My Second Trimester

However, when your membranes rupture before Week 37, Preterm Premature Rupture Of Membranes (PPROM) occurs. This pregnancy complication is present in less than three percent of pregnancies but is associated with 40 percent of preterm deliveries and can lead to significant morbidity and mortality. The earlier PPROM occurs, the more serious it is for both you and your baby. This complication increases your chance of infection as well as the possibility of delivering your baby too soon.

The causes of PPROM are usually unknown in the majority of cases. You may be at risk if you have experienced any of the following:

1. A previous preterm birth, a previous PROM or PPROM.
2. An infection in your reproductive system (cervix, uterus or vagina).
3. Vaginal bleeding.
4. Smoking during pregnancy.
5. Too much stretching.
6. Too much pressure on the amniotic sac (polyhydramnios or multiples).
7. Placental abruption.
8. You have had a surgery or biopsies of the cervix.

The symptoms of PPROM can differ from pregnancy to pregnancy. The major sign to be aware of is fluid leaking from your vagina. Initially, you may experience a popping sensation, a gush, slight leaking or a feeling of wetness in your vagina or underwear. Women may mistake a slow leak of amniotic fluid for urine and not be alarmed. If you notice any leaking, use a pad to absorb the fluid. Then look at it and smell it. If you smell ammonia, it’s probably urine. Amniotic fluid is colorless with a sweet smell. As with any new or different symptom of pregnancy and to avoid confusion, call your health care team immediately to be on the safe side.

Your health care team will ask you about your symptoms and make the diagnosis of PPROM following an examination. Your cervix may have softened and possible be beginning to dilate. The fluid leaking form your cervix will be tested to see if it is amniotic fluid, vaginal fluid, or urine. An ultrasound may also be done to measure the amount of amniotic fluid around your baby.

The primary risks of PPROM are:

1. In an early pregnancy, oligohydramnios.
2. A prematurely delivery.
3. An infection of the amniotic fluid.
4. Placental separation form the uterus.
5. A retained placenta.
6. Primary or secondary postpartum hemorrhage.
7. There may umbilical cord issues such as compression or prolapse of the umbilical cord if your baby’s head is not engaged in the pelvis.
8. Surgical or cesarean section delivery

If your doctor finds that you have PPROM, you may need to be in the hospital on bed rest until your baby is born. Your treatment plan will depend on various factors.

If you are between 34 and 37 weeks when your water breaks, your provider will likely suggest that you be induced; this may be done earlier if complications arise. It is safer for your baby to be born a few weeks early than it is for you to risk an infection.

If your water breaks before 34 weeks, it is more serious. If there are no signs of infection or labor starting, you may be put on bed rest. You will be closely watched and monitored for any signs of labor or contractions, and any sign of infection such as fever, pain or an increase in your baby’s heart rate. Your baby’s movements and heart rate will also be monitored.

Your treatment may include antibiotics to help prevent infections, steroid medicines that will help your baby’s lungs mature and tocolytic medicines to stop preterm labor.

Tests to check your baby’s lungs may be done such as an amniocentesis to check for infection or to see if your baby’s lungs are mature enough for delivery. When the lungs have matured, labor will be induced. Both you and your baby will be watched very closely.

If your baby is delivered prematurely, your health care team will guide you with the safest and best course of action. Once you deliver your baby, he or she will be sent to the Neonatal Intensive Care Unit (NICU) for specialized care. However, if there is not a NICU where you deliver, both you and your baby will be transferred to a hospital with a NICU and care for you both.

Prevention

Depending on your risk factors and circumstances, speak with your health care team about the possibility of preventing PPROM. Together you can discuss the potential benefits of progesterone supplementation, cervical cerclage and other possible treatments that may help your pregnancy reach 40 weeks.

For more information on PPROM, please visit University of Rochester Medical Center and Little Heartbeats.