Waters breaking early (PPROM)

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

PPROM infographic

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 (37 weeks), the medical name for it is preterm prelabour rupture of the membranes, or PPROM. If this happens early, before the contractions start, it can (but does not always) trigger early labour.

This page deals with waters breaking early before 37 weeks. Read here about what to expect when your waters break AFTER 37 weeks.

Have my waters broken early (PPROM)?

If your waters have broken early, you will experience it as a trickle or a gush of water from your vagina. It is likely to continue leaking once it has started 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, which will be helpful information for health professionals. It may be pinkish if it contains some blood, or it may be clear. If it greenish or brown go to the maternity unit as soon as possible. If it is heavy, you may need to use a towel.

Phone your maternity unit immediately for advice.

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.

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 much higher - over 95%

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

You are likely to have an internal examination. This will allow the doctor to look at your cervix and check:

  • if the leaking fluid is amniotic fluid
  • if it is changing in preparation for labour
  • to check for infection by taking a swab.

You might have an ultrasound scan to estimate the amount of fluid left around your baby.

If only a very small amount of amniotic fluid leaks, it is not always easy to be sure whether your waters have broken.

  • You may be advised to wear a pad and stay in hospital for a few hours to monitor the situation.
  • If you go home but continue to leak fluid at home, you should return to the hospital again.

If your waters are shown to have broken, you will be advised to come into hospital for at least 48 hours. You and your unborn baby will be closely monitored for signs of infection. This will include having your temperature and pulse taken regularly, and your baby’s heart rate will also be monitored.

Going home from hospital with PPROM

If there is no infection present you may be able to go home. You will be at risk from infection however, and you will need to self-monitor by

  • checking that your temperature is normal (37 °C or less) every 4–8 hours
  • checking the colour of the fluid does not change by wearing a pad.

You should avoid having sexual intercourse.

Contact your doctor or midwife and return to the hospital immediately if you have:

  • a raised temperature (more than 37 °C)
  • flu-like symptoms (feeling hot and shivery)
  • vaginal bleeding
  • if the leaking fluid becomes greenish or smelly
  • contractions
  • abdominal pain
  • if you are worried that the baby is not moving as normal.

Inducing labour or premature labour with PPROM

If you are past 34 weeks the doctor will weigh up the benefits of inducing labour 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, corticosteroids and magnesium sulphate (if you are less than 30 weeks) to help prepare your baby in case the are born prematurely.

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

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.

Read more about intrauterine infection and chorioamnionitis

Causes of waters breaking early (PPROM)

Intrauterine infection is present in around a third of women with PPROM. In many cases however it happens 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

Read more about delivering an early baby

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

  1. RCOG (2012) Information for you When your waters break early, Royal College of Obstetricians and Gynaecologists
  2. J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders
  3. RCOG (2006) Preterm Prelabour Rupture of Membranes, Greentop guideline 44, Royal College of Obstetricians and Gynaecologists
  4. 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 
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Last reviewed on October 5th, 2016. Next review date October 5th, 2019.

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Comments

  • 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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