What is PPROM?

The abbreviation PPROM stands for preterm premature rupture of membranes. This is when the amniotic sac, or bag of waters, breaks before 37 weeks’ gestation and before labor has started. This complication affects approximately 3 percent of pregnancies in the United States.

There are a few reasons PPROM may occur, with infection in the amniotic fluid being the cause in 15 to 25 percent of cases. Bleeding from placental abruption can also cause the sac to rupture. Certain risk factors make PPROM more likely, and they include a prior history of PPROM, smoking, illicit drug use, low BMI, or abnormalities in the shape of the uterus.

Women who experience PPROM will often report a large gush of fluid that has the consistency of water, while others may complain of a less dramatic but continuous leak of fluid. It is diagnosed with a simple speculum exam, though if the diagnosis is not clear an ultrasound showing low fluid may help confirm it.

Once PPROM is confirmed, it is managed differently depending on the health of the mother and the baby. If at any time the baby or mother appear to be in distress (which may happen if there is a severe infection or heavy bleeding), delivery will be recommended—even if the baby is very preterm. This could be done either via a vaginal delivery or a C-section (which may be needed if the baby is breech or the mother or baby appear very unstable).

If immediate delivery is not needed, most women with PPROM will remain in the hospital until they either go into labor on their own or they are induced or scheduled for a C-section. Usually, the goal is to reach 34 weeks’ gestation, at which point delivery is often recommended since the risk of infection and other complications is higher than the benefit of staying pregnant longer.

During this time, a course of antibiotics is usually administered over 7 days, as we know this can increase the time the woman remains pregnant, known as the latency period. Even a few days can make a huge difference in development for very fragile preterm babies! Steroid injections are also usually given to the mother to help mature the baby’s lungs and blood vessels in the brain and the gastrointestinal tract, which we know greatly helps preterm babies. Some women will also receive medications to stop contractions during this time period, though not all obstetric providers will do this since the data is controversial.

Overall, about 40 to 50 percent of patients who undergo PPROM will deliver within a week. For those who make it past that time point, most deliver from 2 to 5 weeks after the membranes rupture. Being hospital-bound for this long can be difficult, but knowing that each day that your baby grows inside you makes his or her outcome so much better can help during this difficult time.

Sources:

• The American College of Obstetricians and Gynecologists
• Premature rupture of membranes.
  The American College of Obstetricians and Gynecologists
• Your Pregnancy and Childbirth.

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