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Preterm Prelabour Rupture of Membranes (pPROM): Care instructions

Preterm Prelabour Rupture of Membranes (pPROM)

Care instructions

Preterm prelabour rupture of membranes (pPROM) is when the amniotic sac breaks or leaks before contractions start. It’s called preterm when it happens before 37 completed weeks of pregnancy. Preterm labour may begin shortly after pPROM occurs.

The cause for pPROM is often hard to identify and it often happens unexpectedly. Some known causes of pPROM include:

  • Have had preterm PROM or preterm labour and delivery before.
  • Infection of the uterus, which is a common cause of pPROM.
  • Overstretching (distension) of the uterus and amniotic sac. Multiple babies or too much amniotic fluid (polyhydramnios) are common causes of distension.
  • Trauma, as from an injury.

How is pPROM treated?

Your healthcare provider will watch you closely until your baby can be safely delivered. Depending on the number of weeks completed in pregnancy, your healthcare provider may want to start (induce) labour with medicine if labour doesn’t start on its own. This is meant to speed up delivery and lower the risk of infection.

Treatment for pPROM may include:

  • Antibiotics, given to treat or prevent amniotic fluid infection.
  • Antenatal corticosteroid medicines which are used to speed up fetal lung maturity at or before 34 weeks.
  • An observation period or expectant management may be offered.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your healthcare provider or nurse call line if you are having problems. It is also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • If your healthcare provider prescribed medicines, take them exactly as directed. Call your healthcare provider, midwife, or nurse call line if you think you are having a problem with your medicine.
  • Rest until your healthcare provider advises you about activity.
    • You may be asked to take your temperature and pulse (follow the instructions you were given about how often).
  • Watch for signs of infection and preterm labour.
  • Avoid sources of infection.
    • Shower instead of having tub baths.
    • Change your sanitary pad regularly – at least every 3 to 4 hours.
    • Don’t use douches or tampons.
    • Don’t have sexual intercourse.
  • Count your baby’s movements (follow the instructions you were given about how often). For more information on counting your baby’s movements go to: Fetal Movement Count Chart (albertahealthservices.ca).
  • Do not use tobacco or tobacco-like products, including cannabis, and other substances. They can harm your health. They also affect your baby’s growth, health, and the development of their brain and lungs. If you need help to use less or quit, talk to your healthcare provider, or go to the Alberta Quits website.
  • Do not drink alcohol. Alcohol affects everyone differently and may be a risk to your health. Alcohol passes through the placenta to your baby and can cause problems with their growth, health, and development.

Pregnancy can be an emotional and unpredictable time. When you have complications in your pregnancy you may have more stress. This may lead to other concerns for you and your family. Talk to your healthcare provider about how you’re feeling and any concerns you have.

How to check for contractions

It’s important to know how to feel your belly for contractions of your uterus in case you go into preterm labour. To feel for contractions:

  • While lying down, rest your fingertips on the top of your uterus. If your uterus contracts, you’ll feel your belly get tight or hard, then relax and soften when the contraction is over.
  • To tell how often the contractions are, count the minutes that go by from the beginning of 1 contraction to the beginning of the next. You may find it helpful to write the times down on paper.
  • If you have a clock with a second hand, you can also note how long each contraction lasts. There are also apps available for your smartphone to count contractions
  • Keep doing this for 1 hour. If you feel more than 6 contractions in 1 hour, go now to the labour and delivery unit where you plan to have your baby.

Never ignore the symptoms or assume that they mean nothing. It’s better to go to the hospital for an assessment than to wait too long.

When should you call for help?

Share this information with your partner or a friend. They can help you watch for warning signs.

Call 911 anytime you think you may need emergency care. For example, call if:

  • You notice the baby’s umbilical cord has come through the opening of the uterus (cervix). If this happens, get down on your hands and knees so your rear end (buttocks) is higher than your head. This will lower the pressure on the cord until help arrives.
  • You have severe vaginal bleeding.
  • You have severe pain in your belly or pelvis that doesn't get better between contractions.

Call your healthcare provider, midwife, or nurse call line now or seek immediate medical care if:

  • You develop signs of infection.
    • Fever or chills
    • Rapid or racing pulse
    • Tender or painful abdomen (belly).
    • Foul-smelling vaginal discharge.
  • You are experiencing signs or symptoms of preterm labour:
    • Menstrual-like cramps – may be constant or come and go.
    • Low, dull backache.
    • Vaginal bleeding
    • Pelvic pressure or fullness like the baby is pushing down.
    • Abdominal (belly) cramps with or without diarrhea, nausea, or vomiting.
    • Vaginal discharge – change or increase.
    • Contractions of your uterus with or without pain – 6 or more in 1 hour.
  • You notice that your baby has stopped moving or is moving much less than normal.

Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse call line if you have any questions or concerns.

To see this information online and learn more, visit https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=custom.ab_pregnancy_pprom_ac_adult

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For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: February 9, 2022

Author: Antenatal Public Health, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.