Pregnancy and Childbirth: Premature Rupture of the Membranes (PROM)

During pregnancy, the baby is surrounded in the uterus by the amniotic sac. The sac is also called the “bag of waters.” It protects and cushions the baby. Premature rupture of the membranes (PROM) is when the amniotic sac breaks before you go into labor. Normally, the sac breaks after labor begins and contractions have started. If PROM occurs at 37 weeks or earlier in pregnancy, it is called preterm PROM.

Cross section of pregnant woman's pelvis showing baby developing in amniotic sac in uterus. Placenta is attached to inside of uterus. Placenta is attached to baby by umbilical cord. Closeup detail shows tear in amniotic sac.

Are you at risk for PROM?

Doctors aren’t sure what causes PROM. But certain things seem to make PROM more likely. These are called risk factors. Risk factors for PROM include:

  • Lack of prenatal care

  • Smoking during pregnancy

  • Low body weight

  • Bleeding from the vagina during the 2nd or 3rd trimester

  • Having had a sexually transmitted disease (STD), or an infection in the bag of waters

  • Being pregnant with more than one baby

  • Having had certain medical procedures, such as amniocentesis (a test that takes fluid from the amniotic sac) or cerclage (sewing the cervix closed during pregnancy)

The dangers of PROM

PROM can result in the following serious problems:

  • Germs can travel from the vagina into the uterus and cause a dangerous infection.

  • The umbilical cord can be squeezed, reducing blood flow to the baby.

  • The placenta can separate from the wall of the uterus (placental abruption). This can lead to severe bleeding. 

  • The baby can be born too early. This can cause breathing and nervous system problems.

Symptoms of PROM

The main symptom of PROM is fluid leaking or gushing from the vagina. Even though there is loss of fluid, it keeps leaking because the baby is making more. The fluid can be clear or light yellow. Other symptoms include bleeding from the vagina, pain in the lower abdomen or in the low back. If you have any of these symptoms, call your health care provider right away.

Evaluating PROM

Your health care provider will ask about your symptoms. Mention if you have recently had contractions, bleeding from the vagina, sexual intercourse, or a fever. He or she will then likely do the following:

  • Examine your vagina and cervix.

  • Take a swab of fluid from the vagina. This is examined for the presence of amniotic fluid.

  • Do an ultrasound test to measure amniotic fluid in the uterus.

  • Check your baby’s heart rate.

Treating PROM

PROM is treated based on where you are in your pregnancy:

  • If you are 34 weeks or earlier, you’ll likely be admitted to the hospital. There, you’ll be given antibiotics to prevent infection and to prolong the pregnancy. You may also be given medication (steroids) to help the baby’s lungs mature. You and the baby will then be carefully monitored for signs of infection. If there is enough amniotic fluid to test, it will be analyzed to check how well the baby's lungs are developing. The baby’s lungs will also be checked for how they’re developing. Once the baby’s lungs are mature, labor will likely be induced.

  • If you are between 34 and 37 weeks, labor will likely be induced.

  • If you are at 37 weeks or later, if you don't go into labor on your own, your provider will recommend induction of labor. 

Follow-up care

Work with your health care provider. Together, you can take steps to avoid PROM complications. This will ensure your health and the health of your baby.