Rupture of the bladder

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Under rupture is understood in medicine, the opening of the amniotic sac , during the pregnancy the fetus surrounds and until then with amniotic fluid is filled. The rupture of the bladder is one of the signs of the beginning birth and usually happens spontaneously after the onset of labor .

To facilitate and / or accelerate the birth, the amniotic sac can also be pierced from the outside (usually by a midwife ) and thus opened ( amniotomy ).

Premature and premature rupture of the bladder

Classification according to ICD-10
O42.- Premature rupture of the bladder
ICD-10 online (WHO version 2019)

From premature rupture of membranes (ger .: Premature Rupture of Membranes , PROM) occurs when the before the throes of amniotic fluid due to a crack amniotic cavity going on.

Premature rupture of the bladder represents a risk to pregnancy depending on the week of pregnancy. The rupture of the bladder is often triggered by infections in the genital area. A more recent study sees the bacterial colonization of the chorion - the outermost layer of the amniotic sac - as the cause of premature rupture of the bladder. In 50% of all pregnancies, premature rupture of the bladder leads to childbirth within 48 hours. Possible complications from the loss of amniotic fluid are ascending infections , lung damage or contractures of the extremities, depending on the week of pregnancy, as well as a miscarriage or premature birth of the child caused by labor.

Before the child becomes viable (from around the 24th week of pregnancy), premature rupture of the bladder usually leads to a miscarriage. Before the 20th week of pregnancy, pregnancy should be actively terminated in order to protect the mother from infections if the child's prognosis is poor.

Between the 22nd and 24th week of pregnancy, an individual decision should be made between termination of pregnancy or conservative therapy.

From the completed 24th to 28th week of pregnancy, conservative therapy with long-term antibiosis should be carried out to avoid infections, lung maturation, if necessary an inhibition of labor ( tocolysis ) and the least possible strain on the patient. In rare cases (7–9%) the rupture of the bladder closes again spontaneously and the amniotic fluid forms again.

The lack of amniotic fluid often results in severe underdevelopment of the fetal lungs. To improve this, the trachea of the unborn child can be opened from the 26th / 27th A tiny balloon can be used for about a week at the 7th week of pregnancy. The balloon is pushed into place through a tube measuring just a few millimeters through the mother's abdominal wall in a minimally invasive fetal surgical procedure. This treatment method has been established for diaphragmatic hernias for over 15 years. In this way, good growth of the underdeveloped lungs and a significant improvement in their blood flow can be achieved in a very short time.

From the 28th week of pregnancy onwards, an individual decision should be made between conservative therapy and active delivery. From the 32nd week of pregnancy, the children benefit more from ending the pregnancy by initiating childbirth or by caesarean section.

An alternative, experimental therapy in the early weeks of pregnancy is the Amnion Patch. Here an attempt is made to cement the hole in the amniotic sac with the help of platelets - these are injected into the uterus. Successes have been reported, especially in the case of ruptured bladders after amniocentesis . Sometimes the amniotic fluid in the uterus is replenished to such an extent that the child has enough amniotic fluid available to develop optimally. However, this is associated with an increased risk of infection.

From early rupture occurs when the rupture of the membranes after the onset of labor, but before the onset of early takes place expulsion.

Multiple rupture of the bladder

Even more transient bubble jumps are known when the amniotic sac in high areas breaks early and the amniotic fluid is then tamponaded for some time. Later there is another jump in the previal ​​(in the direction of birth) bladder parts with renewed amniotic fluid discharge.

Individual evidence

  1. Kimberly B. Fortner, Chad A. Grotegut, Carla E. Ransom, Rex C. Bentley, Liping Feng, Lan Lan, R. Phillips Heine, Patrick C. Seed, Amy P. Murtha, Kang Sun: Bacteria Localization and Chorion Thinning among Preterm Premature Rupture of Membranes. In: PLoS ONE. 9, 2014, p. E83338, doi : 10.1371 / journal.pone.0083338 .
  2. German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT) at the University Hospital Mannheim: Fetal surgical therapy for premature rupture of the bladder. Retrieved August 9, 2018 .