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Preterm premature rupture of membranes (PPROM) is when the amniotic sac breaks before 37 weeks of pregnancy and labor has not started within 1 hour. The sac holds amniotic fluid and the growing baby. In PPROM, the fluid in the sac leaks or gushes out of the birth canal. This is also known as your water breaking.

Fetus in the Amniotic Sac
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Call your doctor right away if you think that your water has broken.


PPROM is caused by membranes that are weak or thin.

Risk Factors

Factors that may raise your risk are:

  • PPROM in earlier pregnancies
  • Infection in the amniotic sac
  • Amniocentesis
  • Bleeding late in pregnancy
  • Procedures used to treat problems of the cervix
  • Short cervix
  • Enlarged uterus
  • Smoking during pregnancy
  • Low body mass index
  • Connective tissue disorders
  • Lung disease during pregnancy
  • Nutritional problems


The main symptom of PPROM is fluid leaking from the birth canal. You may have a sudden gush or a slow trickle. It can be hard to tell a slow amniotic trickle apart from urine. Your doctor can do tests to find out.

PPROM raises the risk of infection. You may also have:

  • A fever above 100.4°F (38°C)
  • Rapid heartbeat


If a large amount of fluid is leaking from the birth canal, PPROM is likely.

You may also have these tests:

  • Nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
  • Microscopic exam of the fluid

An ultrasound may be done to see how much fluid you have.


Treatment depends on when it happens in the pregnancy.

34-36 Weeks

The doctor will:

  • Watch the baby’s heart rate
  • Start labor with medicines
  • Possibly give antibiotics

24-33 Weeks

The doctor will treat you with antibiotics and steroids. The doctor may try to put off delivery until 33 weeks of pregnancy.

Less than 24 Weeks

The doctor may admit you to the hospital for bed rest and to monitor you and your baby. 24 weeks is about the youngest a baby can be born. The doctor will talk to you about the risks and benefits of your options.


There is no way to prevent PPROM.


American Pregnancy Association  http://www.americanpregnancy.org 

National Institute of Child Health and Development  https://www.nichd.nih.gov 


The Canadian Women's Health Network  http://www.cwhn.ca 

The Society of Obstetricians and Gynaecologists of Canada  http://sogc.org 


ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 160: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2016 Jan;127(1):192-194.

Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and premature birth: Results of a pilot intervention. J Periodontology. 2003;74(8);1214.

Preterm premature rupture of membranes (PPROM). EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T435299/Preterm-premature-rupture-of-membranes-PPROM  . Updated August 4, 2016. Accessed August 9, 2018.

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