About 12 days after you conceive, your baby’s amniotic sac develops.
This sac will hold the amniotic fluid and your growing baby.
Amniotic fluid provides cushion to allow baby to move, protection from infection and injury, nutrition, and helps baby’s lungs and digestive system to develop and mature.
In most pregnancies, the baby’s membranes will rupture (known as the water breaking) sometime after labour has begun, and occasionally it never ruptures with baby being born still inside the sac (called being born in the caul).
In about 10% of pregnancies the water breaks prior to labour beginning, this is known as premature rupture of membranes (PROM).
In 3% of pregnancies the water breaks not only before labor but prior to reaching full term, this is known as a preterm premature rupture of membranes (PPROM).
If you think you might be leaking amniotic fluid prior to 37 weeks, or you know your water has ruptured, it’s very important to contact your maternity care provider immediately.
What Causes A Preterm Premature Rupture Of Membranes?
Sometimes we know why a PPROM occurs (e.g. following a trauma like a car accident) but in some cases there’s not a known reason. There are some risk factors and potential causes for a PPROM which include:
- Cervical insufficiency
- Previous preterm birth with PPROM
- Previous cervical or uterine surgery
- Infections or inflammation
- Polyhydramnios (higher than normal amniotic fluid levels)
- Carrying multiples
- A cerclage or amniocentesis
- A trauma such as a car accident or fall
How Is A PPROM Treated?
How your PPROM is managed will depend on how many weeks pregnant you are, if there’s a known cause such as infection, if labor quickly begins following rupture, and how baby is tolerating the low fluid levels.
Some common steps for managing a PPROM include:
- IV antibiotics are often given; the type and duration depend on GBS status or if any other infections are found
- Depending on your gestation, magnesium is given to protect baby’s brain as well as potentially stop or reduce contractions
- If you’re less than 32 weeks, one to two steroid injections are given to help mature baby’s lungs
- If you’re on magnesium you’re a fall risk and thus will be on strict hospital bedrest. After you finish the magnesium (12-48 hours), or if you didn’t need magnesium, you’ll still be on bedrest but you might be able to get up to use the bathroom.
- Baby’s heart rate will be monitored continuously or intermittently depending on how baby has been doing
- You will be monitored for infection via temperature checks, blood work and symptoms
- The usual goal is to continue pregnancy until 34 weeks when possible, but if mother or baby are no longer tolerating the pregnancy (e.g. infection, fetal heartrate concerns, decreased movement, high blood pressure, etc) then birth becomes necessary regardless of gestation
PPROM At 34-36 Weeks
If you’re 34 weeks or more, many maternity care providers will allow labor to begin if you’re showing signs, recommend an induction, or consider a c-section (if there are complications such as infection).
Typically, if you’re over 34 weeks, many providers believe baby is developed enough that birth is safer than the risk of waiting and potentially developing an infection.
However, some providers might recommend attempting to prolong the pregnancy and using prophylactic antibiotics.
PPROM At 32-33 Weeks
At this stage of pregnancy, your maternity care provider will want to prolong pregnancy provided there’s no active infection, you’re not showing signs of labour, and baby is tolerating the low fluid levels.
If there are any concerns about your wellbeing or baby’s, however, baby is developed enough that the benefit of prolonging pregnancy no longer outweighs the risk of continuing with a prolonged PPROM.
If you’re not showing signs of labour but baby should be born for safety, an induction or c-section is discussed.
PPROM At 24-31 Weeks
During this gestational stage, baby has reached viability but every day in utero improves baby’s chance of survival, and decreases the likelihood of short and long term effects of prematurity.
Unless there’s an active infection or baby is doing unwell, the recommendation is to provide antibiotics to reduce the risk of infection, give magnesium to protect baby’s brain and reduce risk of labour beginning right after PPROM, and give steroid injections to help baby’s lung development.
PPROM At Less Than 24 Weeks
PPROM prior to 24 weeks does carry the risk of extra short and long term complications as baby’s lungs utilize amniotic fluid to properly develop. Extremely low fluid levels at this stage can impact lung development even when the pregnancy is prolonged.
However, it’s important to remember that an increased risk isn’t a guarantee. Your maternity care provider is likely to follow many of the same protocols as the 24-31 week gestation while counseling you about what to expect given the earlier gestation.
What Should I Expect Following A PPROM?
With all of the variables of pregnancy it can be hard to know what to expect even in the most textbook of pregnancies. When things deviate from a typical pregnancy it can be even harder to feel prepared. As with any pregnancy situation, each unfolds uniquely, but there are somethings you’re likely to experience.
If you experience a PPROM you’re likely to experience:
- Admission to a maternity or prenatal ward until baby is born
- Testing for any infections, frequent temperature checks and vital sign checks
- An IV line placed for any antibiotics, basic fluids, or any other necessary medications
- Strict bedrest, if you’re not on magnesium you’re typically able to get up to go to the bathroom, shower, etc. If you’re on magnesium you’re not able to get out of bed, you’re likely to receive a catheter
- A consult with a perinatologist (a doctor specialising in high risk pregnancies)
- A consult with a neonatologist to learn what to expect and information about decision making
- If your hospital staffs lactation consultants, you can have a consult with an IBCLC about providing breast milk for your premature baby
- Depending on how long your pregnancy continues and what, if any, additional complications arise, the birth will likely be attended by several different medical professionals. There may be a midwife and/or doctor, a neonatologist, respiratory therapist and nurses for you and baby
- Every NICU has slightly different policies, but generally you can expect to stay until close to your baby’s original due date. Sometimes, babies are discharged between 34-37 weeks if they meet the discharge criteria (eating, breathing without assistance, no cardiac concerns, maintaining body temperature, and able to safely ride in a car seat)