Waters breaking early (PPROM)

Preterm prelabour rupture of membranes (PPROM) is when your waters break before 37 weeks of pregnancy. If this happens, you will need to get medical help straight away.

PPROM infographic

This page covers waters breaking early before 37 weeks. Read more about what to expect when your waters break after 37 weeks.

What is preterm prelabour rupture of membranes (PPROM)?

Your baby develops inside a bag of fluid called the amniotic sac. When your baby is ready to be born, the sac breaks and the fluid comes out through your vagina. This is your waters breaking. It is also known as rupture of the membranes.

Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is known as preterm prelabour rupture of membranes or PPROM. If this happens, it can (but does not always) trigger early labour.

If your waters break early, the risks and treatment depend on your stage of pregnancy.

Is PPROM common in pregnancy?

PPROM happens in about 3% of pregnancies.

What causes PPROM?

We don’t always know why PPROM happens. But it may be caused by infection, or placental problems, such as placental insufficiency or a blood clot (haematoma) behind the placenta or membranes. Other risk factors may include if you:

It is important to remember that PPROM is not caused by anything you did or didn’t do in pregnancy.

How will I know if my waters have broken?

Your waters breaking may feel like a mild popping sensation, followed by a trickle or gush of fluid that you can’t stop, unlike when you wee. The amount of fluid you lose may vary. You may not have any sensation of the actual ‘breaking’, and then the only sign that your waters have broken is the trickle of fluid. It doesn’t hurt when your waters break.

You can read more about what to expect when your waters break.

What should I do if my waters break early?

If you think your waters may have broken, you should contact your midwife or labour ward and go to the hospital for a check-up straight away.

Amniotic fluid is clear and a pale straw colour. It may be a little pinkish if it contains some blood, or it may be clear. You must tell your healthcare professional if:

  • the waters are smelly or coloured
  • you are losing blood.

This could mean that you and your baby need urgent attention.

If you think that you are leaking fluid from the vagina, wear a pad not a tampon so your doctor or midwife can check the amount and colour of your waters.

“I had cervical incompetence and PPROM. I was put on hospital bedrest, antibiotics and had regular scans on the remaining water levels. Despite the antibiotics my infection markers were getting worse and I had to be induced at 24 weeks because they didn't think my baby would survive much longer in an infected womb. He survived birth, spent 7 months in hospital and then came home. He's now almost 5 years old and starting school in September.”

Rachel

What happens at the hospital?

When you arrive at hospital, your healthcare professional will assess you to see if your waters have broken. This will also include a check on your general health including your temperature, pulse and blood pressure. They will also check your baby’s heartbeat and may do a urine test to check for infection.

Your healthcare professional will talk to you about what has happened, how you are feeling and your pregnancy history.

How is PPROM diagnosed?

Your healthcare professional will likely ask to do an internal vaginal examination (they will ask for your permission before doing so).

You may have what’s called a speculum examination. This is when a small instrument covered in gel is inserted into the vagina. The healthcare professional will then be able to see if there is any fluid pooling in the vagina. They will also take a swab to test for infection and a swab to test for group B strep infection. This will help confirm if your waters have broken. This test isn’t painful but it can sometimes be uncomfortable.

If it isn’t clear from the speculum examination, they may do a swab test of the fluid. They may also do an ultrasound scan to estimate the amount of fluid around your baby.

What happens next?

If your waters have broken, you will usually be advised to stay in hospital where you and your baby will be closely monitored for signs of infection. This may be for a few days or maybe longer. You will have your temperature, blood pressure and pulse taken regularly, as well as blood tests to check for infection. Your baby’s heart rate will also be monitored regularly.

If your waters have not broken, you should be able to go home.

If only a very small amount of amniotic fluid is leaking, it is not always possible to see it during an examination and it can be difficult to confirm whether your waters have broken.

If you continue to leak fluid at home, you should return to the hospital for a further check-up.

What could PPROM mean for me and for my baby?

If your waters have broken early, your healthcare professional will discuss with you the possible outcomes for your baby. These will depend on how many weeks pregnant you are when this happens and your individual circumstances. 

Infection

The membranes form a protective barrier around the baby. After the membranes break, there is a risk that you may develop an infection. This can cause you to go into labour early or cause you or your baby to develop sepsis (a life-threatening reaction to an infection).

