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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PPROM is caused by membranes that are weak or thin.
Things that may raise the risk of this problem are:
- PPROM in earlier pregnancies
- Infection in the amniotic sac
- Bleeding late in pregnancy
- Procedures used to treat problems of the cervix
- Short cervix
- Enlarged uterus
- Low body mass index
- Connective tissue disorders
- Lung disease during pregnancy
- Nutritional problems
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:
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
may be done to see how much fluid you have.
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.
There is no way to prevent PPROM.
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: 4/27/2021