PPROM + what to know if it happens to you

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Preterm premature rupture of the membranes (PPROM) is a pregnancy complication of which most have never heard. However, the PPROM Foundation reports that as many as 30-40% of preterm births are caused by PPROM(1). For a complication that is not as widely known, its impacts can be severe and lasting. The good news is that intervention and monitoring can help prevent preterm delivery or help strengthen your baby's lungs in the event delivery is necessary. Let's take a closer look at the condition and what to know if it happens to you.

PPROM is a condition where the amniotic sac surrounding your baby ruptures before week 37 of pregnancy. Most people know that once the sac ruptures, there is a higher chance of infection, as well as preterm delivery.

So what causes PPROM? In most cases, the cause is largely unknown, yet, the Children's Hospital of Philadelphia reports that there are underlying causes that may by linked to PPROM, including:

*Low socioeconomic conditions (proper prenatal care may not be readily available/affordable for women from lower socioeconomic backgrounds)

*Previous preterm birth

*Vaginal bleeding*

Smoking during pregnancy

PPROM is also one of the higher risk side affects from fetal intervention. The Fetal Health Foundation’s Fetal Therapy Think Tank Innovation Program will be working on new research with multidisciplinary stakeholders in addressing the treatment and prevention (when fetal intervention is needed) of PPROM.

Lonnie Somers, Founder of the Fetal Health Foundation, said, “It is incredibly exciting to have the Think Tank looking to address, research, and find solutions that will improve the outcomes and reduce risks of fetal intervention. This is what Fetal Health and the Fetal Therapy Think Tank were designed to do, and to see this coming to fruition is more than we could have ever dreamed.”

What are the symptoms of PPROM?

Symptoms can present differently in each pregnancy and can include:

*A sudden gush of fluid from your vagina

*Mild to moderate leaking of fluid from your vagina

*A feeling of wetness in your vagina or underwear

It is important that if you notice any leaking, to call your healthcare provider right away. They will likely schedule a scan to determine if your amniotic sac has ruptured before advising on a plan of care.

How is PPROM diagnosed? Your healthcare provider will ask you questions about your pregnancy. They will also ask you about your symptoms and when they started before giving you a physical exam. A speculum will be used to look inside your vagina, as your healthcare provider is looking for fluid leaking from your cervix. They may also remove some fluid for testing whether it is amniotic fluid, vaginal fluid, or urine.

An ultrasound scan may be used in conjunction with a physical exam to help measure the amount of amniotic fluid around your baby. However, it is important to note that an ultrasound scan is not a viable option on its own, as a slow leak in amniotic fluid would be too hard to determine. Together, these tests will help determine next steps.

What are possible complications of PPROM?

As mentioned previously, PPROM happens in many premature births. A baby born too early may have serious problems, including requiring ventilation and feeding tubes, among other special needs. Other complications include:

*Placental abruption, or a separation of the placenta from the uterine wall

*Umbilical cord prolapse due to little to no amniotic fluid; can cause lack of oxygen to the baby

* Chorioamnionitis, an infection that can be fatal if not treated; delivery is necessary to prevent sepsis in the mom

In each of these cases, it is important that you know your hospital's capabilities when it comes to delivering high risk pregnancies. Do they have the surgical and neonatological staff and equipment for a high-risk delivery? Do they offer a qualified Neonatal Intensive Care Unit (NICU) to care for your baby if born early and with special needs? These are great questions to ask of your healthcare provider in the event you require these higher level qualifications.

How is PPROM treated?

Treatment will depend on your symptoms, how long you have had them, how far into the pregnancy you are, and the general health of mom and baby. It will also depend on how severe your condition is. If you are recommended for bed rest and a hospital stay, your healthcare provider will watch you and your baby closely. They may monitor for signs of labor or contractions, as well as your baby's movements and heart rate. They will also watch for signs of infection, which can include fever or pain, or signs that your baby is in distress.

If you are advised to take medication to help with PPROM, you may be prescribed one or more of the following:

*Corticosteroids. These medicines can help your baby’s lungs grow and mature. If your baby is born early, their lungs may not be able to work on their own.

*Antibiotics. These will do the job of preventing or treating a possible infection.

*Tocolytic medicines. These are used in the event of preterm labor, mainly to buy some time.

Induction of labor I

f your condition is severe enough, and your baby's health is at risk, your healthcare provider may give you medicine to help start labor. However, not to worry too much, as your healthcare provider likely will not induce labor until at least week 34 of pregnancy. Timing is always crucial, especially when it comes to the health and well-being of you and your baby. Rest assured that your healthcare provider is monitoring in several different ways to make the best decision possible for your plan of care in this often tricky situation.

What can I do to prevent it?

Since the cause of PPROM is often unknown, there is no way to stop the condition from happening. Schedule an appointment as soon as you know you’re pregnant. If you smoke, ask your healthcare provider how to quit. Beginning or continuing to exercise, as well as improving your nutrition are additional ways to help prevent pregnancy complications down the road. Keeping up with your prenatal checkups and any testing or monitoring are key to keeping tabs on everything as it happens (and as a possible preventative measure). Before your healthcare provider visits, write down any questions you want answered. Receiving a diagnosis with all of its implications of possible treatment, medication, side effects, etc. can be overwhelming. It's easier to remember when you have notes to which you can refer.

What if my baby is born early due to PPROM?

The age of viability is currently held at 24 weeks in the United States, but women and their fighters for babies challenge this barrier year after year. There are certainly complications with prematurity, but these are circumstantial around the cause of preterm labor, the gestational age at which the baby is born, the conditions under which the baby is born, and so on.

One specific complication that can result from PPROM is pulmonary hypoplasia. This occurs because of little amniotic fluid in the sac, preventing the baby from practice breathing and getting the lungs prepared for the real deal. Lung development and respiratory support once the baby is born will be key to helping the baby's growth and survival. These babies require care in the NICU and often go home with respiratory support.

More promising, the PPROM Foundation cites a study showing a 90% survival rate for infants impacted by PPROM between 18-24 weeks who were delivered after the age of viability.² While the babies required lengthy stays in the NICU, their success proves what can be done with proper care and treatment.

The most important thing to take away from understanding PPROM is that premature labor is not the end. There are resources for information and advocacy, and with agressive monitoring and treatment, you and your baby will be in good hands.

It's all about timing... The PPROM Foundation advises that if you suspect amniotic fluid leaking to consult with your healthcare provider immediately. Other things to do to help mitigate further risk to premature birth include bed rest, managing stress factors and staying as hydrated as possible. For more resources and information, visit the PPROM Foundation at aapprom.org.

1. ACOG Practice Bulletin No. 160: Premature Rupture of Membranes. Obstet Gynecol. 2016 Jan. 127 (1):e39-51.

2. Brumbaugh JE, Colaizy TT, Nuangchamnong N, et al. Neonatal Survival After Prolonged Preterm Premature Rupture of Membranes Before 24 Weeks of Gestation. Obstetrics & Gynecology. 2014;124(5):992-998. doi:10.1097/ aog.0000000000000511.