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
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PPROM increases the risks of certain pregnancy complications, including:
Baby is born prematurely and is not fully developed—preterm deliveryPlacenta separates from the uterus before the baby is delivered—placental abruptionUmbilical cord is squeezed between the baby and the pelvis—prolapsed umbilical cordInfection in the uterus or babyMiscarriage
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 pregnanciesInfection in the amniotic sac
Other infections, such as chlamydia or bacterial vaginosisPreterm laborAmniocentesisBleeding during the second and third trimester
Certain procedures used to treat abnormal conditions of the cervix, such as
cervical conizationLung 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 100.4°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 cervixNitrazine 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—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.
The doctor will:
Monitor the baby’s heart rateInduce labor with medicationsPossibly 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.
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
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 website. Available at:
http://www.ebscohost.com/dynamed. 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 website. Available at:
http://www.ebscohost.com/dynamed. Updated May 23, 2016. Accessed June 6, 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.
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