If you’re expecting, you may wonder when your water will break, where you’ll be, and if it will happen unexpectedly or too early. Premature Rupture of Membranes (PROM) is a condition that happens during pregnancy when the membranes of the amniotic sac break at least an hour before labor starts. If this happens before 37 weeks of pregnancy, then the condition is called Preterm Premature Rupture of Membranes (PPROM).
To put your mind at ease, here are some helpful facts and figures about PROM and PPROM:
- PPROM happens in only 150,000 pregnancies each year, and this translates to less than three percent
- Only 15 percent of pregnant women have PROM: the water breaks about one hour to 18 hours (“prolonged” PROM) before labor starts
- PROM, the rupture of the membranes just before the onset of labor, typically initiates labor and there is no extra intervention needed
Why Membranes Rupture
The possible reasons membranes may break early are plentiful. PROM may be associated with factors ranging from sexually transmitted infections to lower socioeconomic conditions (women in such situations may be less likely to get adequate prenatal care).
On the other hand, PPROM usually has different causes and outcomes. While PROM is a variation of the normal 40-week gestation that precedes labor by about an hour or so and generally not serious, PPROM typically is caused by a uterine infection and is quite dangerous. It is more serious than PROM, as it most often triggers an early delivery.
Why PPROM Occurs
Any number of things may contribute to PPROM, including:
- Infections of the uterus, cervix, or vagina
- Excess stretching of the amniotic sac (due to a large amount of fluid or multiple babies exerting pressure on the membranes)
- Poor diet and/or inadequate hydration
- Excessive smoking
- Recent surgery (or other procedure) of the cervix
- Premature rupture of membranes with a previous birth
Other clinical factors linked with PPROM are:
- Low BMI (body mass index)
- Vaginal bleeding during pregnancy
- Weak cervix (incompetent cervix) that opens early
- Amniocentesis
- Inflammation or weakening of the membranes
- Early contractions
Signs of Your Water Breaking
If your membranes rupture when you’re going about your day, the fluid usually comes out as a slow leak—rather than a giant gush.
Since the amniotic fluid usually is a slow trickle, some women mistakenly think it is urine. You can tell the difference between amniotic fluid and urine by odor and appearance: Amniotic fluid has a faint sweet smell, whereas urine has a strong odor of ammonia.
Try to squeeze your pelvic muscles, and if the flow of fluid stops—then it’s urine. If not, then it’s the fluid from the amniotic sac. Be sure to contact your doctor immediately if you believe your membranes have ruptured. You need to get to the doctor right away.
Your Risk for PPROM
Will you have a preterm premature rupture of membranes? This condition -- PPROM -- occurs even less often than PROM. Only 3 percent of expectant moms have PPROM.
The outcome depends on how many weeks you are into the pregnancy. Babies in gestation for less than 32 weeks have an increased risk of pulmonary issues since their lungs have not matured as much. Some doctors recommend antenatal steroids to be given in an effort to enhance lung maturity when PPROM occurs at the time the fetus is less than 32 weeks in gestation.
You can be sure that if your membranes rupture before contractions begin, your labor will pretty much begin within a day. Or, your doctor may induce labor for you (with a medication called Pitocin or oxytocin) within that 24-hour time period.
Lower Your Risk for PPROM
To improve your chances of having a full-term pregnancy, be sure to keep your doctor updated on any abnormal changes. For example, contact your doctor if you show signs of pre-term contractions. Make sure you also inform him or her if you had PROM (the less serious “cousin” of PPROM) with prior pregnancies.
Your doctor plays a vital role in managing your pregnancy and must be kept constantly updated about your condition. He or she can suggest possible interventions to help reduce your chances of complications.