What causes PPROM?

Inflammation or infection can weaken the membranes. Other associated factors include bleeding during pregnancy, stretching of the uterus, a short cervix, previous cervical procedures and having had PPROM before. It can still happen without any known factor and is not usually caused by ordinary movement or routine daily activity.

The membranes normally hold amniotic fluid around the baby and help protect against infection. Once they open, fluid may leak as a gush or a continuing trickle that can be confused with urine or vaginal discharge.

PPROM can lead to labour and increases concern about infection and reduced fluid around the baby. The implications depend on how far the pregnancy has progressed, whether labour or infection is present, the baby's wellbeing and the amount of remaining fluid.

Contact your maternity unit immediately if you think your waters may have broken. Note the time, colour, smell and approximate amount of fluid, use a sanitary pad rather than a tampon, and avoid sex or placing anything in the vagina until assessed.

At the hospital, clinicians may check your temperature and pulse, assess the baby's heartbeat, examine for fluid and consider tests for infection. Depending on the findings, management can include observation, antibiotics, an antenatal steroid injection to support the baby's lung preparation, or planning birth when continuing the pregnancy is less safe.

Do not wait for a routine appointment when watery fluid is leaking, even if there is no pain. Prompt assessment can confirm whether the membranes have ruptured and guide protection for you and the baby.

Seek immediate maternity care for fever, chills, feeling acutely unwell, foul-smelling or greenish fluid, vaginal bleeding, abdominal or uterine tenderness, regular contractions, or reduced fetal movement. Call emergency services if bleeding is heavy, you collapse, or you feel an urge to push.

Ask how PPROM was confirmed, whether infection or labour is suspected, how the baby and fluid will be monitored, and what would change the timing of birth. Clarify which medicines are being offered, their purpose, whether transfer to a hospital with neonatal care is needed, and whom to call if symptoms change.