What happens if my waters break before labour?

Known as Preterm Premature Rupture of Membranes, this condition occurs before the 37th week of pregnancy.

When she was 33 weeks pregnant, first-time expectant mum Chan Huijun 32, suddenly felt a gush of water in her underwear. She thought she had peed.

“I had just gone for yoga, and I was walking around the mall nearby. I was conscious about my pants being stained, so I quickly hopped into a cab and headed home,” she recalls.

She didn’t think that it would be her water bag leaking, because she was still some two months away from her due date.

When she arrived home, the gushing seemed to stop, although she noticed that her underwear seemed to be constantly damp over the next few hours. When Chan called her husband, the couple decided to go to the gynae for a check, just in case.

However, when she felt several “small gushes” on her way to the clinic, it occurred to Chan that her amniotic fluid might be leaking. “Nothing hurt, but I was so worried about moving making sudden movements. I kept trying to hold it in, but it was impossible.”

At the clinic, her gynae confirmed that Chan’s water bag was leaking and placed her on hospital bed rest.

With constant monitoring, Chan delivered a healthy baby girl at 35 weeks.

I was so worried about moving or making sudden movements. I kept trying to hold it in, but it was impossible.”

Preterm Premature Rupture of Membranes (PPROM)

The membranes of the amniotic sac rupturing before 37 weeks of pregnancy, which causes the amniotic fluid to leak, is known as PPROM. The condition happens in some 2 per cent of pregnancies.

Dr Liana Koe, an obstetrician and gynaecologist at Thomson Medical, says that it could feel like a gush of fluid from the vagina, or just a trickle of water. “You will likely feel fluid leaking thereafter. The fluid is usually clear in colour, but can be mixed with red or pink discharge.”

In addition, if the baby is distressed, it may pass motion in the womb, resulting in green or brown amniotic fluid. “In this case, immediate attention is needed,” Dr Koe warns.

What causes PPROM?

Thomson Medical obstetrician and gynaecologist Dr Freda Khoo explains that a common cause is an infection in the genital tract, “The infection weakens the integrity of the membranes, causing a leak prematurely.”

Other causes include recurrent bleeding in pregnancy, a weak cervix and smoking. “In the case of a weak cervix, for example, if the expectant mum has had a previous surgery done on the cervix before, the weakened cervix may fail to act as a barrier to the ascending infections from the external environment,” Dr Khoo explains.

Other factors that increase the chances of PPROM include a previous history of preterm birth, or multiple pregnancies, says Dr Koe. “An extremely high amniotic water level may also stretch the womb, increasing the risk of PPROM,” she adds.

 

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Does PPROM pose a danger?

PPROM can vary in danger and severity. For instance, if there is only a small “hole” in the membrane, it may quickly seal up, Dr Khoo notes. But if it doesn’t, it means that the foetus in the uterus is exposed to the external environment, and thus potential infections, she explains. “There is a risk of infection of the amniotic fluid and membranes, which may lead to the infection of the foetus and even in the pregnant mum”.

Dr Koe lists the four main dangers of PPROM:

a) Early labour

The early rupture of membranes can trigger labour pains, resulting in early delivery. How dangerous this is depends on the baby’s gestation period ― which impacts whether it would have breathing difficulties that require supportive care, infections, or damage to their brain. “The younger they are, the more serious the implications,” Dr Koe points out.

b) Infection affecting the baby and mother

If delivery doesn’t happen, both the mum and baby are at risk of infection. The doctor has to balance the risk of infection against the risk of early delivery. If there are signs of infection, delivery is usually required to reduce the risk of complications.

The aim of PPROM treatment is to prevent and detect infection, while prolonging the pregnancy as much as possible.

c) Low amniotic fluid levels

If the waters have broken, the fluid level will usually be lower. Since these waters are required for the baby’s lung development (especially before 23 weeks), it may affect the development of their lungs, giving rise to severe problems after birth.

After 24 weeks, low fluid levels may not affect lung development as much. However, the reduced space for the baby to move around means that the umbilical cord may be compressed, which can affect the baby’s heartbeat.

d) Cord prolapse

When the amniotic sac breaks, the baby’s umbilical cord may fall through the cervix ― known as cord prolapse. “This can affect the baby’s heartbeat suddenly, which is an emergency situation that requires immediate delivery,” Dr Koe explains. 

How PROM is treated

If you suspect that you have PPROM, see your doctor immediately. Your doctor can assess and perform tests to confirm if the amniotic sac has indeed been ruptured, Dr Khoo says.

Dr Koe explains that PPROM treatment aims to prevent and detect infection, while prolonging the pregnancy as much as possible.

“Antibiotics are given to reduce infection risks,” she says. “During this time, mother and baby will be monitored ― this includes the mother’s heart rate, blood pressure, and temperature.”

The doctor will also look for other signs like abdominal pain or contractions, and foul-smelling discharge. Urgent delivery may be advised if there is a sign of infection.

If the baby is at a risk of coming too early, the doctor can do several things, she notes. These include:

* An intramuscular injection of steroids to help baby’s lung mature and reduce the chance that it will suffer breathing difficulties when it’s born;

* If the pregnancy is at 30 to 32 weeks, the ob-gyn might give a medication called magnesium sulphate intravenously to improve the baby’s brain outcomes.

Can a mum-to-be avoid this condition?

While there is no one way to prevent PPROM, it helps to reduce known risk factors such as smoking, and treating any known vaginal infections.

Also, keeping the perineal area clean and dry can prevent potential infections of the genital tract, Dr Khoo states. “If you notice any vaginal discharge that is foul smelling, causes itch, or is yellowish or greenish, let your doctor know, so you can be treated early.”

Photos: iStock

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