Membrane breaks prematurely

The membranes that hold amniotic fluid (the water surrounding the baby) usually break at the end of the first stage of labor. However, in about 10% of pregnancies after 37 weeks, the membranes will break early (before labor). This is referred to as premature rupture of membranes (PROM). There is also preterm premature rupture of membranes (PPROM), which is when the membranes rupture before 37 weeks.

Why Does It Happen?

The cause of PROM is often unknown. Some causes are thought to be:

• Uterine or genital tract infections, including sexually transmitted diseases
• Poor nutrition
• Overstretching of the uterus and amniotic sac, which sometimes occurs with multiple fetuses or too much amniotic fluid (hydramnios)
• Cigarette smoking
• Increased susceptibility if it occurred in previous pregnancies
• Previous cervical surgery, including cone biopsies or cerclage suture to hold the cervix closed

How Do I Know I Have It?

The most important symptom of PROM is fluid leaking from the vagina. It may leak slowly or may gush out. Sometimes when it leaks out slowly, women mistake it for urine. Although some of the fluid is lost when the membranes rupture, the baby continues to produce more, so it may continue to leak all day.

If you suspect PROM, it is very important to contact your doctor or healthcare provider immediately to obtain appropriate medical care for you and your baby. Tests to confirm the diagnosis of PROM include medical history, physical exam, lab tests, vaginal exam for the presence of a pool of amniotic fluid in the vagina, and ultrasound.

What Will Happen?

If the doctor confirms that your membranes have ruptured, you may have to be admitted into the hospital. Most mothers start labor within 24 hours of PROM. If labor does not start within that time frame, the baby becomes susceptible to infection. In addition, the umbilical cord could become compressed because there is no longer enough fluid to protect it. If you are close to term, or in most cases, over 34 weeks, the doctor may artificially induce labor if you don't begin labor within 24 hours, as the risk of infection to the baby outweighs the risk of prematurity.

If it is before 34 weeks, the situation becomes more serious. If the baby is not infected and your uterus is not infected, the doctor may try to delay labor with medication until the baby's lungs are more mature. Antibiotics are usually given. Steroids are often given to help the baby's lungs develop quicker. You and your baby will be hospitalized and monitored carefully.

If there is an infection in the baby or your uterus, the baby will need to be born as soon as possible regardless of its age. Approximately 11% of babies in the US are born prematurely and 3-4% of those are due to PROM. The earlier in the pregnancy that a PROM takes place, the greater the risk for potential problems. If the hospital you are admitted to does not have a preterm nursery, you will likely be transferred to a hospital with a neonatal intensive care unit. While infrequent, even with proper medical care there is a small increased risk of stillbirth with preterm PROM.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.

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