What is preterm prelabour rupture of membranes (PPROM) and what should you do? Hospital monitoring, infection risk, treatment and birth timing.
Preterm prelabour rupture of membranes is the waters breaking before labour has started and a considerable time before the expected due date. The cause cannot always be found; when you notice fluid leaking, use a pad instead of a tampon, note the colour and amount of the fluid, and contact your health team or the hospital straight away. The assessment and monitoring done in hospital aim to reduce the risk of infection and to make sure birth happens at the most suitable time.
What is preterm prelabour rupture of membranes (PPROM)?
Preterm prelabour rupture of membranes is the waters breaking before labour has started and at an early stage of pregnancy.
Why does preterm prelabour rupture of membranes happen?
The cause cannot always be found; some infections and conditions related to the placenta may play a part. Its occurrence is not related to something you did; it is nobody's fault.
What should you do when you notice your waters have broken?
If you think your waters have broken, use a pad instead of a tampon, note the colour and amount of the fluid if you notice them, and contact your health team or the hospital straight away. The amount of fluid leaking can range from a few drops to a large amount; you should seek care even if you only suspect it.
How is the diagnosis made in hospital?
The diagnosis is made with a sterile examination. If the fluid is not clearly seen, an additional test on the vaginal fluid or an assessment of the amount of amniotic fluid by ultrasound may be needed.
How is monitoring done in hospital?
A stay of a few days is generally recommended; during this time your temperature, blood pressure, pulse and blood tests for infection are monitored regularly, and your baby's heart rate is also followed. If leakage continues at home, you will need to be checked again; monitoring generally goes on according to a plan made together with your doctor.
What is the risk of infection and how is it recognised?
Once the membranes have opened, the chance of infection reaching the womb is higher. Fever, bad-smelling discharge, a rise in pulse, lower abdominal pain and a rise in the baby's heart rate are among the signs of infection; these are closely monitored. If a sign of infection is found, the baby may need to be delivered.
What are the treatment options?
The fluid that has come cannot be put back, and the opening in the membrane does not repair itself. Your doctor will plan antibiotics to reduce the risk of infection, a medicine to support the baby's lungs and development, and, if needed, additional treatments. A medicine aimed at stopping labour pains (tocolysis) is generally not recommended in this situation. The choice and length of medicines are determined by your doctor; do not use any medicine on your own or stop the recommended treatment part-way.
When and how will birth happen?
If you and your baby are well and there are no signs of infection, it may be possible to wait before birth for a time; this period is planned specifically for you. If you are found to be carrying a particular germ, birth may need to be considered earlier. Vaginal birth is mostly possible; timing, the baby's position and your personal situation are decisive.
What can it mean for the baby?
Problems with breathing, feeding and infection, and the need for newborn intensive care, can be seen in the baby; the earlier the birth, the higher the risk. Most babies are born healthy with close monitoring.
Can I go home, and how is follow-up done afterwards?
If you and your baby are well and you are not at high risk, going home after a few days can be considered. After that, your baby's heart rate, your temperature, your pulse, your blood pressure and your blood tests for infection are assessed with regular check-ups; a plan for your pregnancy is made together with your doctor.
How can you support yourself?
- Contact your health team or the hospital straight away when fluid comes.
- Do not miss the tests and check-ups recommended in hospital.
- Follow your baby's movements, and report it if you notice a change in the usual pattern.
- Report symptoms such as fever, bad-smelling discharge or abdominal pain straight away.
- Continue the recommended treatment according to your doctor's plan; do not stop it on your own.
- Share your worries; ask for support if needed.
What can you ask your doctor in hospital?
- How will you assess the leaking fluid, and is an additional test needed?
- How long will I stay in hospital, and what are the conditions for discharge?
- What is the purpose of the treatments given, and when will they end?
- When and how will my birth be planned?
- How often will check-ups be needed if I am discharged?
Frequently Asked Questions
Will preterm prelabour rupture of membranes come back in my next pregnancy?
Having had preterm prelabour rupture of membranes may raise the likelihood of preterm birth in a later pregnancy; for this reason it is recommended that you are monitored more closely by a specialist team in your next pregnancy.
Do I need to stay in hospital, or can I be monitored at home?
Most of the monitoring is done in hospital; however, in some situations follow-up at home may also be suitable. This is a decision assessed together with your doctor according to the condition of you and your baby.
Why are an antibiotic or an injection given?
These treatments aim to reduce the risk of infection and to support your baby's development. Your doctor decides which treatment is suitable for you.
Will I definitely give birth early?
A significant proportion go into labour within a short time, but this does not apply to everyone. If you and your baby are well, it may be possible to wait before birth for a time.
What other risks may there be for my baby?
Compression of the umbilical cord (cord prolapse) and problems related to lung development are also among the risks that can be seen in this situation; these possibilities are also closely followed during monitoring in hospital.
If I only suspect my waters have broken, should I still seek care?
Yes. The amount of fluid leaking can range from a few drops to a large amount. Even in doubt, contact your health team or the hospital straight away.
Should I use a tampon when fluid comes?
No. Use a pad instead of a tampon; if you can, note the colour and amount of the fluid. Do not delay seeking care.
Is one examination always enough for the diagnosis?
If the fluid is not clearly seen on the sterile examination, an additional test on the vaginal fluid or an assessment of the amount of fluid by ultrasound may be needed. Your health team decides whether it is necessary.
Can signs of infection affect the birth plan?
Yes. Fever, bad-smelling discharge, a rise in pulse, lower abdominal pain and a rise in the baby's heart rate are monitored. If infection is found, the baby may need to be delivered.
Are medicines that stop labour pains routinely recommended in preterm prelabour rupture of membranes?
No. Tocolysis is generally not recommended in this situation. Your doctor determines which medicines are used and for how long.
Does the waters breaking early mean I will definitely have a caesarean?
No. Vaginal birth is mostly possible. Timing, the baby's position and your personal situation are assessed together.
If I am discharged, is the follow-up complete?
No. Your and your baby's condition is monitored with regular check-ups. If leakage continues at home, you will need to be checked again; you should report new symptoms and changes in movements.
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