An unmistakable sign that you’re going into labor is the sudden release of amniotic fluid through the vagina, commonly known as your water breaking. In normal pregnancies, this is accompanied by the pains of labor and contractions, but in some cases, the water breaks early, prior to going into labor and before reaching a full term pregnancy. This can lead to complications that require a variety of different approaches to treatment.
PPROM stands for “preterm premature rupture of membranes.” There’s a lot going on in this acronym, so let’s break it down. Rupture of membranes is the clinical term for breaking water. When it’s premature, it’s happening before going into labor. And when it’s preterm, it’s happening before 37 weeks gestation.
PPROM is a high risk for premature birth, although when cared for by talented maternal fetal medicine specialists, often results in a healthy baby who may need special care in the NICU depending on how premature it is.
Yes, PPROM affects as many as 3% of all births. Although that number may not sound significant, it represents hundreds of thousands of mothers and babies each year, and is a relatively unknown condition. Risk factors for PPROM include: history of PPROM in a prior pregnancy, infections, vaginal bleeding, smokng, and having extra amniotic fluid. However, many patients have no risks factors, and there’s little to no way to know who will experince PPROM, as its causes are not identifiable through current testing and pregnancy care standards.
PPROM requires careful monitoring of patients to determine the safest treatment strategy, whether it’s inducing labor for premature delivery, or monitoring the mother and giving antibiotics while the baby continues developing.
While there are many known influences that play a role in PPROM, causes are not always diagnosable in every patient who has the condition. As Dr. Shari Gelber said in a recent episode of our Healthful Woman podcast, “For any individual patient, we never know the reason, but there are lots of possible reasons.”
PPROM is often the result of some kind of infection, such as mycoplasma, ureaplasma, GBS, and E. coli getting to the uterus, although we can not always identify the cause. Infections may weaken the membranes that are responsible for your water breaking. Other factors possibly at play include unusually strong contractions that put lots of stress on the membranes, as well as bleeding in the second trimester, as components of blood can interfere with the membranes. There may be a genetic predisposition to PPROM [you can change predisposition to risk]
Treating PPROM is a delicate responsibility, as different patients with different symptoms and conditions will need to be treated in very different ways. As the most common cause of PPROM is infection, we can separate treatment strategies into those who arrive at the hospital with obvious signs of infection and those who don’t appear to have an infection.
Once the membranes break, there’s no longer that protection against the outside world and the placenta, fetus, and uterus. This means, as Dr. Nathan Fox said on the same podcast, “It’s almost a matter of time, whether a week or two or more, before [uninfected patients] become infected.” Since infection of the uterus has severe implications for the health of the baby, typically the best treatment for near-full-term babies is to induce labor and deliver the baby.
However, for patients whose water broke early, doctors may decide to closely monitor the mother and baby to allow the baby more time to develop. This could mean waiting a week or several weeks, depending on the onset of signs of infection or labor. Supplemental treatments during this time include monitoring using ultrasound, antibiotics, steroids, and magnesium (up until 32 weeks).
When patients come to the hospital with obvious symptoms of infection regardless of gestational age, we recommend delivering the baby as the best course of treatment. This is because we cannot treat infections in the uterus, and infections come with serious risks for fetuses and mothers alike.
People of all ages and conditions are able to successfully conceive and bear healthy children, thanks to modern medical technology and techniques. With all we know about PPROM, we’re able to deliver healthy babies despite the confusing and worrying circumstances they may have been born in. To learn more about PPROM and other common pregnancy conditions, schedule an appointment with Maternal Fetal Medicine Associates by calling our office or contacting us online today.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!