What is preterm prelabour rupture of membranes (PPROM)?

Your baby is inside the amniotic sac, which is a thin-walled bag filled with amniotic fluid. ‘Rupture of membranes’ is the medical term for the amniotic sac breaking open. Many people refer to it as their ‘waters breaking’.

Usually, your waters break when your baby is ready to be born. In 3 out of 100 pregnancies, the waters break early — before 37 weeks of pregnancy and before labour starts. This is known as preterm prelabour rupture of membranes (PPROM).

What causes PPROM?

It’s unclear what causes PPROM. It’s more likely if:

• there is an infection inside the amniotic sac
• your placenta detaches from your uterus (the medical term for this is placental abruption)
• you have had a procedure involving your uterus, such as amniocentesis
• you are pregnant with more than one baby

How will I know if my waters have broken?

If your waters break, you’ll feel fluid coming from your vagina. The amount can vary. You may feel a big gush or a slow leak, or your underwear might feel damp.

Amniotic fluid usually smells sweet and may be clear or pink. If the fluid has a smelly odour or is green, brown or bright red, this could be a sign that you and your baby need urgent attention.

Sometimes it can be hard to tell if it’s amniotic fluid or urine. Your doctor or midwife can test the fluid to see what it is.

What should I do if my waters break early?

If you think your waters have broken early, call your doctor or midwife immediately. You’ll need to be examined straight away.

Put a clean pad in your underwear to collect the fluid.

Be aware that if your waters have broken, the umbilical cord could slip out into your vagina. This is a serious emergency called cord prolapse. It is life-threatening for your baby.

How is PPROM diagnosed?

Your doctor or midwife will ask about your fluid loss and look at the fluid on your pad.

They may also do a vaginal examination using a speculum to look for amniotic fluid in your vagina. If there’s any doubt, they can do a test on the fluid in your vagina to see if it’s amniotic fluid. The test gives results in 5 to 10 minutes.

How is PPROM managed?

Once the amniotic sac has broken, it can’t be closed.

You’ll be asked to stay in hospital for monitoring and treatment. If you and your baby are well and you’re not in labour, you might go home after a few days.

You will be prescribed antibiotics to prevent infection.

If you are less than 36 weeks pregnant, you may be offered 2 injections of steroid medicine to help protect your baby’s lungs. If you are less than 30 weeks pregnant and your baby’s birth is expected within the next 24 hours, you may be prescribed a magnesium sulphate infusion (this medication is given through your vein) to help protect your baby’s brain.

You’ll have blood tests, urine tests and vaginal and anal swabs to check for infection. You’ll also have a cardiotocograph and an ultrasound to check your baby’s wellbeing.

When will my baby be born?

Most people with PPROM will go into labour within 2 weeks.

When your baby is born depends on:

• whether you go into labour
• your stage of pregnancy
• your and your baby’s health

You may be able to wait for labour to start naturally. Although, if you or your baby are unwell, it may be safest to have your baby early.

Your doctor or midwife will talk to you about the safest time to have your baby. It’s a balance between the risks of your baby being born early and the risks of staying pregnant after your waters have broken. It’s generally best to wait until you are term, 37 weeks, but the timing of your baby’s birth will depend on your individual circumstances.

Are there risks if my waters break early?

Risks of PPROM include:

• infection inside your uterus — if the amniotic sac is open, bacteria can get in
• cord prolapse
• prematurity

How should I look after myself after my waters break?

Pay attention to your baby’s movements, watch for fluid loss and check your body temperature regularly.

Tell your doctor or midwife immediately if:

• your baby’s pattern of movement changes
• you have a fever or feel unwell
• you have abdominal pain
• the fluid changes in colour, smell or amount
• you start bleeding from your vagina

Make sure you go to your antenatal appointments and do the recommended tests.

Here are some ways to help prevent infection:

• Change your pad every 4 hours. Don’t use tampons.
• Shower every day.
• Don’t have a bath or go swimming.
• Avoid all types of sexual intercourse.
• Wipe from front to back after using the toilet.
• Don’t put any medicines into your vagina.