Preterm Prelabour Rupture of the Membranes (PPROM)

Rupture of the membranes anytime before term (37 weeks gestation) is called PPROM. Rupture of membranes after 37 weeks but before the onset of contractions/labour is called prelabour rupture of the membranes (PROM).

PPROM affects about 3% of all pregnancies and is one of the leading causes of preterm birth. About 80% of women who break their membranes early will deliver within a week or two, usually because they develop an infection around the baby (Chorioamnionitis) which is not treatable with antibiotics.

Women who break their membranes early may be initially hospitalized for treatment with antibiotics (usually for a week) to try to delay the onset of an infection; treating for longer than a week has not been shown to be beneficial and may increase the chance of developing antibiotic resistant bacteria. You may also receive a course of steroids if you break your membranes between 24-32 weeks to improve your baby’s chances if he/she is born prematurely. (Course of steroids is usually 2 doses of betamethasone 24 hours apart or 4 doses of dexamethasone 12 hours apart; more or repeat doses is of no benefit and may in fact be harmful to the fetus).

You and your baby will be monitored for any signs that you are developing an infection around the baby.

Signs and Symptoms of an infection

Maternal

• Fever
• Increasing white blood cell count
• Infected looking amniotic fluid
• Uterine contractions

Baby

• Increased baseline heart rate

After the one-week course of antibiotics, you may be discharged from the hospital but will be closely monitored as an outpatient. This will likely involve multiple visits to the hospital each week to check on you and the baby. You will be asked to check your temperature at least twice a day and you will also likely have regular ultrasounds to watch the baby’s growth and assess his/her wellbeing. We want to avoid an infection at all costs, it is not good for you and certainly not good for your baby; If at any point we suspect there may be an infection or an infection is beginning to take hold, we will make the recommendation for delivery. If however, you get to 34-36 weeks of gestation without getting an infection, your doctor will likely speak to you about induction. It’s always a balance of risks and benefits; is it better for baby to still be inside you if you get an infection or better for baby to be in the nursery? Beyond 34 weeks, we know the majority of babies do fine but may need to spend some time in the nursery and may need some initial help with their feeding. Your doctor will speak to you about the plans for the different time points in pregnancy after you break your membranes.

Commonly asked questions

Q. Can you fix the hole in the membranes?

A. No. Researchers have tried all kinds of things including injecting blood to try to form a clot and plug the hole. Unfortunately, nothing has been shown to be effective.

Q. Should I be on bed rest to try to prevent leaking fluid?

A. No. Bedrest has not been shown to fix/improve anything in pregnancy. While it’s true you may leak more fluid when you are up-and-about, it’s probably just fluid that has been pooling in the vagina and will leak out when you stand up. Sometimes, the baby will act like a plug… when baby is leaning against the hole it may briefly prevent fluid from leaking out but when baby moves, fluid may then leak. The fluid that is around the baby is essentially the baby’s urine and as disgusting as that is, it’s important for the development and maturation of the baby! The baby will continue to produce urine and you will continue to leak it. When we look with ultrasound, the amount of fluid around the baby may increase/decrease at each visit.

Q. Is there anything I shouldn’t do?

A. No intercourse and no vaginal douches. You should also avoid baths and swimming (not that water typically gets into the vagina during bathing/swimming).

Q. Will having low fluid affect the baby?

A. Fluid is important for the development of the baby’s lungs and allows the baby to move. The earlier you break your water (typically before 22-24 weeks gestation), there is an increased chance the baby’s lungs will not develop and may adversely impact on the baby’s ability to breath after birth. Similarly, having very low fluid for prolonged periods of time during pregnancy constricts the baby’s movements and may result in limb contractures. Because the baby hasn’t been able to stretch out his/her arms and legs physiotherapy may be required after birth to try to get the limbs to move normally. If you rupture your membranes after about 24 weeks, the chance of either the lungs not developing properly or the baby having limb contractures is relatively low.