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Preterm Premature Rupture of Membranes (pPROM)

Overview

Before a baby is born, the amniotic sac breaks open, causing amniotic fluid to gush out or, less commonly, to slowly leak. When this happens before contractions start, it is called prelabour rupture of membranes (PROM). PROM can occur at any time during pregnancy.

When PROM occurs before 37 completed weeks of pregnancy, it usually leads to preterm labour. You may hear this early PROM referred to as preterm prelabour rupture of membranes, or pPROM.

Preterm PROM is often unexpected, and the cause is often hard to identify. Known causes of pPROM include:

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

Course of pPROM

Preterm labour may begin shortly after pPROM occurs. Sometimes, when a slow leak is present and infection has not developed, contractions may not start for a few days or longer. In general, the later in a pregnancy PROM occurs, the sooner the onset of labour.

Sometimes a leak high up in the amniotic sac may reseal itself so that preterm labour does not start or subsides.

Treatment for pPROM

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.
  • 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.

Other treatment for pPROM

After amniotic membranes have ruptured, tocolytic medicine is less effective in slowing or stopping preterm labour contractions. But tocolytic medicine is sometimes used to delay a preterm birth long enough for antibiotics and antenatal corticosteroid medicine to work (24 hours) or long enough to transport the pregnant person to a hospital that has a neonatal intensive care unit (NICU).footnote 1

References

Citations

  1. American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2007). Obstetric and medical complications. In Guidelines for Perinatal Care, 6th ed., pp. 175–204. Elk Grove Village, IL: American Academy of Pediatrics.

Credits

Adaptation Date: 5/24/2022

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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