The symptoms of infection include:

  • a raised temperature
  • an unusual vaginal discharge with an unpleasant smell
  • a fast pulse rate
  • pain in your lower stomach.

Your baby’s heart rate may also be faster than normal. If there are signs that you have an infection, your baby may need to be born straight away. This is to try to prevent both you and your baby becoming more unwell. 

PPROM and premature birth

About 50% of women with PPROM will go into labour within 1 week after their waters break. The further along you are in your pregnancy, the more likely you are to go into labour within 1 week of your waters breaking. PPROM is associated with 3-4 out of every 10 premature births.

Babies born prematurely have an increased risk of health problems and may need to spend time a neonatal unit. Find out more about premature birth.

Cord prolapse

This is when the umbilical cord falls through your cervix into the vagina. This is an emergency complication and can be life-threatening for your baby, but it is uncommon.

Pulmonary hypoplasia

This is when your baby’s lungs fail to develop normally because of a lack of fluid around them. It is more common if your waters break very early on in pregnancy (less than 24 weeks) when your baby’s lungs are still developing.

Placental abruption

This when your placenta separates prematurely from your uterus. It can cause heavy bleeding and can be dangerous for both you and your baby. Find out more about placental abruption.

If you experience PPROM, sometimes your baby sadly may not survive. There is a higher risk of this happening if your waters break very early, if the baby is born very prematurely (under 24 weeks) or, in some cases, following infection or cord prolapse.

Are there any treatments for PPROM?

It is not possible to ‘fix’ or heal the membranes once they are broken. But you may be offered treatment to reduce the risks to your baby. This could include:

  • a short course of antibiotics to reduce the risk of an infection and delay labour
  • a course of steroid injections (corticosteroids) to help with your baby’s development and to reduce the chance of problems caused by being born prematurely
  • magnesium sulphate once you are in labour, which can reduce the risk of your baby developing cerebral palsy if they are born very premature.

If you do go into premature labour, you may be offered intravenous antibiotics (where the antibiotics are given through a needle straight into a vein) to reduce the risk of early-onset group B strep infection.

Do I need to stay in hospital?

You will usually be advised to stay in hospital for 5 to 7 days after your waters break, to monitor your and your baby’s wellbeing. You may be allowed to go home after that if you are not considered at risk for giving birth early.

When should I seek help if I go home?

Contact your healthcare professional and return to the hospital immediately if you experience any of the following:

  • raised temperature
  • flu-like symptoms (feeling hot and shivery)
  • vaginal bleeding
  • if the leaking fluid becomes greenish or smelly
  • contractions or cramping pain
  • abdominal pain or back pain
  • if you are worried that the baby is not moving as normalContact your midwife or maternity unit immediately if you think your baby’s movements have slowed down, stopped or changed.

You should be given clear advice on how to take your pulse and temperature at home. You’ll probably also be advised to avoid having sex during this time.

What follow-up should I have?

You should have regular check-ups with your healthcare professional (usually once or twice a week).

During these check-ups, your baby’s heart rate will be monitored, your temperature, pulse and blood pressure will be checked and you will have blood tests to look for signs of infection. Your doctor will work with you to make an ongoing plan for your pregnancy, including regular ultrasound scans to check on your baby’s growth.

Your mental health

Experiencing PPROM can be stressful and cause a lot of anxiety. Coping with new symptoms and complications in pregnancy can sometimes be overwhelming. You could try our top 10 tips to relax.

If you’re feeling low, talk to your partner, family or friends about how you are feeling. You can also talk to your midwife. You won’t be judged for how you feel. They will help you stay well so you can look after yourself and your baby. They may also be able to signpost you to more help and support if you need it.

You can also call the Tommy’s midwives for a free, confidential chat on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected].

When is the right time to give birth?

If you and your baby are both well with no signs of infection, you may be advised to wait until 37 weeks to give birth. This is because it can reduce the risks associated with being born prematurely.

If you are carrying the GBS bacteria, then you may be advised to give birth from 34 weeks because of the risk of GBS infection for your baby.

Your healthcare professional will talk to you about what they think is best and ask you what you want to do. Don’t be afraid to ask as many questions as you need to in order to feel comfortable and able to make informed decisions about your care.

