Preterm Prelabour Rupture of Membranes (PPROM)
A quick guide
If you experience PPROM symptoms during pregnancy such as fluid loss or pelvic pressure seek medical help immediately. Preterm prelabour rupture of membranes can pose risks for both mother and baby.
What is PPROM?
Preterm Prelabour Rupture of Membranes (PPROM) occurs when the amniotic sac ruptures before 37 weeks of pregnancy and before labour begins. It is a leading cause of preterm birth and is associated with maternal, foetal, and neonatal complications.
Symptoms of PPROM
Primary PPROM symptoms include:
- Sudden gush of fluid from the vagina, indicating rupture of the amniotic sac
- Continuous leaking of fluid, leading to persistent wetness
- Changes in vaginal discharge, including increased volume or unusual odour
- Lower abdominal pain or cramping, which may signal early labour
- Pelvic pressure or discomfort, due to changes in foetal position and amniotic fluid loss
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Does PPROM cause premature birth?
PPROM significantly increases the likelihood of premature birth, with clinical management focused on reducing complications and improving neonatal survival. Data from The Royal Hospital for Women NSW indicates PPROM complicates up to 3% of pregnancies and accounts for 30-40% of preterm births. More recent studies indicate 70-90% of women with PPROM go into labour within seven days, leading to preterm birth.
What causes PPROM?
PPROM is caused by a combination of infection, inflammation, and structural factors that weaken the amniotic sac. In some cases, the exact cause is unclear, which is why clinical awareness and following PPROM guidelines are essential.
- Infections – Bacterial infections in the uterus or lower genital tract can lead to membrane weakening.
- Inflammation – Elevated inflammatory markers and enzymes contribute to premature rupture.
- Placental abruption – Early separation of the placenta increases the risk of PPROM.
- Cervical insufficiency – A weakened cervix may fail to support the pregnancy, leading to rupture.
- Polyhydramnios – Excess amniotic fluid puts pressure on the membranes.
- Multiple pregnancies – Twin or triplet pregnancies increase strain on the uterus.
- Previous PPROM or preterm birth – A history of PPROM raises the likelihood of recurrence.
- Invasive procedures – Amniocentesis, chorionic villus sampling, or cervical cerclage can increase risk.
- Smoking – Strongly linked to membrane weakening and early rupture.
FAQs
How common is PPROM in Australia?
PPROM is responsible for over 60% of preterm births in Australia and occurs in approximately 2-4% of singleton pregnancies and 7-20% of twin pregnancies.
What happens if PPROM happens before 24 weeks?
At this early gestational stage, neonatal survival rates are low, with only 26% of babies born before 23 weeks surviving until hospital discharge. Mothers face increased risks of sepsis and potential surgical complications, making early intervention and medical management crucial in such cases.
What are the survival rates of babies born after PPROM?
PPROM Survival rates vary depending on gestational age at rupture and medical intervention.
23–27 weeks – Neonatal mortality remains high, with 63.2% of babies not surviving.
28–33 weeks – Survival rates increase significantly, with most babies surviving.
What Neonatal care is needed for PPROM babies?
In Australia, neonatal care for babies born after PPROM focuses on infection prevention /antibiotic therapy, respiratory support, and feeding/developmental care. Hospitals follow structured PPROM guidelines to reduce complications and support long-term outcomes.
The impact of medical research and intervention
Despite significant advances in prenatal care, proper management, particularly in early gestational age, remains unclear. Identifying factors associated with neonatal mortality in PPROM is important to develop therapeutic interventions and improve perinatal outcomes.
This is where charities like Running For Premature Babies play a key role in funding essential medical research, focussing on advancing care in pre-natal, peri-natal, and post-natal health.
At Running for Premature Babies, we are incredibly grateful for our dedicated community of fundraisers and volunteers. Support research into conditions like PPROM by donating today. Your contribution helps fund equipment, neonatal care, and innovations in treating preterm prelabour rupture of membranes.
A?ao?lu, R.T., Öztürk, Ö., Ulusoy, C.O. et al. Perinatal outcomes and predictors of neonatal mortality in preterm premature rupture of membranes: a tertiary centre experience. BMC Pregnancy Childbirth 25, 585 (2025). Retrieved 29th May 2025 https://doi.org/10.1186/s12884-025-07688-9
The Royal Hospital for Women, Local Operating Procedure (2016) Retrieved 29th May 2025 https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/pprom2016.pdf
NSW Government Management of Threatened Preterm Labour (2022) Retrieved May 29th 2025 https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2022_006.pdf
Safer Care Victoria. (n.d.). Preterm pre-labour rupture of membranes. Retrieved 29th May from https://www.safercare.vic.gov.au/best-practice-improvement/clinical guidance/maternity/preterm-pre-labour-rupture-of-membranes
Laura Goodfellow, Angharad Care, Ciara Curran, Devender Roberts, Mark A Turner, Marian Knight, Alfirevic Zarko - Preterm prelabour rupture of membranes before 23 weeks’ gestation: prospective observational study: BMJ Medicine 2024;3:e000729. Retrieved 29th May https://bmjmedicine.bmj.com/content/3/1/e000729
