Definition

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.

PPROM increases the risks of certain pregnancy complications, including:

• Baby is born prematurely and is not fully developed—preterm delivery
• Placenta separates from the uterus before the baby is delivered—placental abruption
• Umbilical cord is squeezed between the baby and the pelvis—prolapsed umbilical cord
• Infection in the uterus or baby
• Miscarriage

Call your doctor right away if you suspect that your water has broken.

Causes

PPROM is caused by weakening and/or thinning of the opening of the membrane.

Risk Factors

Factors that 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 (such as 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 100.4°F (38°C). 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.

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.

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

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

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 May 28, 2015.

Practice Bulletins No. 139: Premature rupture of membranes. Obstet Gynecol. 2013;122(4):918-930.

Premature rupture of membranes: Causes, risks, and treatment. Pregnancy Info website. Available at:
http://www.pregnancy-info.net/prom.html
Accessed May 28, 2015.

Preterm premature rupture of membranes (PPROM). EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 1, 2015. Accessed May 28, 2015.