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Preterm Premature Rupture of Membranes

Definition

Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of gestation. 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 with Amniotic Sac
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PPROM increases the risks of certain pregnancy complications, including:

Call your doctor right away if you suspect that your water has broken.

Causes

The causes of PPROM are not clearly understood. Some of the possible causes are:

  • Early dilation of the cervix (may be due to the weight of baby and placenta, or changes in the cervix itself)
  • Infections of the vagina, uterus, or membranes surrounding the fetus
  • Premature labor (occurring previously in the same pregnancy)

Risk Factors

The following factors may increase your chance of PPROM:

  • PPROM in earlier pregnancies
  • Infection in the amniotic sac
  • Other infections in mother (chlamydia, bacterial vaginosis)
  • Preterm labor
  • Amniocentesis
  • 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

Symptoms

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 degrees Fahrenheit (38 degrees Celsius). If you have any of these symptoms, call your doctor right away.

Diagnosis

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
  • A 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—using sound waves, the doctor examines the baby and amniotic sac to see if there is plenty of fluid and the baby is doing well

The doctor will also check you for fever and other signs of infection. He will monitor your baby for any signs of distress.

Treatment

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 by giving you medicines
  • 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.

Less than 24 weeks of gestation

The doctor may admit you to the hospital for bed rest and to monitor you and your baby. Twenty-four weeks of gestation is about the youngest a baby can be born. The doctor will discuss the risks and benefits of your treatment options.

Prevention

Researchers are investigating ways 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.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 10/2012 -
  • Update Date: 05/11/2013 -
  • American Pregnancy Association

    http://www.americanpregnancy.org

  • National Institute of Child Health and Development

    http://www.nichd.nih.gov

  • About Kids Health

    http://www.aboutkidshealth.ca

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    http://www.sogc.org/index%5Fe.asp

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  • Premature Rupture of Membranes, Practice Bulletin No. 80, April 2007, The American College of Obstetricians and Gynecologists.