Will I be able to have a vaginal birth after PPROM?

This is possible, but it depends on when you go into labour, the position your baby is lying, and your own individual circumstances and choices.

Your healthcare professional will discuss this with you. 

Will I have PPROM again a future pregnancy?

Possibly. Having PPROM or giving birth prematurely means that you are at an increased risk of having a preterm birth in any future pregnancies, but it doesn’t mean that you definitely will.

You will probably have specialist care in your next pregnancy. If you are not offered specialist care, you can ask for it. Remember that you can always talk to your midwife if you have any concerns about your care.

Read more

  • Discharge in pregnancy

    Discharge in pregnancy

    Having more vaginal discharge during pregnancy is common, but speak to your midwife or doctor if you are unsure about any increase or change in your vaginal discharge.

Sources

Royal College of Obstetricians & Gynaecologists (2019) When your waters break prematurely https://www.rcog.org.uk/en/patients/patient-leaflets/when-your-waters-break-prematurely/

Dayal, S and Peter L. Hong, Peter L (2019) Premature Rupture of Membranes. StatPearls Publishing

Macdonald, Sue (2017) Mayes’ Midwifery. London, Elsevier Health Sciences UK

NHS Choices. Signs that labour has begun. https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/ (page last reviewed 09/11/2017 Next review due 09/11/2020)

NHS Choices. Premature labour and birth. https://www.nhs.uk/conditions/pregnancy-and-baby/premature-early-labour/ (page last reviewed 04/11/2019 Next review due 04/11/2022)

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    Last reviewed on July 8th, 2020. Next review date July 8th, 2023.

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    Comments

    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
    • By Midwife @Tommys on 29 Sep 2016 - 16:54

      A small increase in vaginal discharge is normal in pregnancy. Generally it has a white or milky appearance. Any sign of blood or discharge that is brown/yellowy should be checked by a midwife.

    • By Anonymous (not verified) on 27 Sep 2016 - 22:05

      My water broke at 33 weeks and I HV been admitted at d hospital been treated wit antibiotics incase of infection baby has been moving well but im on rest wit water leaking still antibiotics has stopped so i need best advice wat can be done to save myself n my baby

    • By Midwife @Tommys on 28 Sep 2016 - 11:12

      Hello, are you still in hospital receiving regular care and monitoring? It is important to monitor your baby's movements, to check on the colour and smell of the water leaking and make sure that you let your midwives know if you feel feverish, tachycardic (rapid heart rate) or experience any abdominal pain.
      These are signs of infection and need to be treated and may mean your baby will be born prematurely.
      If you remain well and your baby continues to be active (you mention you have already been treated with antibiotics) it may be safe to wait until your labour begins spontaneously.
      Please speak with you obstetric team. They will be able to make a plan with you for your remaining antenatal care and speak with someone from the neonatal team so that you feel supported.

    • By Nelly (not verified) on 12 Sep 2016 - 22:06

      I'm 34 weeks and 3 days today and my water just broke immediately I came out of the tub. What should I do? Should I wait till morning before I go to the hospital! Is it safe for me and the baby? Mom worried.

    • By Midwife @Tommys on 13 Sep 2016 - 11:27

      You should go straight to the labour ward at your hospital,if you have not already, as your baby is a little premature so you will need to be assessed & monitored closely at the hospital. Keep an eye on your baby's movements and your vaginal loss by wearing a pad & seek medical advice as soon as possible

    • By Hello (not verified) on 9 Sep 2016 - 14:22

      My waters broke at 15 weeks, I have been put on antibiotics to keep infections abay. which had been going great up until I reached my 22nd week , I have now experienced bleeding . what are the chances for survival ?

    • By Midwife @Tommys on 9 Sep 2016 - 14:30

      Hello,
      I am so sorry to hear what you are going through in this pregnancy and what a difficult time it must be for you. It is very difficult to answer your question, I think it is important to just take each day at a time. If you are bleeding I hope that you have been to the hospital to be reviewed, if not please call the maternity unit straight away and go to hospital to be reviewed. If you would like to talk further once you have been reviewed then please do email [email protected] or call our pregnancy line on 0800 0147 800. Take care

    • By Anonymous (not verified) on 7 Sep 2016 - 04:48

      What is the earliest time a pregnant woman can give birth naturally? 33weeks or 37week?

