Susan L. Madden, MS
Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of gestation and labor has not started within 1 hour. The sac contains amniotic fluid and the developing baby. In PPROM, the amniotic fluid inside the sac leaks or gushes out of the vagina. Membrane rupture is also known as your water breaking.
PPROM increases the risks of certain pregnancy complications, including:
Call your doctor right away if you suspect that your water has broken.
PPROM is caused by weakening and/or thinning of the opening of the membrane.
Factors that may increase your chance of PPROM:
The main symptom of PPROM is fluid leaking from the vagina. You may experience a sudden gush of fluid or a slow, constant trickle. It can be difficult to distinguish between a slow amniotic trickle and urine. Your doctor can do simple tests to determine this.
PPROM also increases the risk of infection. Symptoms include a fever above 100.4°F (38°C). If you have any of these symptoms, call your doctor right away.
To diagnose PPROM, the doctor may do the following tests:
The doctor will check for a fever and other signs of infection. Your baby will be monitored for any signs of distress.
Treatment of PPROM depends on when it occurs in the pregnancy. There are other considerations as well which your doctor will discuss with you.
The doctor will:
The doctor will provide treatment with antibiotics and steroids. The doctor may attempt to delay delivery until completion of 33 weeks gestation.
The doctor may admit you to the hospital for bed rest and to monitor you and your baby. Twenty-four weeks of gestation is about the youngest a baby can be born. The doctor will discuss the risks and benefits of your treatment options.
There are no current guidelines to prevent PPROM. Taking preventive antibiotics during the second and third trimester may reduce your risk. You can also take steps for a healthier pregnancy, like
American Pregnancy Association
National Institute of Child Health and Development
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
ACOG Committee on Practice Bulletins-Obstetrics.
ACOG Practice Bulletin No. 160: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists.
Obstet Gynecol. 2016 Jan;127(1):192-194.
Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and premature birth: Results of a pilot intervention.
J Periodontology. 2003;74(8);1214.
Placental abruption. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116309/Placental-abruption. Updated November 4, 2016. Accessed November 28, 2016.
Preterm premature rupture of membranes (PPROM). EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T435299/Preterm-premature-rupture-of-membranes-PPROM. Updated August 4, 2016. Accessed November 28, 2016.
Last reviewed November 2016 by Michael Woods, MD
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