doctor can also place a hand on your belly (over the uterus) to feel for the length of the contractions and the firmness of your uterus during contractions (a measure of the intensity of the contractions). Immediately after the contraction, he or she may listen to the baby's heart with a stethoscope and take your pulse at the same time, so that the two are not confused.
