Updated August 1, 2026

Diagnosed with PPROM? 

PPROM care depends on gestational age, individual medical circumstances, and available maternal and neonatal care.

For very early PPROM, current guidance recommends individualized counseling about maternal and fetal risks and the medically appropriate options for care.

Read here:  Society for Maternal-Fetal Medicine Consult Series #71: Management of previable and periviable preterm prelabor rupture of membranes (August 2024).

What is PPROM?

PPROM stands for Preterm Premature Rupture of Membranes.

PPROM occurs when the amniotic sac, sometimes called the “water” or “bag of waters”, breaks before 37 weeks of pregnancy and before labor begins. PPROM may happen with a sudden gush of fluid or with a slower, continuous or intermittent leak.

PPROM is a serious pregnancy complication.

PPROM affects approximately 150,000 pregnancies in the United States each year and is associated with approximately 1 in 3 preterm births.

For parents and families, PPROM can change the course of a pregnancy in an instant. A diagnosis can bring uncertainty, difficult decisions, changes in care, hospitalization, premature birth, NICU care, pregnancy or infant loss, and effects that continue well beyond pregnancy.

Know the Signs of PPROM

Signs of ruptured membranes may include:

• a sudden gush of fluid from the vagina;

• continuous leaking or trickling of fluid;

• persistent wetness that is different from normal vaginal discharge;

• fluid that is clear, pale, pink-tinged, or sometimes has another appearance.

If you believe your water may have broken, contact your healthcare provider or Labor & Delivery for evaluation.

PPROM cannot be diagnosed or ruled out based on symptoms alone.

Risk Factors for PPROM

PPROM can happen in any pregnancy, and sometimes there is no known cause or risk factor. Some factors that may increase the risk of PPROM include:

• Previous PPROM or preterm birth

• Vaginal bleeding or trauma

• Infections, including some sexually transmitted or urinary tract infections

• Smoking during pregnancy

• Cervical insufficiency

• Multiple pregnancy, such as twins or triplets

• Certain connective tissue disorders

Having one or more risk factors does not mean PPROM will happen. Sometimes the cause is unknown.

Researchers continue to study why the membranes weaken or rupture early and how PPROM may someday be better predicted or prevented.

How is PPROM Diagnosed?

A healthcare provider may use several methods to determine whether the amniotic membranes have ruptured.

Evaluation may include:

• your description of what happened and your symptoms;

• a sterile speculum examination;

• examination or testing of vaginal fluid;

• ultrasound to evaluate the pregnancy and amniotic fluid; and

• additional testing when the diagnosis is uncertain.

If you continue to experience leaking or symptoms after an evaluation, discuss your ongoing concerns with your healthcare provider.

What Happens After a PPROM Diagnosis?

There is no single experience or course of PPROM. What happens next depends on many individual factors, including:

• gestational age at rupture;

• whether labor has started;

• signs of infection or inflammation;

• vaginal bleeding or placental complications;

• fetal wellbeing;

• amniotic fluid levels;

• other maternal or pregnancy conditions;

• available maternal and neonatal care; and

• the person's individual circumstances and choices.

Some people deliver shortly after their membranes rupture. Others experience a period of latency and remain pregnant for days, weeks, or longer.

What is Latency?

Latency is the amount of time between rupture of the membranes and delivery. Latency is one of the most unpredictable parts of PPROM. There is no test that can tell an individual person exactly how long pregnancy will continue after rupture. Some pregnancies have a short latency. Others continue for days or weeks.

During this time, healthcare providers monitor for changes that may affect the safety of continuing the pregnancy.

What is Expectant Management?

Expectant Management means continuing the pregnancy while monitoring the pregnancy and baby rather than proceeding with immediate delivery.

Expectant Management may look different depending on gestational age, medical circumstances, hospital practices, and the individual person.

Monitoring may include evaluation for:

• infection;

• labor;

• bleeding or placental abruption;

• fetal wellbeing;

• changes in amniotic fluid; and

• other complications.

Some people undergoing Expectant Management are hospitalized. In selected circumstances, some people may be managed outside of the hospital under the direction of their healthcare team.

Medical treatments may also be recommended depending on gestational age and individual circumstances.

Treatments Used in PPROM

Treatment varies based on gestational age and individual medical circumstances.

Latency Antibiotics

Antibiotics may be used during Expectant Management to reduce some infection-related complications and help prolong latency. Recommendations vary by gestational age.

Antenatal Corticosteroids

Corticosteroids may be given when premature delivery is anticipated and neonatal treatment would be considered. They help reduce some complications of premature birth.

Magnesium Sulfate

Magnesium sulfate may be given before very premature delivery for fetal neuroprotection.

Other Treatments

Other medications or interventions may be recommended based on the individual pregnancy. Some approaches being studied for PPROM remain experimental and are not part of routine care.

