Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM).
PROM occurs in about 8 to 10 percent of all pregnancies. PPROM (before 37 weeks) accounts for one fourth to one third of all preterm births.
Rupture of the membranes near the end of pregnancy (term) may be caused by a natural weakening of the membranes or from the force of contractions. Before term, PPROM is often due to an infection in the uterus. Other factors that may be linked to PROM include the following:
PROM is a complicating factor in as many as one third of premature births. A significant risk of PPROM is that the baby is very likely to be born within a few days of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis, which can be very dangerous for mother and baby. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum (after delivery) infection.
The following are the most common symptoms of PROM. However, each woman may experience symptoms differently. Symptoms may include:
If you notice any symptoms of PROM, be sure to call your doctor as soon as possible. The symptoms of PROM may resemble other medical conditions. Consult your doctor for a diagnosis.
In addition to a complete medical history and physical examination, PROM may be diagnosed in several ways, including the following:
Specific treatment for PROM will be determined by your doctor based on:
Treatment for premature rupture of membranes may include:
Unfortunately, there is no way to actively prevent PROM. However, this condition does have a strong link with cigarette smoking and mothers should stop smoking as soon as possible.
ACOG guidance on Prelabor Rupture of Membranes (PROM) addresses current literature especially related to management of late preterm PROM (34w0d to 36w6d). Following appropriate counseling, expectant management or delivery is appropriate. The use of ‘prelabor’ is in keeping with reVITALize terminology (see ‘Related ObG Topics’ below) and is defined as the ‘spontaneous rupture of membranes that occurs before the onset of labor’.
Note: In August 2018, the FDA sent a letter to health providers to be aware of rupture of membranes (ROM) test limitations, due to reports of adverse events. The FDA letter states that “health care providers may be over-relying on ROM test results when making critical patient management decisions, despite labeling instructions warning against this practice.” To promote awareness and aid in the proper use of the ROM test, the FDA letter states
PROM at < 24 Weeks
Preterm PROM at 24w0d-33w6d
Note: There are multiple regimens in use | There is no evidence to support a single optimal regimen for latency antibiotics
Late Preterm (34w0d to 36w6d)
Additional Clinical Considerations
PROM Following Amniocentesis
Preterm PROM and Future Pregnancies
Learn More – Primary Sources:
ACOG Practice Bulletin 217: Prelabor Rupture of Membranes
ACOG Practice Bulletin 831: Medically Indicated Late-Preterm and Early-Term Deliveries
FDA: Risks Associated with Use of Rupture of Membranes Tests – Letter to Health Care Providers
FDA News Release: FDA alerts healthcare providers, women about risks associated with improper use of rupture of membranes tests
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