When I was pregnant with my fourth baby, I learned I was at risk for preterm premature rupture of membranes, or PPROM. It meant my baby could be born prematurely.

While I’d heard of premature births, I had no idea what PPROM meant on a personal level. How common was it? How would I know if it happened?

The uncertainty of a pregnancy complication is scary, but it helps to have all of the information. Here's what you need to know about your risk for PPROM, what you can do to prevent it, and when to seek emergency care.

What Is PPROM?

PPROM occurs when a woman's water breaks any time before 37 weeks of pregnancy, and labor doesn’t start within an hour.

The earlier on in the pregnancy that the water breaks, the more risks and complications are involved.

It’s possible to have premature labor without the bag of water actually breaking. In some cases, doctors can control or stop labor. But if the preterm labor cannot be stopped, it will lead to a premature birth.

The American College of Obstetricians and Gynecologists explains that premature labor begins with contractions in the uterus any time before 37 weeks. The contractions can cause a woman's cervix to start dilating and thinning out.

How Common Is PPROM?

Overall, prematurity occurs in approximately 12 percent of all births in the United States. It’s a serious problem that leads to many complications and even death in babies.

Preterm births account for approximately 70 percent of newborn deaths, and 36 percent of infant deaths. Prematurity is the leading factor in infant deaths in the United States.

While premature labor and birth is common, PPROM occurs in only about 3 percent of all pregnancies.

The United States is one of the 10 worst countries in the world when it comes to premature births. There are more premature births there than in Brazil, Bangladesh, and the Philippines.

What Causes PPROM?

Doctors don't always know why premature labor occurs, making it difficult to stop or treat.

Some of the most common causes of preterm birth include:

  • multiple pregnancies
  • infection
  • chronic health condition like diabetes and high blood pressure
  • genetics
  • history of PPROM
  • pregnancy as a result of assisted reproductive technologies

Risk Factors for PPROM

There are several risk factors for PPROM, which can include:

  • history of PPROM
  • infection
  • preterm labor
  • amniocentesis
  • bleeding during pregnancy
  • procedures that involve the cervix
  • lung disease
  • connective tissue disease
  • nutritional deficits
  • low body mass index
  • low socioeconomic status
  • smoking

Treatment Options

The treatment for PPROM will depend on many different factors. They include how far along a woman is in her pregnancy. Your doctor will factor in the risks of delivering the baby versus trying to maintain the pregnancy.

Other risks that need to be considered include infection, placental abruption, and umbilical cord complications. If you’re over 34 weeks, you’ll be monitored and possibly deliver. But any PPROM occurring before 33 weeks might be treated by trying to delay labor and giving your baby steroids to help promote their lung function.

You may also be prescribed bed rest and/or admitted to the hospital for monitoring. Any PPROM at less than 24 weeks will be handled on a case-by-case basis. The outcome for babies born before 24 weeks is usually poor.

Prevention of PPROM

Doctors aren't always sure what causes PPROM, so it can be difficult to know how to prevent it.

Here are a few steps you can take to reduce your risk:

  • Take all antibiotics for bladder infections and UTIs as prescribed. These can cause premature labor and they can easily be treated.
  • Quit smoking and don’t drink alcohol or take any drugs.
  • Get regular prenatal care and attend all appointments.

If a woman has a known history of giving birth prematurely, her doctor might prescribe progesterone medication. Procedures like cervical cerclage might also help prevent a future premature birth.

While there isn't always any warning that your water is about to break, PPROM could be preceded by premature labor.

For that reason, it's important to be aware of the signs of premature labor, too. It can include any of the following symptoms before 37 weeks of pregnancy:

  • contractions every 10 minutes, or more frequently
  • leaking fluid (even a small amount) or bleeding from the vagina
  • pelvic pressure, or the feeling that the baby is pushing down or a "bulging" feeling in the vaginal area
  • low, dull backache
  • cramps, with or without diarrhea
  • fever

If your water breaks without you realizing it, it could lead to an infection. For that reason, it’s important to seek medical care right away.

The Takeaway

When it comes to premature birth and PPROM, it’s important to know if you’re at risk. You should be aware of the symptoms of preterm labor so you can seek immediate medical treatment if necessary.

During your pregnancy, be sure to ask your doctor the following questions:

  • Am I at risk for PPROM?
  • Is there anything I can do to lower my risks?
  • How can I get in touch with you if I have any questions?
  • What signs or symptoms would warrant seeking emergency care?

Having a plan for PPROM or premature labor ahead of time will help you to give the best, healthiest start to life to your baby.