Updated October 2013

Explaining premature birth - risks and causes

Waters breaking early (PPROM)

If your waters break early seek medical advice straight away as you could be at risk of premature labour.

Your unborn baby lies in an amniotic sac of fluid or ‘waters’. ‘Waters breaking’ means that the sac has ruptured or broken. Your waters normally break around the time labour is due but in around 2% of pregnancies they break early for various reasons (see below).

If your waters break before your baby has reached full term, the medical name for it is preterm premature rupture of the membranes, or PPROM. If this happens early, before the contractions start, it can (but does not always) trigger early labour.

Waters breaking early (PPROM) illustration

Have my waters have broken early (PPROM)?

If your waters have broken early, you will experience it as a trickle or a gush of water from your vagina. If it isn't too heavy you can use a sanitary towel to catch it. This will also allow you to see what colour it is. It may be pinkish if it contains some blood, or it may be clear. If it is heavy, you may need to use a towel.

What are the risks if my waters break early (PPROM)?

If your waters break early the risks and treatment are dependent on the stage of pregnancy you are at.

  • You are at risk of going into labour prematurely – the health risks for the baby of early birth are greater the younger they are.
  • If you do not go into labour, you and the baby are at risk of infection because the normally sterile waters have been broken.

The doctors have to balance these two considerations. If the waters have broken because of infection, you and the baby have a high risk of getting the infection and you may need to deliver sooner to prevent this.

If the waters have broken but there is no infection currently present, you and the baby are still at risk but the immediate risk is lesser and your treatment will depend on your stage of pregnancy.

If you are under 24 weeks of pregnancy and the baby is born, sadly, it is unlikely the baby will survive.

If you are over 30 weeks and the baby is born, the likelihood of your baby surviving is very high - over 95%

What will happen if my waters break early (PPROM)?

Over 80% of women who have PPROM deliver their baby within seven days of their waters breaking.

If you don't go into labour, you may leak fluid for the rest of your pregnancy. However, you and the baby are at high risk of infection and you could suddenly go into labour.

If you are past 34 weeks the doctor will weigh up the benefits of inducing delivery before the due date to avoid the risk of infection with the disadvantages of being born premature, and may make a recommendation for early delivery.

You may need to stay in a hospital that has a neonatal unit and be monitored carefully for any sign of infection. You may also be treated with antibiotics and corticosteroids, to help prepare your baby's lungs in case he is born prematurely.

What if there are no waters left in my womb?

Your baby’s amniotic sac has to have the right amount of amniotic fluid for the pregnancy to continue normally. If there is a break in the waters your baby will continue to produce amniotic fluid.

Before 23 weeks, the baby needs ‘waters’ to be present for their lungs to develop normally. Loss of water before this can lead to severe problems with lung development that can be critical after birth. After 23 weeks your baby does not need the amniotic fluid so much, so low levels of fluid may not be a problem in itself, but if the low levels are due to your waters breaking then there is a risk of infection.

Causes of waters breaking early (PPROM)

Intrauterine infection is present in around a third of women with PPROM. Although there is clear evidence that infection travelling from the vagina is linked to PPROM, many cases happen without any infection being present. The reason for these cases is unclear, however it has been linked to heavy smoking (more than 10 cigarettes a day) in pregnancy


Sources

RCOG (2012) Information for you When your waters break early, Royal College of Obstetricians and Gynaecologists

J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders

RCOG (2006) Preterm Prelabour Rupture of Membranes, Greentop guideline 44, Royal College of Obstetricians and Gynaecologists

England MC, Benjamin A, Abenhaim HA (2013) Increased Risk of Preterm Premature Rupture of Membranes at Early Gestational Ages among Maternal Cigarette Smokers. Am J Perinatol. 2013 Jan 17

 


The causes and problems of premature birth

Your premature baby:

You can also read about

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On this page


Have my waters broken early

What are the risks if my waters break early?

What will happen if my waters break early

What if there are no waters left?

Causes of waters breaking early



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DID YOU KNOW?

PPROM is a factor in around 40 percent of premature deliveries.

'Knowing what I now know, and running a support group, if someone says they think something's up, I say "Just get down to the hospital".'

MEGAN

TIP

If you think there's any chance that your waters have broken - even if you are not sure - contact your healthcare team straight away.