In brief — the direct answer
Preterm Prelabor Rupture of Membranes (PPROM) is a condition where the amniotic sac—the water-filled bag around the baby—ruptures before 37 weeks of pregnancy. This is often described as the 'water breaking early.' Once the membranes are ruptured, the protective seal around the baby is gone, increasing the risk of infection (chorioamnionitis) and usually leading to premature birth. At the MFM Unit, we focus on a 'watchful waiting' approach, using medication to mature the baby's lungs and prevent infection while monitoring you closely in the hospital.
What is Preterm Prelabor Rupture of Membranes (PPROM)?
The management of PPROM is a 'balancing act.' On one hand, every extra day the baby stays in the womb helps their lungs and brain develop. On the other hand, a uterus without amniotic fluid is prone to infection, which can be dangerous for both the mother and the baby. The goal of our management is to buy as much time as possible, ideally reaching 34 weeks, while staying alert for any signs that delivery is necessary for safety.
Who is at risk?
PPROM can happen unexpectedly, but factors include:
- Previous PPROM: In a prior pregnancy.
- Infection: Silent infections in the vagina or cervix.
- Cervical Weakness: A cervix that has shortened or opened early.
- Multiple Pregnancy: Twins or triplets putting more pressure on the membranes.
- Smoking: A known risk factor for membrane weakness.
How we diagnose it
Confirming PPROM involves a gentle assessment:
- Clinical Check: A sterile speculum exam to look for 'pooling' of fluid in the vagina.
- Biochemical Tests: Using swabs (like Actim Prom or Amnisure) that detect specific proteins found only in amniotic fluid.
- Ultrasound: Checking the level of fluid remaining around the baby (AFI).
What does management involve?
Once PPROM is confirmed, we use a specialized bundle of care:
- Antibiotics: A 10-day course (often Erythromycin or Azithromycin) to prevent infection and prolong the pregnancy.
- Steroids: Two injections given 24 hours apart to speed up the development of the baby's lungs.
- Magnesium Sulfate: If delivery is expected before 32 weeks, this medication is given to help protect the baby's developing brain.
- Monitoring: Daily checks of maternal temperature, pulse, and the baby's heart rate tracing (CTG).
What are the outcomes?
The outlook for PPROM has improved significantly with modern neonatal care:
- Latency: Most women will deliver within one week of their water breaking, but some can continue for several weeks.
- Delivery Timing: Unless there is an infection, we usually aim to deliver by 34 weeks, as the risk of infection after this point outweighs the benefits of staying in the womb.
- The Baby: Babies born after PPROM may need time in the NICU, but the use of steroids and antibiotics significantly reduces the risk of respiratory distress and other complications.
When to see a subspecialist
If you feel a 'gush' or a 'constant trickle' of fluid from your vagina, you must seek medical attention immediately. Do not wait for contractions to start.
Our team, led by Dr. Leanne Bricker, provides expert high-risk obstetric care for PPROM. We offer a safe and supportive hospital environment where you and your baby can be monitored by specialists until the safest time for delivery.
Questions to ask your doctor
References & Clinical Guidelines
- Care of Women Presenting with Preterm Prelabour Rupture of Membranes from 24 Weeks of Gestation (Green-top Guideline No. 73)
- Prelabor Rupture of Membranes (Practice Bulletin 217)
- Preterm labour and birth (NG25)