Learn More about PPROM Interventions & Treatments

Amniotic Fluid After PPROM

The amniotic sac contains the fluid surrounding the baby during pregnancy. After PPROM, amniotic fluid may continue to leak.

Oligohydramnios means that the amount of amniotic fluid is lower than expected.

Anhydramnios refers to very little or no measurable amniotic fluid.

Fluid levels after PPROM may remain low, fluctuate, or sometimes increase. The amount of fluid seen on an ultrasound is only one part of the overall clinical picture and cannot, by itself, predict the outcome of a pregnancy.

Learn more about Amniotic Fluid

PPROM and Lung Development

Amniotic fluid plays an important role in fetal lung development.

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

Pulmonary hypoplasia occurs when the lungs do not develop to their expected size or capacity. The risk and severity vary greatly, and not every baby exposed to early PPROM or prolonged low fluid has the same respiratory outcome.

Learn more about Pulmonary Hypoplasia

Complications

What maternal complications are possible with PPROM?

• Intrauterine infection

• Sepsis

• Placental abruption

• Antenatal, intrapartum, and postpartum hemorrhage

• Increased risk of C-Section

• Death

Learn more about PPROM Complications

What fetal neonatal complications are associated with PPROM?

• Umbilical cord prolapse

• Premature birth a subsequent complications

• Neonatal sepsis

• Stillbirth or death

• Complications of prolonged low fluid

  1. Respiratory Distress Syndrome

  2. Pulmonary hypoplasia

  3. Limb contractures and skeletal deformities

  4. Intrauterine growth restriction

Learn more about PPROM Complications

Very Early PPROM

PPROM can happen in the first or second trimester, long before a baby is ready to be born.

When PPROM happens this early, families may suddenly face difficult questions about whether the pregnancy can continue, what care is available, and what the risks may be for both the pregnant parent and baby.

You may hear the terms previable PPROM or periviable PPROM. 

Previable PPROM means the membranes rupture before a gestational age at which a baby is considered able to survive outside the womb with medical support. 

Periviable PPROM refers to rupture occurring around the earliest gestational ages when neonatal intensive care may be considered, depending on the hospital and the baby’s condition.

Know the Laws Where You Receive Care

In the United States, laws affecting pregnancy care vary by state.

If you have been diagnosed with PPROM, it is important to understand whether state laws may affect the medical care available to you, particularly if serious maternal complications develop or your pregnancy is previable or periviable.

If you live in one state and may travel or receive medical care in another, consider learning about the laws in both locations.

Laws and policies can change. Information from a website should not replace legal advice or information from your healthcare team about the care available in your individual circumstances.

Read here:  Society for Maternal Fetal Medicine -  Patient Fact Sheet - Periviable PROM (2020).

Can the Pregnancy Continue?

Sometimes.

Some people go into labor or experience pregnancy loss soon after their membranes rupture. Others remain pregnant for days, weeks, or longer.

If continuing the pregnancy is medically appropriate and Expectant Management is available, some parents continue the pregnancy with close monitoring for complications.

Very early PPROM can also lead to serious and potentially life-threatening complications for the pregnant person. Depending on the circumstances, ending the pregnancy may be chosen or may become medically necessary.

Current medical guidance recommends individualized counseling about the risks, options, and expected course so parents and patients can make informed decisions about their care.

However, the full range of medically-appropriate options may not be available everywhere. State law, hospital policy, provider practices, and access to appropriate specialists can affect whether Expectant Management or pregnancy-ending care is available.

What Happens During Expectant Management in Very Early PPROM?

Expectant Management means continuing the pregnancy with monitoring for complications.

With very early PPROM, care may change as the pregnancy progresses. Depending on gestational age and individual circumstances, this may include outpatient or hospital monitoring, antibiotics, consultation with Maternal-Fetal Medicine and Neonatology, and planning for possible premature delivery.

Antibiotics may be considered beginning at 20 weeks and are recommended during Expectant Management at 24 weeks and later when appropriate.

Corticosteroids and magnesium sulfate are generally considered when neonatal resuscitation and intensive care would be offered and desired.

What Are the Main Concerns?

Very early PPROM carries serious risks for both the pregnant parent and baby.

For the parent, complications may include infection, sepsis, bleeding, placental abruption, retained placenta, or the need for urgent delivery.

For the baby, concerns may include:

• extremely premature birth;

• prolonged low amniotic fluid;

• impaired lung development;

• complications of prematurity;

• infection;

• pregnancy or infant loss; and

• long-term health or developmental effects.

These risks are not the same in every pregnancy.

What Affects Outcomes?

Important factors include:

• how early PPROM occurs;

• how long the pregnancy continues afterward;

• gestational age at delivery;

• whether infection or other complications develop;

• amniotic fluid levels and fetal development;

• the baby's condition at birth; and

• the neonatal care available.

This is why a single survival percentage cannot describe every very early PPROM pregnancy.

When Does Neonatal Treatment Become an Option?

There is no single universal gestational age at which a baby becomes “viable.”

