As your baby grows inside your womb, they’re encased in an amniotic sac. The amniotic fluid cushions your baby, providing protection for growth. Part of the labor process includes the rupture of membranes (ROM). When the membranes rupture, it usually means the baby’s birth is going to happen soon.
Sometimes, membranes rupture before labor begins. When this occurs after 37 weeks gestation, it’s known as premature rupture of membranes (PROM.) When this occurs before the fetus is 37 weeks, this is known as preterm premature rupture of membranes (PPROM). Because the membranes prevent infectious organisms from reaching you and your baby, the risks for infection are much greater once the membranes have ruptured. The risk continues to increase the longer that that your membranes have been ruptured prior to delivery.
Amniotic fluid levels can vary during your pregnancy. At about 36 weeks, the amount of fluid is roughly 1 quart. It begins to decrease as your baby grows larger.
When your membranes rupture, you may experience a strong gush of fluid. For some women, the amniotic fluid doesn’t flow as quickly. Instead, you may notice some unexplained wetness in your underwear that continues with time.
Call your doctor if you suspect PROM has taken place. They can conduct a physical exam to determine if PROM has taken place.
Certain groups of women are known to be at risk for PROM. Your doctor may discuss these risks with you. There are many you can’t change, which include:
- having lower socioeconomic status
- experiencing significant vaginal bleeding
- being African-American
- experiencing uterine distention, such as from excess amniotic fluid or pregnancy with multiple babies
- having a history of preterm delivery
- having a history of sexually transmitted infections, such as chlamydia and gonorrhea
Women experience PROM every day without any of these risk factors. Some women have multiple risk factors and don’t experience PROM. If you’re concerned about your unique risks, talk to your doctor.
Your doctor will diagnose PROM based on your symptoms and a physical examination. Your doctor will ask you questions about the fluid leaking, including how much you noticed leaking and when it began. Your doctor may take a sample of the fluid. They can test the pH level of the fluid, which can indicate if the fluid is coming from the membranes. The dried fluid also will create a distinctive, fern-like pattern when examined under a microscope.
Your doctor will also likely perform an ultrasound to determine how much fluid is around your baby. If the fluid has significantly decreased, you’ve likely experienced PROM.
Treatments for PROM depend on how far along your are in your pregnancy. The American Academy of Family Physicians has a suggested an algorithm for obstetricians to follow when treating women with PROM.
24 to 31 Weeks Pregnant
If you’re 24 to 31 weeks pregnant, your doctor will give corticosteroids to help your baby’s lungs mature. Antibiotics will also be given to prevent infection. If possible, your doctor will delay delivery until 34 weeks’ gestation. If your baby’s lungs seem mature enough, your doctor will deliver your baby earlier.
32 to 33 Weeks Pregnant
If you’re 32 to 33 weeks pregnant, your doctor will give you antibiotics and corticosteroids. They may also perform an amniocentesis or other tests to determine your baby’s lung maturity to determine when to deliver your baby. If possible, waiting until 34 weeks’ gestation is preferred.
34 to 36 Weeks Pregnant
If you’re 34 to 36 weeks pregnant, your doctor will likely recommend delivering your baby. You’ll also be given antibiotics to reduce your risk of infections from bacteria such as group B Streptococcus.
If you’re 37 weeks along or further, your doctor will likely recommend delivering your baby.
PROM increases the risk of infection for both women and their babies. Also, if you experience PPROM before 24 weeks, your baby is at risk for medical conditions, such as limb deformities, neurologic impairment, and pulmonary hypoplasia, in which the lungs don’t develop properly.
Your doctor will work with you to do everything possible to allow your baby to mature before delivery to prevent these complications. With prompt care, you can safely welcome your baby into the world, even if it’s a little earlier than planned.
Getting regular prenatal care and quitting smoking if you smoke are two ways you may be able to prevent PROM. There are few other known interventions that could help prevent PROM from occurring.
Get help from your doctor immediately if you think your membranes have ruptured.
Written by: Rachel Nall, RN, BSN, CCRN
Medically reviewed on Feb 10, 2016 by Steve Kim, MD