PPROM - Preterm Premature Rupture of the Membranes

Amniotic Fluid
When the membranes rupture prematurely, the baby loses the protection of the amniotic fluid and the barriers against infection.. Photo © A.D.A.M.

Premature Rupture of Membranes, often abbreviated as PROM, means that a mother's amniotic sac breaks or leaks fluid before she is actually in labor. In most women, the membranes rupture -- the experience known as the "water breaking" -- at some point during labor and not before it starts.

Despite the word "premature," PROM is most common after 37 weeks -- at which point the baby would no longer be considered premature.

But in about 3% of pregnancies, the membranes rupture before 37 weeks, causing a condition called "preterm" PROM. Preterm PROM can be a risk factor for stillbirth or premature infant loss.

Why PROM Is Risky:

Ruptured membranes often cause the mom to go into labor. This is not a problem after 37 weeks, but with preterm PROM the risks are much higher. Babies born before 37 weeks face potential complications of prematurity. Very early preterm delivery can mean loss of the baby.

In addition, when doctors need to postpone labor in women with preterm PROM, there is an increased risk of infection as well as cord compression and health problems for the baby.

Symptoms of PROM:

Symptoms of PROM include a sudden gush of fluid from the vagina or a continual leak of fluid. Sometimes PROM can appear to be an inability to stop urinating. (Obviously, if you have any concerns that you might have PROM, see a doctor right away.)

Risk Factors and Causes:

Certain types of infections appear to be able to cause preterm PROM, and in rare cases procedures such as amniocentesis can cause PROM, but researchers do not believe there is a single cause of the condition. The following are some known risk factors:

  • Lower socioeconomic status


When PROM occurs after 37 weeks, the usual treatment is to induce labor if the mom does not go into labor naturally, and at that point, the baby might be born with no further complications.

Before 37 weeks with preterm PROM, the treatment is more complicated. If the mom is between 34 and 36 weeks, the doctor will administer antibiotics for group B strep bacteria and then deliver the baby. Babies born between 34 and 36 weeks usually do not have serious problems, although they may need to stay in a special care nursery for a few days or weeks.

With preterm PROM before 34 weeks, the doctor will usually hospitalize the mother and then try to postpone labor until the baby's lungs are mature, giving steroids to boost lung development, along with antibiotics and monitoring for signs of infection. If an infection occurs in the uterus, the baby may need to be delivered right away.

Although doctors can give medications to postpone labor, the majority of women with preterm PROM end up delivering their babies within one week. Depending on when the birth occurs, this can mean an increased risk of infant loss. Also, approaches vary when the PPROM occurs between 32 and 34 weeks. Some doctors will advocate delivering the baby right away whereas others opt to postpone labor and administer steroids.

Preterm PROM before 24 weeks has the worst odds for a good outcome. The odds of survival for the baby are much lower, especially if doctors are not able to delay the onset of labor or if there is already an infection when the condition is diagnosed. Generally, babies born before 22 weeks have no chance of survival. When doctors can delay the birth until at least 23 or 24 weeks, the baby can survive in some cases but with high odds of long-term developmental problems due to the premature birth.


Everest, N.J., S.E. Jacobs, P.G. Davis, L. Begg, and S. Rogerson, "Outcomes following prolonged preterm premature rupture of the membranes." Archives of Disease in Childhood - Fetal and Neonatal Edition 2008. Accessed 31 Aug 2008.

Farooqi, A., P.A. Holmgren, S. Engberg, and F. Serenius, "Survival and 2-year outcome with expectant management of second-trimester rupture of membranes." Obstetrics & Gynecology 1998. Accessed 18 Aug 2008.

Medina, Tanya M. and D. Ashley Hill, "Preterm Premature Rupture of Membranes: Diagnosis and Management." American Family Physician 15 Feb 2006. Accessed 18 Aug 2008.

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