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About this information
This information is for you if you think that, or have been told that, your waters have broken early but you have not gone into labour. It may also be helpful if you are a partner, friend or relative of someone who is in this situation.
This applies to you if your waters may have broken between 24 and 37 completed weeks of pregnancy. If your waters break before 24 weeks, you should have a discussion with your healthcare professional about your individual circumstances.
The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.
A glossary of medical terms is available on the RCOG website at: www.rcog.org.uk/en/patients/medical-terms.
Key points
What is preterm prelabour rupture of membranes (PPROM)?
Your baby is surrounded by amniotic fluid or ‘waters’ contained within a membrane bag (the amniotic sac) inside your uterus.
When the waters break, it is also known as rupture of the membranes. Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is known as preterm prelabour rupture of membranes (PPROM). This can happen in up to 3 out of every 100 (3%) pregnant women. PPROM is associated with 3 to 4 in 10 preterm births.
The reason why PPROM happens is not always known but may be because of infections, placental problems or other causes.
How will I know if my waters have broken?
You may notice a ‘gush’ of fluid or you may feel damp. The amount of fluid you lose may vary from a trickle to a gush.
What should I do?
If you think that you are leaking fluid from the vagina, wear a pad not a tampon and note the colour and amount of the fluid. Leaking urine is common while you’re pregnant, but if you think your waters may have broken, you should contact your healthcare professional and go to the hospital for a check-up straight away.
What happens at the hospital?
You will have a check-up that should include:
How is PPROM diagnosed?
What happens next?
If your waters have broken, you will usually be advised to stay in hospital for a few days, although in some situations this may be for longer. You and your baby will be closely monitored for signs of infection. This will include having your temperature, blood pressure and pulse taken regularly, together with blood tests to check for infection. Your baby’s heart rate will also be monitored regularly.
If your waters have not broken, you should be able to go home.
If only a very small amount of amniotic fluid is leaking, it is not always easy to see on examination and it can be difficult to confirm whether your waters have broken. If you continue to leak fluid at home, you should return to the hospital for a further check-up.
What could PPROM mean for me and for my baby? - Infection
The membranes form a protective barrier around the baby, and after these have broken, there is a risk of infection getting into your uterus (chorioamnionitis). If you have an infection, this can cause you to go into labour early or cause you or your baby to develop sepsis.
The symptoms of infection include a raised temperature, an unusual vaginal discharge with an unpleasant smell, a fast pulse rate and pain in your lower abdomen. Your baby’s heart rate may also be faster than normal.
If there are signs that you have an infection, your baby may need to be born straight away to try to prevent both you and your baby becoming more unwell.
Preterm birth
About 50% of women with PPROM will go into labour within the first week after their waters break. The further along you are in your pregnancy the more likely you are to go into labour within 1 week of your waters breaking.
Problems of prematurity
Babies born prematurely have an increased risk of health problems, particularly with breathing, feeding and infection, and may need admission to a neonatal unit. The earlier your baby is born, the more likely that this will be the case.
If your waters have broken early, your healthcare professional will discuss with you the possible outcomes for your baby, depending on how many weeks pregnant you are when this happens and on your individual circumstances.
Other complications
Cord prolapse, when the umbilical cord falls through your cervix into the vagina: this is an emergency complication and can be life-threatening for your baby, but it is uncommon.
Pulmonary hypoplasia, when your baby’s lungs fail to develop normally because of a lack of fluid around them: this is more common if your waters break very early on in pregnancy (less than 24 weeks) when your baby’s lungs are still developing.
Placental abruption, when your placenta separates prematurely from your uterus: this can cause heavy bleeding and can be dangerous for both you and your baby.
If you experience PPROM, sometimes your baby may not survive. The risk of this happening is greater if your waters break very early, if the baby is born very prematurely or, in some cases, following infection or cord prolapse.
Are there any treatments for PPROM?
It is not possible to replace the fluid or repair the hole in the membranes around your baby. You may carry on leaking fluid for the rest of your pregnancy as amniotic fluid continues to be made.
However, treatment may be offered to reduce the risk to your baby. This could include:
Further information
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Sources and acknowledgements