Each state has different laws about pregnancy care. Hospitals and neonatal centers may differ in when they offer resuscitation and intensive care. The parent's goals and the baby's individual circumstances also matter.

As pregnancy progresses toward the earliest gestational ages at which neonatal treatment may be considered, families may meet with Maternal-Fetal Medicine and Neonatology to discuss:

• whether neonatal resuscitation would be offered;

• what treatment could involve;

• local survival and health outcomes;

• whether transfer to a higher-level NICU is appropriate; and

• the family's goals if delivery occurs.

Understanding Survival Statistics

Very early PPROM research can be difficult to interpret because studies do not always count the same people.

Some studies begin with every pregnancy diagnosed with PPROM. Others count only:

• pregnancies that continued long enough to reach a certain gestational age;

• babies born alive;

• babies admitted to a NICU; or

• babies who received active neonatal treatment.

These differences can produce very different survival percentages.

When looking at a statistic, ask:

• Who was included?

• At what gestational age did PPROM occur?

• At what gestational age were the babies born?

• Were pregnancy losses included?

• Were only babies receiving intensive care counted?

• How recent is the study?

• Does it reflect the hospital where I may deliver?

A statistic can help describe what has happened to other families. It cannot tell you exactly what will happen in your pregnancy.

Care Options May Depend on Where You Live

The medical options for very early PPROM and the care actually available to a person may not always be the same.

State laws, hospital policies, provider practices, gestational age, available specialists, and hospital capabilities can affect whether Expectant Management or pregnancy-ending care is available.

Some parents may have difficulty accessing care to continue a pregnancy. Others may want or medically need to end a pregnancy but face legal or institutional restrictions.

Current medical guidance recommends individualized counseling about both Expectant Management and abortion care for previable and periviable PPROM. However, the full range of medically appropriate care may not be available in every location.

Parents should receive clear information about:

• the medical options for their individual situation;

• which of those options are available where they are receiving care;

• what symptoms or complications could change the plan;

• when hospitalization, transfer, or delivery may be recommended; and

• whether another hospital or healthcare system may offer care that is not available locally.

PPROM Affects More Than Pregnancy

PPROM affects parents and families in many different ways.

The experience may include:

• sudden changes in pregnancy plans;

• uncertainty about what happens next;

• hospitalization;

• separation from home or family;

• difficult medical decisions;

• premature birth;

• NICU hospitalization;

• pregnancy or infant loss;

• physical recovery;

• anxiety, grief, or trauma; and

• long-term effects on parents and families.

The impact of PPROM does not necessarily end at delivery.

This is why PPROM awareness, person- and family-centered care, research, and support are important.

Questions to Ask Your Healthcare Team

A PPROM diagnosis comes with a great deal of information. You do not have to remember every question at once.

Consider asking:

• What are you monitoring for right now?

• Are there signs of infection, labor, bleeding, or other complications?

• Is Expectant Management an option in my situation?

• What are the benefits and risks of the options available to me?

• What treatments are recommended now or may be recommended later?

• Should I meet with Maternal-Fetal Medicine or Neonatology?

• What symptoms require immediate evaluation?

• What level of neonatal care is available here?

• Could transfer to another hospital become appropriate?

• What outcomes does this hospital see at the gestational ages we are discussing?

It is appropriate to write down questions, take notes, ask for clarification, and ask healthcare providers to explain unfamiliar medical terms. Consider reviewing The PPROM Regimen & Perinatal / Neonatal Plan for support.

The PPROM Regimen

A parent- and patient-developed guide to help people with PPROM track information, ask questions, and take an active role in their care.

View The PPROM Regimen

Perinatal / Neontal Plan

A parent- and patient-developed planning guide to help families prepare questions, priorities, and preferences for pregnancy, delivery, and neonatal care.

View The Perinatal / Neonatal Plan

Learn More About PPROM

The PPROM Foundation maintains resources for parents, families, healthcare providers, and researchers.

PPROM Library

Explore current research and publications related to PPROM, Expectant Management, maternal and neonatal outcomes, infection, amniotic fluid, pulmonary outcomes, recurrence, and other areas of PPROM research.

Explore the PPROM Library

PPROM Patient Registry

Learn more about The PPROM Foundation's Patient-Reported Outcomes Registry.

Learn About the PPROM Registry

Peer Support

Access the PPROM Foundation's existing support resources and community.

Find PPROM Support

Current PPROM Research & Guidance

Medical knowledge surrounding PPROM continues to evolve.

Recent research has expanded what is known about:

• very early PPROM;

• maternal outcomes;

• neonatal survival and morbidity;

• long-term childhood outcomes;

• infection and inflammation;

• the vaginal microbiome;

• pulmonary outcomes;

• recurrence;

• latency; and

• fetal membrane healing and repair.

Visit the PPROM Library for current open-access publications and professional guidance.

Visit the Library

Information reviewed: August 2026