Preterm Premature Rupture Of Membranes
Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of gestation and labor has not started within one hour. The sac contains amniotic fluid and the developing baby. In PPROM, the amniotic fluid inside the sac leaks or gushes out of the vagina. This is also known as your water breaking.
Fetus in the Amniotic Sac
PPROM increases the risks of certain pregnancy complications, including:
- Baby is born prematurely and is not fully developed—preterm delivery
- Placenta separates from the uterus before the baby is delivered—placental abruption
- Umbilical cord is squeezed between the baby and the pelvis—prolapsed umbilical cord
- Infection in the uterus or baby
Call your doctor right away if you suspect that your water has broken.
PPROM is caused by weakening and/or thinning of the opening of the membrane.
Factors that may increase your chance of PPROM:
- PPROM in earlier pregnancies
- Infection in the amniotic sac
- Other infections, such as chlamydia or bacterial vaginosis
- Preterm labor
- Bleeding during the second and third trimester
- Certain procedures used to treat abnormal conditions of the cervix, such as cervical conization
- Lung disease during pregnancy
- Connective tissue disease
- Nutritional deficits
- Low body mass index
- Low socio-economic status
- Smoking during pregnancy
The main symptom of PPROM is fluid leaking from the vagina. You may experience a sudden gush of fluid or a slow, constant trickle. It can be difficult to distinguish between a slow amniotic trickle and urine. Your doctor can do simple tests to determine this.
PPROM also increases the risk of infection. Symptoms include a fever above 100.4°F (38°C). If you have any of these symptoms, call your doctor right away.
To diagnose PPROM, the doctor may do the following tests:
- Visual exam—the doctor may be able to see a trickle of fluid through the cervix, or a pool of fluid collected behind the cervix
- Nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
- Look at the fluid under a microscope to see if it is amniotic fluid
- Ultrasound—to examine the baby and amniotic sac to see if there is plenty of fluid
The doctor will check for a fever and other signs of infection. Your baby will be monitored for any signs of distress.
Treatment of PPROM depends on when it occurs in the pregnancy. There are other considerations as well which your doctor will discuss with you.
34 weeks or longer of gestation
The doctor will:
- Monitor the baby’s heart rate
- Induce labor with medications
- Possibly give antibiotics
32-33 weeks of gestation
The doctor may:
- Induce labor if your baby’s lungs have matured enough
- Give antibiotics
- Possibly give steroids to help your baby's lungs develop faster
- Try to delay delivery until completion of 33 weeks gestation
24-31 weeks of gestation
The doctor will provide treatment with antibiotics and steroids. The doctor may attempt to delay delivery until completion of 33 weeks gestation.
There are no current guidelines to prevent PPROM. Taking preventive antibiotics during the second and third trimester may reduce your risk. You can also take steps for a healthier pregnancy, like quitting smoking.
American Pregnancy Association
National Institute of Child Health and Development
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and premature birth: Results of a pilot intervention. J Periodontology. 2003;74(8);1214.
Majerone BA. Baceterial vaginosis: an update. Am Fam Physician. 1998;57(6):1285-1289.
Placental abruption. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116309/Placental-abruption. Updated December 19, 2014. Accessed June 6, 2016.
Practice Bulletin No. 160: premature rupture of membranes. Obstet Gynecol. 2016;127(1):e39-e51.
Preterm premature rupture of membranes (PPROM). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T435299/Preterm-premature-rupture-of-membranes-PPROM. Updated August 4, 2016. Accessed September 29, 2016.
Last reviewed June 2016 by James Cornell, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.