Premature Rupture of Membranes (PROM)

What is Premature Rupture of Membranes?

Premature Rupture of Membranes (PROM) is when the amniotic sac breaks (water breaks) before the onset of labor. Preterm Premature Rupture of Membranes (Preterm PROM) is when it occurs before the 37th week of pregnancy. When the pregnancy is at term, PROM often indicates that labor will soon begin and up to 90 percent of women deliver within 24 hours. In Preterm PROM, the condition greatly increases the risk that the baby will be born prematurely. Infection is the primary risk with premature rupture of membranes. Other complications, including premature delivery and rarely, death, may occur. The earlier PROM happens, the greater the risk of complications to the mother and baby.

Signs of PROM

If you experience the following symptoms of rupture of membranes at any time during your pregnancy, call your clinic or the OB floor at your local hospital immediately:

• A gush or trickle of clear or bloody fluid from the vagina
• A sensation that you can’t stop peeing
• Increased vaginal discharge/wetness that seems more than usual
• Vaginal bleeding
• Pelvic pressure

Because of the significant risk of infection after your water breaks, it’s important to seek care immediately. Do not have sex or place anything into your vagina, including your fingers or tampons before you see a physician.

What Causes Premature Rupture of Membranes?

The exact cause of premature rupture of membranes is often unknown. The following may cause it to occur:

• Infections in the uterus
• Multiple gestations (twins, triplets, or more)
• In-competent cervix (when the cervix is unable to remain closed during pregnancy)
• Placental abruption (when the placenta separates from the uterus)
• Excess amniotic fluid

Risk factors include:

• Smoking
• African-American descent
• History of sexual transmitted disease
• Previous preterm delivery
• Vaginal bleeding
• Procedures such as amniocentesis and cerclage

How is Preterm Rupture of Membranes Diagnosed?

Your provider will examine you for evidence of amniotic fluid and to determine if your cervix has begun to dilate (open) and efface (thin).

Diagnostic procedures may include:

• Testing vaginal secretions to determine if amniotic fluid is present
• Pelvic exam by speculum to inspect your cervix
• Tests for infection
• Possible amniocentesis to determine the baby’s lung maturity
• Ultrasound to determine the baby’s well-being, maturity and level of amniotic fluid lost

What Does it Mean for My Baby?

If you are at term, you may go into labor spontaneously or your provider may induce labor to help reduce the risk of infection. If you are 37 weeks or less, your provider will discuss with you the risks of going into labor early and available treatment options.

The primary risk of preterm rupture of membranes is infection and, when before 37 weeks, preterm delivery. PROM is associated with 30-40 percent of preterm deliveries and is the leading cause of preterm delivery. When Preterm PROM occurs, it significantly increases the risks for complications and mortality for both mother and baby.

Approximately 40 percent of women who experience PROM between 24 and 37 weeks deliver within one week, while 30 percent remain pregnant after five weeks. Because of the likelihood of preterm delivery, it’s important that you seek care at a hospital equipped with a Neonatal Intensive Care Unit and Maternal-Fetal Care specialist team.

Preterm PROM before the 26th week is rare and often results in fetal death.

If I am Diagnosed with PROM, What Happens Next?

Seek medical care immediately. Your provider will discuss with you the treatment and management options. You may be hospitalized for observation, to deliver your baby or be transferred to a facility with a Neonatal Intensive Care Unit in anticipation of preterm delivery.

How is it Preterm Rupture of Membranes Treated?

If you are at term, you may go into labor spontaneously or be induced.

If you are preterm, your provider will discuss your unique situation and the risks and management options available to you and your baby.

Rarely, the amniotic sac reseals itself and the leakage stops allowing amniotic fluid to build back up in the uterus and delay delivery.

Common management methods include:

• Hospitalization
• Antibiotics
• Steroid injections to speed up lung development in the baby
• Medication to prevent contractions
• Frequent ultrasounds and tests for infection
• Fetal monitoring
• Bedrest
• Delivery