    • By Midwife @Tommys on 8 Sep 2016 - 10:06

      The normal length of pregnancy is 37-42 weeks long, a baby born during this time is referred to as term. Any time before 37 weeks the baby is premature. I hope this answers your question.

    • By Anonymous (not verified) on 5 Sep 2016 - 17:25

      I had PPROM @ 27 wks, cervix closed. managed with antibiotics and steroid injections but sadly resulted in still birth.
      SROM @ 34 wks, cervix closed. Emergency c-section to previous.
      Would this happen again? Would another pregnancy be safe?

    • By Midwife @Tommys on 8 Sep 2016 - 10:00

      I am so sorry to hear what you have been through and for the loss of your little one in your first pregnancy. It is very difficult to answer this question in brief without knowing more information and having access to your notes. I would suggest to see your GP and be referred for a preconception appointment at the hospital where your history can be reviewed and talk about having another pregnancy. You can also email us [email protected] with further information and we can discuss this in confidence.

    • By Anonymous (not verified) on 8 Sep 2016 - 10:08

      Thank you. I didn't know such appointments existed. We had a debrief after we lost our baby girl but nothing after our second pregnancy.

    • By Prasanth (not verified) on 2 Sep 2016 - 04:52

      What are main reason for water broken in 18week

    • By Midwife @Tommys on 2 Sep 2016 - 15:52

      Often the main cause of waters breaking at 18 weeks of pregnancy is infection however it can be due to the cervix being weak and sometimes a cause is never known. If this has affected you then please do know you can talk to a midwife in confidence, you can email us mid[email protected]

    • By Midwife @Tommys on 1 Sep 2016 - 12:37

      If your daughter's waters broke at 32 weeks, the hospital staff will be monitoring her closely with scans and regular checks of the baby's heart rate. They will do regular blood tests to ensure no infection is developing which could trigger labour and they will allow the pregnancy to continue to term as long as mum and baby are well. Usually once the waters have gone, contractions do follow but when can be unclear!!

    • By Anonymous (not verified) on 28 Aug 2016 - 22:25

      Can head water bust by the discharge , i have in s stitched.

    • By Anonymous (not verified) on 27 Aug 2016 - 10:56

      I am just out of hospital after treatment they told me that I would more than likely miscarriage I'm supposed to fly out on holidays next Saturday..is it safe?

    • By Midwife @Tommys on 1 Sep 2016 - 14:59

      I am so sorry you have been ill. If your hospital has advised you that there is an increased risk of miscarriage, I would definitely advise you not to fly on Saturday. Given that you have been recently hospitalized, I am sure you can get a letter from your GP for travel insurance purposes. Remember just because there is an increased risk, it does not mean it will happen.. stay positive

    • By Midwife @Tommys on 25 Aug 2016 - 15:54

      It sounds as if you are having the perfect management at your hospital for you and your baby.
      Being given steroid injection to mature your baby's lungs and being given iv antibiotics is the correct management for you and baby at this time. Good luck with everything :) They will take good care of you both. Just listen to their plan of care for you and ask them plenty of questions. It can be scary, but it is less scary when you have all of the information - when you have had all of your questions answered.

    • By Midwife @Tommys on 25 Aug 2016 - 15:47

      If your waters break after 37/40 gestation this can be a normal feature of early labour. A term baby is one which is 37 weeks gestation and over.
      Most hospitals differ slightly in their guidance about how long to leave a lady to naturally go into labour after their waters have broken. However most of time it ranges between 12-24 hrs. After this time, you would be strongly recommended to come into the labour ward to have your labour augmented - where you would be put on a hormone drip to start giving you contractions and to start labour off. Your baby would have continuous monitoring if augmentation of labour was chosen. Your midwife and Obstetric team would go through everything in detail with you before this too.

