Preterm Premature Rupture of Membranes

(PPROM)

by Susan L. Madden, MS and Rebecca J. Stahl, MA

• Definition • Causes • Risk Factors • Symptoms • Diagnosis • Treatment • Prevention

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

PPROM increases the risks of certain pregnancy complications, including:

Preterm delivery —baby is born prematurely and is not fully developed
Placental abruption —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 baby
Miscarriage

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 (eg, 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 100.4ºF (38ºC). 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.

RESOURCES:

American Pregnancy Association
http://www.americanpregnancy.org/

National Institute of Child Health and Development
http://www.nichd.nih.gov/

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca/

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

REFERENCES:

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

Cunningham FG, et al. Williams Obstetrics . 22nd ed. New York, NY: McGraw-Hill Medical Publishing Division; 2005.

DynaMed editors. Preterm premature rupture of membranes at term. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2010. Accessed June 1, 2010.

Eisenberg A, Murkoff HE, Hathaway SE. What to Expect When You’re Expecting . New York: Workman Publishing; 2002.

Ferris DG. Management of bacterial vaginosis during pregnancy. Am Fam Physician . 1998;57(6).

Jeffcoat MK, et al. Periodontal disease and premature birth: results of a pilot intervention. J Periodontology . 2003;74(8);1214.

Kohnle D. Placental abruption. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated May 2008. Accessed December 1, 2008.

Pregnancy Info.net. Premature rupture of membranes: causes, risks, and treatment. Pregnancy Info.net website. Available at: http://www.pregnancy-info.net/prom.html . Accessed June 1, 2010.

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

Last reviewed October 2012 by Andrea Chisholm
Last Updated: 10/31/2012

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