Preterm premature rupture of membranes (PPROM)

What is PPROM?

Preterm premature rupture of membranes refer to the breaking of your water bag before 37 weeks of pregnancy.

Why has PPROM happened?

In many cases, the cause cannot be found. Some risk factors include:

• Premature birth or PPROM in previous pregnancy
• Smoking 
• Infection 
• Vaginal bleeding during current pregnancy
• Having twins or more 

How will I know if I have PPROM?

Not everyone will experience a “pop”, but you will feel fluid continuously trickling out of your vagina which is beyond your control (unlike urine). You may wet your underwear or clothes. If you think you may be having PPROM, contact your gynaecologist immediately.

What tests do I need to diagnose PPROM?

Your gynaecologist will need to take a detailed history and perform a vaginal examination to confirm the presence of fluid in your vagina, as well as cervical dilation. A test e.g. Actim PROM or amnicator may need to be done to confirm that the fluid in your vagina is coming from your water bag. Your temperature, blood pressure and pulse will be taken. Vaginal swabs, urine samples and blood tests need to be taken to check for infection. An ultrasound scan will be done to check your baby’s position and amniotic fluid level. An electronic monitor (cardiotocography/CTG) will be used to monitor your baby’s well-being by checking his/her heartbeat and the frequency of your contractions (if any).

What are the risks of PPROM?

• Infection
  As your water bag has broken, there is a risk of the amniotic fluid (water in your water bag) getting infected – this infection can spread to your blood from your uterus and your baby can catch the infection as well.

• Compression of umbilical cord
  With less amniotic fluid, your baby’s umbilical cord can get squeezed and blood supply/oxygen to your baby can get intermittently cut off.

• Placenta abruption
  The placenta can separate from your womb prematurely due to the decompressive effects from your water bag bursting/leaking. This can cut off blood supply and oxygen to your baby.

• Premature birth
  Most women with PPROM will end up going into premature labour within a week of their waters leaking due to various reasons. Premature babies can have problems with their brains, lungs, hearts, eyes and other organs. They can also have long-term health issues including intellectual and development delays.

How is PPROM treated?

You will need to be hospitalised. Depending on how many weeks pregnant you are, you may require:

• Steroid injections: these help mature your baby’s lungs faster to reduce the risk of breathing difficulties at birth
• Antibiotics: these reduce the risk of infection 
• Tocolytics: these are medications to relax your uterus and stop premature labour
• Intravenous magnesium sulphate: to reduce risk of preterm brain injury
• Regular temperature, blood pressure, pulse rate monitoring: fever, low blood pressure and high pulse rate are signs of infection
• Regular blood tests: increasing white cell count and other inflammatory markers are signs of infection 
• Regular checks on your baby’s heartbeat and uterine contractions (if any)
• Regular ultrasound scans to check on baby’s weight, umbilical cord blood flow and amniotic fluid levels

If you and your baby are well and your investigations return fine, you will be allowed to continue with your pregnancy with close monitoring. Labour will need to be expedited if either you or your baby start showing signs of infection or distress – this may come in the form of induction of labour or caesarean section, depending on the urgency. 

I’ve had PPROM in my previous pregnancy. Will it happen again in my next pregnancy?

You do have an increased risk of having PPROM and premature labour in your subsequent pregnancies, but there are things that can be done to reduce this risk – do speak with your gynaecologist for advice.