What is PPROM and how should doctors manage it?

Preterm premature rupture of membranes (PPROM) is a subtype of PROM (premature rupture of membranes), a condition where a mother’s ‘water breaks’ before 37 weeks gestation. The condition is particularly concerning because amniotic fluid serves as a protective environment. With this environment missing, the baby becomes significantly more prone to infection and a large number of other complications. This condition can be dangerous for a baby because delivery often occurs within 48 hours after the membranes ruptured. PPROM often occurs due to infections such as herpes simplex virus (HSV), GBS, bacterial vaginosis (BV) or a urinary tract infection (UTI), though this isn’t always necessarily the case. It can also happen in cases where the mother has had previous cervical surgery, has had or is having multiples (twins or triplets), has too much amniotic fluid (polyhydramnios), or if the mother has sepsis.

How common is PPROM?

In the United States, around 11% of total births are premature. 3-4% of premature births are caused by PPROM.

What does PPROM look like?

Several signs can indicate that PPROM occurred. The most prominent is pale yellow or clear fluid leaking from the vagina, either in a steady trickle or all at once.  

Because PPROM and infections co-occur in a significant number of cases, physicians can look for signs of infection in the baby as well. These include:

  • Increase in fetal heart rate (Fetal tachycardia)
  • Increase in maternal heart rate (Maternal tachycardia)
  • Contractions
  • Uterine tenderness
  • Foul-smelling vaginal discharge
  • Increased white blood cell count or change in relative quantities of white blood cell type in the mother

If these signs are present, a physician can:

  • Use a speculum to see if fluid is leaking from the cervix
  • Take a sample and verify it is amniotic fluid
  • Order an ultrasound to see how much fluid is left
  • Take a thorough medical history

What are some of the complications associated with PPROM?

The complications associated with PPROM are the same as those that occur with PROM. These include:

  • Chorioamnionitis (placental membrane inflammation/infection)
  • Umbilical cord prolapse or compression
    • This can cut off air supply to the baby and cause brain injury.
  • Infections passed from mother to baby
    • Infections can lead to sepsis and infections such as meningitis, which can have permanent and serious effects on a baby’s brain development

What are some of the health risks associated with PPROM?

PPROM carries with it a variety of risks for a baby. Some of these include:

How are medical professionals obligated to care for PPROM?

Physicians may follow different guidelines for care depending on how many weeks’ gestation the fetus is. However, because PPROM can be either the cause or the result of an infection, they should give mothers antibiotics to avoid passing infection from mother to baby.

A C-section might be necessary to protect the baby from infection, because the longer the time period between the rupture of membranes and delivery, the likelier an infection will happen (especially if more than 12 hours elapse between rupture and delivery).

Once the baby is born, physicians should follow standards of care, including respiratory management, which can require the use of surfactant or ventilation.

Note: It is crucial to understand that that a premature baby with an infection is much more worrisome than a premature baby.  Ideally, the baby should be delivered at the first signs of potential infection.    This is difficult to predict, so close monitoring is essential, and signs of infection or changes in the baby’s testing (even subtle ones) should be relied upon.

What are the long-term outcomes associated with PPROM?

Many infants that are born as a result of properly managed PPROM do well, as most complications tend to arise from mismanagement of the condition. Because PPROM has the added risk factor of prematurity, it’s very important that physicians be exceedingly careful in their treatment of the baby. Good outcomes stem from proper management of care.

PPROM and Medical Malpractice

Birth Injury Attorneys, Reiter & Walsh, P.C. | Award BadgeIf you had PPROM and suspect that you child has developmental delays, hypoxic ischemic encephalopathy (HIE), cerebral palsy or other injuries from medical staff’s mishandling of the complication, we are available 24/7 to speak with you. Please contact us by phone (at 888.812.6009), via live chat (on the left of the screen) or via email.

We are one of only a few select firms that handle exclusively birth injury. We are also one of the few to employ in-house medical staff, who apply their knowledge to exhaustively interpreting your medical records and determining if medical malpractice occurred. Our attorneys have won numerous settlements for our clients and have received numerous awards for their work.

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