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
Copyright © Nucleus Medical Media, Inc.
PPROM increases the risks of certain pregnancy complications, including:
—baby is born prematurely and is not fully developed
—placenta separates from the uterus before the baby is delivered
Prolapsed umbilical cord
—umbilical cord is squeezed between the baby and the pelvis
Infection in the uterus or babyMiscarriage
Call your doctor right away if you suspect that your water has broken.
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 fetusPremature labor (occurring previously in the same pregnancy)
The following factors may increase your chance of PPROM:
PPROM in earlier pregnanciesInfection in the amniotic sac
Other infections in mother (
Preterm laborAmniocentesisBleeding during the second and third trimester
Certain procedures used to treat abnormal conditions of the cervix (eg,
Lung disease during pregnancyConnective tissue diseaseNutritional deficitsLow body mass indexLow socio-economic statusSmoking
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 100.4ºF (38ºC). 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 cervixA nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluidLook at the fluid under a microscope to see if it is amniotic fluidUltrasound
—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 of PPROM depends on when it occurs in the pregnancy. There are other considerations as well which your doctor will discuss with you.
The doctor will:
Monitor the baby’s heart rateInduce labor by giving you medicinesPossibly give antibiotics
The doctor may:
Induce labor if your baby’s lungs have matured enoughGive antibioticsPossibly give steroids to help your baby's lungs develop fasterTry to delay delivery until completion of 33 weeks gestation
The doctor will provide treatment with antibiotics and steroids. The doctor may attempt to delay delivery until completion of 33 weeks 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.
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
The American College of Obstetricians and Gynecologists. Premature Rupture of Membranes,
Practice Bulletin No. 80. April 2007.
Cunningham FG, et al.
. 22nd ed. New York, NY: McGraw-Hill Medical Publishing Division; 2005.
Eisenberg A, Murkoff HE, Hathaway SE.
What to Expect When You’re Expecting
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Ferris DG. Management of bacterial vaginosis during pregnancy.
Am Fam Physician
Jeffcoat MK, et al. Periodontal disease and premature birth: results of a pilot intervention.
Premature Rupture of Membranes, Practice Bulletin No. 80, April 2007, The American College of Obstetricians and Gynecologists.
Last reviewed October 2012 by Andrea Chisholm
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.
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