Definition

Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of pregnancy and labor has not started within 1 hour. The sac holds amniotic fluid and the growing baby. In PPROM, the fluid in the sac leaks or gushes out of the birth canal. This is also known as your water breaking.

Fetus in the Amniotic Sac
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Causes

PPROM is caused by membranes that are weak or thin.

Risk Factors

Things that may raise the risk of this problem are:

  • PPROM in earlier pregnancies
  • Infection in the amniotic sac
  • Amniocentesis
  • Bleeding late in pregnancy
  • Procedures used to treat problems of the cervix
  • Short cervix
  • Enlarged uterus
  • Smoking during pregnancy
  • Low body mass index
  • Connective tissue disorders
  • Lung disease during pregnancy
  • Nutritional problems

Symptoms

The main symptom of PPROM is fluid leaking from the birth canal. There may be a sudden gush or a slow trickle.

PPROM raises the risk of infection. There may also be:

  • Fever
  • Rapid heartbeat

Diagnosis

If a large amount of fluid is leaking from the birth canal, PPROM is likely.

It can be hard to tell a slow amniotic trickle apart from urine. You may also have these tests:

  • Nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
  • Microscopic exam of the fluid

An ultrasound may be done to see how much fluid you have.

Treatment

Treatment depends on when it happens in the pregnancy.

34 to 36 Weeks

The doctor will:

  • Watch the baby’s heart rate
  • Start labor with medicines
  • Possibly give antibiotics

24 to 33 Weeks

The doctor will give antibiotics and steroids. Delivery may be delayed until 33 weeks of pregnancy.

Less than 24 Weeks

The doctor may admit you to the hospital for bed rest and monitoring. 24 weeks is about the youngest a baby can be born.

Prevention

There is no way to prevent PPROM.

RESOURCES:

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

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

CANADIAN RESOURCES:

The Canadian Women's Health Network
http://www.cwhn.ca

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

REFERENCES:

Committee on Practice Bulletins-Obstetrics. American College of Obstetricians and Gynecologists Practice Bulletin No. 188: Prelabor Rupture of Membranes. Obstet Gynecol. 2018 Jan;131(1):e1-e14.

Preterm premature rupture of membranes (PPROM). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/preterm-premature-rupture-of-membranes-pprom. Accessed October 19, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG  Last Updated: 10/19/2020