    • By Anonymous (not verified) on 25 Aug 2016 - 14:18

      2days before at night 2'o clock i was lying at bed and suddendly felt a gush of water wtting my paint and matress on bed....aftr tht i felt watr evry half and my paints get wet....the next da i visit my dctr and she told tht my amniotic sax has broken...fron thn i am at hsptl now getting injection for the baby's lungs and anfibiotics to avoid infectuon...dctr says u hv nt much watd loss sufficent fluid is present inside for the baby...so v try to wait till u entr ur 36 weeks...bt i am too much scared

    • By Anonymous (not verified) on 25 Aug 2016 - 12:43

      hello.
      if the water breaks after 37 wks, what is the best management to do?
      what is the effect of it to the unborn child? is it normal that when BOW breaks b4 labor it it will affects the contractions?

    • By Midwife @Tommys on 19 Aug 2016 - 15:32

      Hi, I am very sorry but I am not sure I understand your question, if the information above does not answer your query please do email a midwife at [email protected] or you can call us on 0800 0147 800.

    • By Anonymous (not verified) on 19 Aug 2016 - 15:24

      mery uterus weak hai mjy shirodkar sti????ch lga hua tha bt 8th month m mera water break ho gaea aor premature baby boy hua bt 2nd day os ki death ho gae.kia water break ka koi ilaj nai hai k pregnency ful term posible ho sky????

    • By Midwife @Tommys on 29 Jul 2016 - 15:28

      If you think your waters may have broken it is really important that you go straight to your maternity unit to be reviewed. Please do not put off going in, you can take someone with you to support you. Please also know we are here too if you need some support on 0800 0147 800 or [email protected]

    • By Midwife @Tommys on 29 Jul 2016 - 15:25

      Sorry to hear you are having such an eventful pregnancy. Rest up and if you would like to speak to a midwife please do get in contact either call on 0800 0147 800 or [email protected]

    • By Anonymous (not verified) on 29 Jul 2016 - 05:50

      So on July 1st 2016 I noticed some fluid it had gushed out I sat down for 30 minutes and stood back up and it gushed again. I called the hospital and was told to come.in immediately, well when they called.my doctor he did some exams on me.and found out the sac had a tear in it, im 25 eeeks and 2 days now and in complete bedrest until my due date . When I went back to obgyn they said that they were going g to send me to Huntsville AL to get a second opinion on whether I should deliever or stay in bed rest
      .... Right now the fluid still come out but it comes then goes. Hoping for a safe delivery!!!

    • By Anonymous (not verified) on 28 Jul 2016 - 20:38

      I think my water just break as we speak. I feel wet in my panty, and water just run out of my vigina so what can I do I'm scared of loosing my baby.

    • By Anonymous (not verified) on 27 Aug 2016 - 06:23

      Hi my daughter waterbag broke 1 night before she is 33 weeks some water left in her and some come out. Bit she haviong not pain when will she have pain to go in deliver

    • By [email protected]'s on 19 Jul 2016 - 10:43

      Losing a baby is devastating whatever the gestation, so you have to come to terms with the loss emotionally as well as physically. The natural instinct is to get pregnant again as soon as possible and there is no problem with this, but allow yourself some time to recover too. Regarding how long to wait before trying to get pregnant after a loss, it is usually advised to wait to have your next period first as there is often some bleeding & period like pains following a 20 week loss, so best to let that settle down first. Please feel free to contact one of our Tommy’s Midwives for a chat on 0800 0147 9800 to help you talk through your concerns at this difficult time.

    • By Anonymous (not verified) on 8 Jul 2016 - 15:12

      I hope everything worked out for you...

    • By Anonymous (not verified) on 8 Jul 2016 - 06:54

      Hi I recently lost my baby at 20 weeks due to pprom the dr. Said his lungs weren't developed yet so I was wondering how long do I have to wait before trying to get pregnant again?

    • By [email protected]'s on 7 Jul 2016 - 10:49

      Hi,
      Your situation sounds very worrying. We can't discuss or advise here without knowing more though. Please call us on 0800 0147 800 to talk. We're on the line 9-5 Mon to Fri.
      Tommy's Midwives

    • By Anonymous (not verified) on 3 Jul 2016 - 19:53

      My water broke at 25 weeks and had labour pains,the doctors wer able to stop the pains but was put on total bedrest,i was give antiboitic shots and shots for babys lungs,was told no water was left there,the baby is still playing but am bleeding like its periods i keep changing pads,im so worried on whats happening.doctor told me the baby might be delivered in 2 or three days but whats worrying me is the bleeding

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