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by Madden SL

Preterm Premature Rupture of Membranes

(PPROM)

Definition

Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of gestation and labor has not started within 1 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. Membrane rupture is also known as your water breaking.
Fetus in the Amniotic Sac
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Copyright © Nucleus Medical Media, Inc.
PPROM increases the risks of certain pregnancy complications, including:
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, such as chlamydia or 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
  • 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—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

Treatment of PPROM depends on when it occurs in the pregnancy. There are other considerations as well which your doctor will discuss with you.

37 weeks or longer of gestation

The doctor will:
  • Monitor the baby’s heart rate
  • Induce labor with medications
  • Possibly give antibiotics

34-36 weeks of gestation

The doctor will:
  • Monitor the baby’s heart rate
  • Induce labor with medications
  • Possibly give antibiotics

24-33 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

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 quitting smoking.

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

ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 160: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2016 Jan;127(1):192-194.
Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and premature birth: Results of a pilot intervention. J Periodontology. 2003;74(8);1214.
Placental abruption. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116309/Placental-abruption. Updated November 4, 2016. Accessed November 28, 2016.
Preterm premature rupture of membranes (PPROM). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T435299/Preterm-premature-rupture-of-membranes-PPROM. Updated August 4, 2016. Accessed November 28, 2016.

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