Preterm Premature Rupture of Membranes (PPROM)

What is PPROM?

Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.

What causes PPROM?

In most cases of PPROM, the cause is not known.

Who is at risk for PPROM?

These things may increase your risk: 

• Having a preterm birth in a previous pregnancy

• Having an infection in your reproductive system

• Vaginal bleeding during pregnancy

• Smoking during pregnancy

What are the symptoms of PPROM?

Symptoms can occur a bit differently in each pregnancy. They can include:

• A sudden gush of fluid from your vagina

• Leaking of fluid from your vagina

• A feeling of wetness in your vagina or underwear

Call your healthcare provider right away if you have these symptoms.

The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.

How is PPROM diagnosed?

Your healthcare provider will ask you questions about your pregnancy. They will also ask you about your symptoms.

Then your healthcare provider will give you an exam. The exam may be done with a tool (speculum) to look inside your vagina. Your healthcare provider will look for fluid leaking from your cervix. They will also remove some fluid to test it. This is to check if it’s amniotic fluid, vaginal fluid, or urine. Testing may include:

• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.

• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.

You may also have an ultrasound exam. This is done to check the amount of amniotic fluid around your baby.

How is PPROM treated?

Treatment will depend on your symptoms, pregnancy, and general health. It will also depend on how bad your condition is.

Hospital stay and bed rest

Your healthcare provider will watch you closely. They may keep track of:

• Signs of labor or contractions

• Your baby’s movement, heart rate, and other tests

• Symptoms of infection. These can include a fever and pain. Your baby’s heart rate may also increase.

Medicine

You may need these medicines:

• Corticosteroids. These medicines can help your baby’s lungs grow and mature. If your baby is born early, their lungs may not be able to work on their own.  

• Antibiotics. You may need these to prevent or treat an infection.

• Tocolytic medicines. These are used to stop preterm labor.

Induction of labor

Your healthcare provider may give you medicine to start labor. Or they may tell you to stop taking tocolytic medicine. Your labor likely won’t be induced until at least week 34 of pregnancy. But this may need to be done earlier if there are problems.

What are possible complications of PPROM?

PPROM happens in many premature births. A baby born too early may have many serious problems. Other complications of PPROM include:

• Infection, such as infections of the amniotic fluid and membranes

• Separation of the placenta from the uterus

• Problems with the umbilical cord

• Surgical or cesarean section (C-section) delivery

What can I do to prevent PPROM?

The cause of PPROM is often unknown. There is no way to stop this from happening in most pregnancies.

You should take good care of yourself during pregnancy. This means that you should see your healthcare provider as soon as you know you’re pregnant. Keep up with your prenatal checkups. If you smoke, ask your healthcare provider how to quit.

When should I call my healthcare provider?

Call your healthcare provider right away if you have signs of PPROM. These include a sudden gush of fluid from your vagina, leaking of fluid, or a feeling of wetness in your vagina or underwear.

Key points about PPROM

• PPROM is when the sac (amniotic membrane) surrounding your baby breaks (ruptures) before 37 weeks of pregnancy.

• The cause of PPROM is unknown in most cases.

• If you think you have PPROM, call your healthcare provider right away.

• PPROM raises the risk for infection. It also increases your chance of having your baby too early.

• Treatment may include medicine to help your baby’s lungs develop. Or you may need medicine to stop preterm labor. 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours or on weekends.