To deliver or not to deliver-both options carry risks, and deciding which is the best option for your particular situation can be extremely difficult. Not only is every case different, but your situation can change from day to day-or even from moment to moment. You and your doctor must continually review your options as time passes and new information is obtained.
When deciding whether to deliver your baby now or later, your doctor considers two questions:
- Are there signs of cord compression? If your baby's heart rate drops below 100 for 60 seconds or more, there's a good chance the cord is compressed. If this happens frequently, your doctor may want to deliver the baby right away.
- Are there signs of infection? Signs of infection include:
- contractions of the uterus;
- increased temperature and heart rate (in the mother);
- tenderness of the uterus;
- foul-smelling vaginal discharge;
- increased white blood cell count or a change in the pattern of white blood cell type; and
- an increase in the baby's heart rate.
If infection is suspected and you are at least 34 weeks pregnant, your doctor may decide to induce labor right away. If you are less than 34 weeks pregnant, your doctor may perform additional tests, like amniocentesis, to confirm the infection and/or to test for fetal lung maturity, before inducing delivery.
If there are no signs of cord compression or infection, you and your doctor need to consider the following additional factors:
- Length of your pregnancy. Doctors generally agree upon the following:
- When PPROM occurs before 32 weeks of pregnancy, it is best to delay delivery. Babies delivered this early often have lung problems (respiratory distress syndrome or RDS), bleeding in the brain (intraventricular hemorrhage), and intestinal problems (necrotizing enterocolitis).
- When PPROM occurs during the 34th week or later, it is best to induce delivery.
- When PPROM occurs between 32 and 34 weeks, the standard recommendation is less clear. These cases require careful evaluation and frequent reevaluation.
- Length of time since your membranes broke.
As the time since membrane rupture increases, the risks of infection increases. However, studies have shown that the amount of time the membranes are ruptured doesn't increase the risk of brain problems in babies.
This is in contrast to recent studies that suggest a link between a baby's response to infection and the development of cerebral palsy. These results have encouraged some doctors to lean toward delivering as soon as possible. Thus, the lack of clear-cut evidence adds even more challenge to the decision you and your doctor must make.
- Additional risks of delaying delivery. Delaying delivery can also:
- increase the risk of the placenta tearing (abruption), which may cause heavy bleeding and require urgent delivery; and
- increase the risk of blood clots in the legs among women who are on strict bed rest to prolong pregnancy. Blood clots occur in 2 to 4% of these women.
Extreme Prematurity
When the amniotic sac ruptures before 22 weeks of pregnancy, it is said to occur before viability -that is, before the fetus can survive outside the womb. Some of these pregnancies can be extended long enough for the baby to have a good chance of survival. However, many babies will not survive, and a significant percent of those that do will face long-term consequences. Since this is such a difficult choice, it is important for you to have frank, open discussions with your doctor and your partner.
The following table summarizes some of the risks and benefits of early delivery:
Risk of prematurity | Benefit of delivering baby |
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