Preterm Birth

Preterm Birth and (Premature) Rupture of Membranes

About 8 babies out of every 100 in the UK are born before the 37th week of pregnancy. This is called preterm (or premature) birth. Preterm labour usually starts by itself, although sometimes a preterm birth is planned if it’s thought to be safest for the baby or the mother. There are risks to the baby from being born early, and the earlier a baby is born, the higher their chances of health problems at birth and later in life. Choosing the right treatments to help stop or slow down early labour can reduce these risks.

Preterm prelabour rupture of membranes (PPROM) is when your waters break before 37 completed weeks of pregnancy but you haven’t gone into labour yet. If this happens, you have a higher chance of giving birth prematurely and there is an increased chance that both you and your baby may develop an infection that can make you both unwell. You will be offered a course of antibiotics to reduce the risk of an infection developing and to help the pregnancy to continue. If you are well with no signs of infection and your baby is growing well in your uterus (womb), then it may be better to allow your pregnancy to continue until 37 weeks. You will be monitored very closely for any signs of infection by your healthcare team, and your individual circumstances and preferences will be taken into account. If you or your baby show any signs of infection or develop other complications, you may need to give birth to your baby straight away. 

When the waters break, it is also known as rupture of the membranes. Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is known as preterm prelabour rupture of membranes (PPROM). This can happen in up to 3 out of every 100 (3%) pregnant women. PPROM is

Associated with 3 to 4 in 10 preterm births. The reason why PPROM happens is not always known but may be because of infections, placental problems or other causes.

Risks Associated with PPROM

Infection
The membranes form a protective barrier around the baby, and after these have broken, there is a risk of infection getting into your uterus (chorioamnionitis). If you have an infection, this can cause you to go into labour early or cause you or your baby to develop sepsis. The symptoms of infection include a raised temperature, an unusual vaginal discharge with an unpleasant smell, a fast pulse rate and pain in your lower abdomen. Your baby’s heart rate may also be faster than normal. If there are signs that you have an infection, your baby may need to be born straight away to try to prevent both you and your baby becoming more unwell.

Preterm birth
About 50% of women with PPROM will go into labour within the first week after their waters break. The further along you are in your pregnancy the more likely you are to go into labour within one week of your waters breaking.

Problems of prematurity
Babies born prematurely have an increased risk of health problems, particularly with breathing, feeding and infection, and may need admission to a neonatal unit. The earlier your baby is born, the more likely that this will be the case. If your waters have broken early, your healthcare professional will discuss with you the possible outcomes for your baby, depending on how many weeks pregnant you are when this happens and on your individual circumstances.

Other Complications

Cord prolapse, when the umbilical cord falls through your cervix into the vagina: this is an emergency complication and can be life-threatening for your baby, but it is uncommon.

Pulmonary hypoplasia, when your baby’s lungs fail to develop normally because of a lack of fluid around them: this is more common if your waters break very early on in pregnancy (less than 24 weeks) when your baby’s lungs are still developing.

Placental abruption, when your placenta separates prematurely from your uterus: this can cause heavy bleeding and can be dangerous for both you and your baby. If you experience PPROM, sometimes your baby may not survive. The risk of this happening is greater if your waters break very early, if the baby is born very prematurely or, in some cases, following infection or cord prolapse.

You should have regular check-ups with your healthcare professional (usually one or two times per week). During these check-ups, your baby’s heart rate will be monitored, your temperature, pulse and blood pressure will be checked and you will have blood tests looking for signs of infection. Your obstetrician will work with you to make an ongoing plan for your pregnancy.

Right time to deliver the baby

If you and your baby are both well with no signs of infection then you may be advised to wait until 37 weeks to give birth. This is because carrying on with the pregnancy reduces the risk to your baby that are related to being born preterm. If you are known to carry the GBS bacteria then you may be advised to give birth from 34 weeks because of the risk of GBS infection in your baby.

Hope you found this information helpful