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A. This information is for you if you think that, or have been told that, your waters have broken early but you have not gone into labour. This applies to you if your waters may have broken between 24 and 37 completed weeks of pregnancy.
A. Your baby is surrounded by amniotic fluid or ‘waters’ contained within a membrane bag (the amniotic sac) inside your uterus.
When the waters break, it is also known as rupture of the membranes. Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is known as preterm prelabour rupture of membranes (PPROM). This can happen in up to 3 out of every 100 (3%) pregnant women. PPROM is associated with 3 to 4 in 10 preterm births.
The reason why PPROM happens is not always known but may be because of infections, placental problems or other causes.
A. You may notice a ‘gush’ of fluid or you may feel damp. The amount of fluid you lose may vary from a trickle to a gush.
A. If you think that you are leaking fluid from the vagina, wear a pad not a tampon and note the colour and amount of the fluid. Leaking urine is common while you’re pregnant, but if you think your waters may have broken, you should contact your obstetrician and go to the hospital for a check-up straight away.
A. You will have a check-up that should include:
A. PPROM is best diagnosed by a vaginal examination. With your consent, your healthcare professional will use a sterile speculum (an instrument used to separate the walls of the vagina) to look at your cervix and see whether the leaking fluid is amniotic fluid.
A swab test of the fluid may help to decide whether your waters have broken, if it is still unclear after the speculum examination.
An ultrasound scan to estimate the amount of fluid around your baby is sometimes helpful.
A. If your waters have broken, you will usually be advised to stay in hospital for a few days, although in some situations this may be for longer. You and your baby will be closely monitored for signs of infection. This will include having your temperature, blood pressure and pulse taken regularly, together with blood tests to check for infection. Your baby’s heart rate will also be monitored regularly.
If your waters have not broken, you should be able to go home.
If only a very small amount of amniotic fluid is leaking, it is not always easy to see on examination and it can be difficult to confirm whether your waters have broken. If you continue to leak fluid at home, you should return to the hospital for a further check-up.
A. PPROM may lead to the following:
Infection
The membranes form a protective barrier around the baby, and after these have broken, there is a risk of infection getting into your uterus (chorioamnionitis). If you have an infection, this can cause you to go into labour early or cause you or your baby to develop sepsis.
The symptoms of infection include a raised temperature, an unusual vaginal discharge with an unpleasant smell, a fast pulse rate and pain in your lower abdomen. Your baby’s heart rate may also be faster than normal.
If there are signs that you have an infection, your baby may need to be born straight away to try to prevent both you and your baby becoming more unwell.
Preterm birth
About 50% of women with PPROM will go into labour within the first week after their waters break. The further along you are in your pregnancy the more likely you are to go into labour within 1 week of your waters breaking.
Problems of prematurity
Babies born prematurely have an increased risk of health problems, particularly with breathing, feeding and infection, and may need admission to a neonatal unit. The earlier your baby is born, the more likely that this will be the case.
If your waters have broken early, your obstetrician will discuss with you the possible outcomes for your baby, depending on how many weeks pregnant you are when this happens and on your individual circumstances.
Other complications
If you experience PPROM, sometimes your baby may not survive. The risk of this happening is greater if your waters break very early, if the baby is born very prematurely or, in some cases, following infection or cord prolapse.
A. It is not possible to replace the fluid or repair the hole in the membranes around your baby. You may carry on leaking fluid for the rest of your pregnancy as amniotic fluid continues to be made.
However, treatment may be offered to reduce the risk to your baby. This could include:
A. You will usually be advised to stay in hospital for a few days after your waters break, to monitor both your and your baby’s wellbeing. Your obstetrician will discuss with you the option of going home after this time, if you are well and not considered to be at higher risk for giving birth early.
A. Contact your obstetrician and return to the hospital immediately if you experience any of the following:
A. You should have regular check-ups (usually one or two times per week).
During these check-ups, your baby’s heart rate will be monitored, your temperature, pulse and blood pressure will be checked and you will have blood tests looking for signs of infection. Your obstetrician will work with you to make an ongoing plan for your pregnancy.
A. If you and your baby are both well with no signs of infection then you may be advised to wait until 37 weeks to give birth. This is because carrying on with the pregnancy reduces the risk to your baby that are related to being born preterm.
If you are known to carry the GBS bacteria then you may be advised to give birth from 34 weeks because of the risk of GBS infection in your baby.
A. It is often possible to have a vaginal birth after PPROM but this will depend on when you go into labour, the position your baby is lying in in your uterus, and your own individual circumstances and choices.
A. Having PPROM or giving birth prematurely means that you are at an increased risk of having a preterm birth in any future pregnancies.
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