Complications

PPROM can increase the risk of complications for the parent and baby.

Not every person with PPROM will experience every complication. Risk varies based on gestational age, length of latency, amniotic fluid, infection or inflammation, placental complications, fetal wellbeing, and other individual circumstances.

Some complications require urgent medical evaluation.

Infection

Once the membranes rupture, the protective barrier between the pregnancy and microorganisms in the lower reproductive tract is disrupted. This increases concern for ascending infection.

Chorioamnionitis / Intraamniotic Infection

Chorioamnionitis, also called intraamniotic infection, involves infection and inflammation within the pregnancy.

Signs and symptoms can vary and may include:

• fever or temperature changes

• chills or feeling suddenly unwell

• abdominal or uterine tenderness

• foul-smelling or concerning vaginal fluid

• maternal or fetal heart rate changes

• contractions or cramping

• abnormal laboratory findings

Fever is not the only possible sign of infection.

When intraamniotic infection is diagnosed or strongly suspected, the healthcare team will evaluate maternal and fetal safety and determine whether delivery and antibiotic treatment are indicated.

Sepsis

Sepsis is a life-threatening response to infection that can cause organ dysfunction. Maternal sepsis is an uncommon but serious potential complication of PPROM.

Seek urgent medical evaluation if you develop symptoms your healthcare team has identified as concerning or if you feel suddenly or significantly unwell.

Placental Abruption and Bleeding

Vaginal bleeding can occur during a pregnancy complicated by PPROM. Some bleeding may be mild, while new or significant bleeding can be a sign of placental abruption.

Placental abruption occurs when part or all of the placenta separates from the uterus before delivery.

Symptoms may include:

• vaginal bleeding

• abdominal or back pain

• uterine tenderness

• contractions

• changes in fetal wellbeing

The amount of visible bleeding does not always reflect the severity of an abruption.

Report new or changing bleeding to your healthcare team. Seek urgent evaluation for heavy bleeding, severe pain, contractions, dizziness, fainting, or other concerning symptoms.

Umbilical Cord Prolapse

Umbilical cord prolapse occurs when the umbilical cord moves through the cervix ahead of the baby.

PPROM and low amniotic fluid can increase the risk, particularly when the presenting part of the baby is not firmly engaged in the pelvis.

Cord prolapse can interrupt blood flow and oxygen to the baby and is an obstetric emergency.

Seek emergency medical care if you see or feel something protruding from the vagina after your membranes have ruptured.

Do not attempt to push the cord back inside.

Umbilical Cord Compression

Low amniotic fluid may also allow the umbilical cord to become compressed. Cord compression can affect fetal heart rate and blood flow.

Healthcare teams may monitor fetal wellbeing using heart-rate monitoring, ultrasound, or other assessments depending on gestational age and clinical circumstances.

Premature Birth

Most pregnancies affected by PPROM ultimately result in premature delivery. Complications related to prematurity vary widely based on gestational age at birth and individual circumstances.

Premature babies may experience challenges involving:

• breathing

• feeding and growth

• infection

• temperature regulation

• brain and neurologic development

• vision and hearing

• intestinal health

• long-term development

Learn more about Premature Birth

Pulmonary Hypoplasia

When PPROM occurs very early and very low amniotic fluid continues for a prolonged period, fetal lung development may be affected.

Pulmonary hypoplasia means that the lungs have not developed to their expected size or capacity.

Severity varies greatly, and prenatal imaging cannot fully predict how an individual baby's lungs will function after birth.

Learn more about Pulmonary Hypoplasia

Low Amniotic Fluid

PPROM may lead to oligohydramnios, or lower-than-expected amniotic fluid, and sometimes anhydramnios, meaning very little or no measurable fluid.

Prolonged low fluid may contribute to:

• impaired lung development

• umbilical cord compression

• reduced space for fetal movement

• orthopedic or positional complications

Fluid levels may change throughout the pregnancy and are only one part of the overall clinical picture.

Learn more about Amniotic Fluid

Limb Contractures and Positional Changes

When very low amniotic fluid continues for a prolonged period, reduced space for fetal movement can sometimes contribute to joint contractures or positional abnormalities.

These may include conditions such as:

• clubfoot

• joint contractures

• hip or limb positioning abnormalities

Risk appears to be influenced by how early and how long severe oligohydramnios occurs. Not every baby exposed to prolonged low amniotic fluid develops orthopedic complications.

Some conditions improve with growth, physical therapy, bracing, casting, or other orthopedic treatment after birth.

Fetal Growth Restriction

Some pregnancies complicated by PPROM may also involve fetal growth restriction, meaning the baby is smaller than expected for gestational age.

Growth may be monitored with ultrasound during ongoing pregnancy. Fetal growth restriction can occur for many reasons and is not caused by PPROM in every case.

Stillbirth and Infant Loss

PPROM can be associated with pregnancy or infant loss.

Potential causes may include:

• extreme prematurity

• severe infection

• placental abruption

• umbilical cord complications

• severe pulmonary hypoplasia

• other maternal, fetal, or neonatal complications

The risk varies widely depending on gestational age and individual circumstances. Families experiencing pregnancy or infant loss deserve compassionate medical care and support.

Find Pregnancy & Infant Loss Resources

When Should I Seek Medical Care?

If you have been diagnosed with PPROM, your healthcare team should provide individualized instructions about when to seek evaluation.

Contact your healthcare provider or Labor & Delivery promptly for symptoms such as:

• fever, chills, or feeling significantly unwell

• new or worsening abdominal or uterine pain

• foul-smelling or concerning vaginal fluid

• new or increasing vaginal bleeding

• contractions or signs of labor

• decreased fetal movement when movement is normally expected

• something protruding from the vagina

• any sudden change that concerns you

You do not need to be certain that something is wrong before contacting your healthcare team.

Research & Additional Reading

Infection and PPROM

ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection
American College of Obstetricians and Gynecologists, 2024.

Current guidance regarding the clinical criteria used when intraamniotic infection is suspected.

Read the ACOG/SMFM Clinical Practice Update

Placental Abruption & CAOS

Perinatal Outcomes of Chronic Abruption Oligohydramnios Sequence
Kasuga Y, et al. 2025.

A multicenter study examining maternal, pregnancy, and neonatal outcomes associated with chronic abruption-oligohydramnios sequence (CAOS).

Read the Full Study

View on PubMed

Very Early PPROM & Maternal Outcomes

Preterm Prelabour Rupture of Membranes Before 23 Weeks' Gestation: Prospective Observational Study
Goodfellow L, et al. BMJ Medicine. 2024.

A national prospective study examining maternal and perinatal outcomes following PPROM before 23 weeks, including maternal infection and sepsis.

Read the Full Study — BMJ Medicine

Read the Open-Access Version — PubMed Central

Orthopedic Effects of Prolonged Low Amniotic Fluid

Limb Deformations in Oligohydramnios Sequence: Effects of Gestational Age and Duration of Oligohydramnios
Christianson C, et al. 1999.

Foundational research examining how the timing and duration of oligohydramnios relate to joint contractures and limb positioning abnormalities.

View on PubMed

Read the Journal Article

Additional PPROM Guidance

Society for Maternal-Fetal Medicine Consult Series #71: Management of Previable and Periviable Preterm Prelabor Rupture of Membranes
SMFM, 2024. Endorsed by ACOG.

Current professional guidance addressing counseling, maternal risks, infection, expectant management, and care following very early PPROM.

Read SMFM Consult Series #71