ConditionWomen's & pregnancy health
Premature Rupture of Membranes (PROM and PPROM)
Premature rupture of membranes (PROM) means the amniotic sac breaks, and your water breaks, before labor begins. At term (37 weeks or later) it happens in about 8 to 10% of pregnancies, and most people go into labor within a day. When it happens before 37 weeks it is called preterm PROM (PPROM), which affects about 3% of pregnancies and is a leading cause of preterm birth. Any suspected leak of fluid needs prompt assessment at your birthing unit.
Also called: PROM, PPROM (preterm premature rupture of membranes), water breaking early, prelabor rupture of membranes
At a glance
- What it is
- Breaking of the amniotic sac before labor starts.
- PROM
- At 37 weeks or later. Labor usually follows within 24 hours.
- PPROM
- Before 37 weeks. Raises risks of preterm birth and infection.
- Signs
- A gush or steady trickle of clear or pale fluid from the vagina.
- Main risks
- Infection (chorioamnionitis), cord prolapse, placental abruption, preterm birth.
- Care
- Hospital assessment. Induction at term, or careful monitoring with antibiotics and steroids if preterm.
When to get help
Call 911 or go to the ER
- Feeling or seeing the umbilical cord in the vagina after your water breaks. Call 911, get on hands and knees with your bottom raised, and do not push the cord back
- Heavy bleeding, constant severe abdominal pain or a hard, tender uterus
- Fever with fast heartbeat, foul-smelling fluid or abdominal tenderness after your water breaks
- Reduced or no baby movements
See a doctor within a day or two
- Any gush or continuous trickle of fluid from the vagina before labor, at any stage of pregnancy. Call your birthing unit and go in for assessment
- Green, brown or bloody fluid
- Regular contractions before 37 weeks
Book a routine appointment
- Increased watery discharge that you are unsure about, after calling your provider for advice
What happens when membranes rupture
The baby develops in a fluid-filled sac made of two membranes. The amniotic fluid protects the baby, allows lung development and cushions the umbilical cord. Normally the sac breaks during labor. When it breaks earlier, the barrier against infection from the vagina is lost, the cord can slip down, and the uterus may start contracting.
How to tell if your water broke or it is urine
| Amniotic fluid | Urine | Normal pregnancy discharge | |
|---|---|---|---|
| Amount | Gush or steady trickle you cannot stop | Small leak, often with coughing or laughing | Thin, milky, small amounts |
| Color | Clear or pale straw, may have white specks | Yellow | White or clear |
| Smell | Mild, sweet or no smell | Smells like urine | Mild |
| Control | Cannot stop it with pelvic floor squeeze | Often can stop | Not a flow |
If you are unsure, put on a pad, lie down for 30 minutes, then stand up. A new gush suggests amniotic fluid. Still, always call your provider to get checked.
Causes and risk factors
Often the cause is not known. Risk factors include:
- infection of the vagina, cervix or uterus, including group B strep, bacterial vaginosis and sexually transmitted infections
- previous PPROM or preterm birth
- smoking
- short cervix or cervical insufficiency
- multiple pregnancy or excess amniotic fluid, which stretch the uterus
- vaginal bleeding during pregnancy
- procedures such as amniocentesis or cervical cerclage
- low body weight and nutritional deficiencies
Diagnosis
- Sterile speculum examination: looking for fluid pooling in the vagina or leaking from the cervix
- pH (nitrazine) testing: amniotic fluid is alkaline
- Fern test: dried amniotic fluid shows a fern pattern under a microscope
- Rapid protein tests such as PAMG-1 or IGFBP-1 when the diagnosis is unclear
- Ultrasound: to check the baby's position, growth and fluid level (oligohydramnios)
- Monitoring the baby's heart rate and checking for contractions and signs of infection
Digital vaginal exams are limited, especially in PPROM, to reduce infection risk.
Management
Term PROM (37 weeks or later)
- most people start labor within 24 hours
- ACOG recommends inducing labor (usually with oxytocin) rather than waiting, as this lowers infection risk for the mother and baby
- antibiotics for group B strep if positive or unknown
Preterm PROM
Management depends on gestational age, infection and the baby's condition:
| Gestation | Typical management |
|---|---|
| 34 weeks or later | Delivery is generally recommended |
| 24 to 33 weeks | Expectant management in the hospital, antibiotics to prolong pregnancy, corticosteroids for baby's lungs, magnesium sulfate if birth before 32 weeks is likely, monitoring for infection |
| Before 24 weeks (previable) | Counseling about outcomes, which can be poor, and individualized care |
Delivery is recommended at any stage if there is infection, abruption, fetal distress or cord problems.
Complications
- Chorioamnionitis: infection of the membranes and fluid, causing fever, fast heart rate and uterine tenderness
- Preterm birth and its complications for the baby
- cord compression or prolapse
- placental abruption
- low amniotic fluid, affecting lung development in very early PPROM
- postpartum infection
Outlook
At term, most babies are born healthy within a day or two. With PPROM, outcomes depend mainly on gestational age at birth. Babies born after 32 to 34 weeks generally do well. Very early PPROM carries higher risks. Those with a history of PPROM may be offered progesterone or closer monitoring in future pregnancies.
Frequently asked questions
What is premature rupture of membranes?
It is when the amniotic sac breaks before labor starts. At 37 weeks or later it is called PROM. Before 37 weeks it is called preterm PROM (PPROM), which raises the risk of premature birth and infection.
How do I know if my water broke or if I peed?
Amniotic fluid usually comes as a gush or a steady trickle you cannot control, is clear or pale and does not smell like urine. Urine is yellow and smells like urine. If you are not sure, call your provider and get checked.
What happens if your water breaks before 37 weeks?
You will be admitted to the hospital. Depending on how many weeks you are, care may include antibiotics to prevent infection and lengthen pregnancy, steroids for the baby's lungs, and close monitoring. Delivery is usually recommended at 34 weeks or if infection develops.
How long can a baby stay in the womb after the water breaks?
At term, delivery is usually within about 24 hours, often with induction. With PPROM, pregnancy may continue for days to weeks with careful monitoring, though most people deliver within a week.
Can you prevent premature rupture of membranes?
Not always. Avoiding smoking, treating vaginal and urinary infections, attending prenatal care, and, for those at high risk, progesterone or cerclage when recommended may lower the risk of preterm birth.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Obstetricians and Gynecologists: Practice Bulletin 217, Prelabor Rupture of Membranes (2020)
- American College of Obstetricians and Gynecologists: Preterm Labor and Birth FAQ
- MedlinePlus: Premature rupture of membranes
- NHS: Waters breaking early
- Society for Maternal-Fetal Medicine: Patient resources on PPROM