prom in pregnancy

Right then, let's get our terminology straight before we go off half-cocked. PROM stands for Premature Rupture of Membranes, which is exactly what it sounds like—your amniotic sac decides to throw in the towel and burst open before labour actually kicks off. Now, when we're talking about prom in pregnancy, we're specifically referring to when this happens at or after 37 weeks of gestation. That's the magic number where your baby is considered full-term and ready to meet the world, even if they're being a bit impatient about it. The key thing to remember is that prom in pregnancy isn't necessarily an emergency—it's more of a "right, let's get this show on the road" situation. Your body's basically saying, "Right, I'm done with this whole pregnancy business—let's get this baby out!"

Here's where things get a bit tricky, so pay attention—this is important stuff. While PROM happens at or after 37 weeks, PPROM (Preterm Premature Rupture of Membranes) is when your waters break before 37 weeks. That seemingly small difference is actually massive in terms of implications and treatment. With prom in pregnancy, you're dealing with a full-term baby who's ready to rock and roll. But with PPROM? That's a whole different kettle of fish—you're looking at potential complications like infection, cord prolapse, and the baby not being fully developed yet. The distinction between PROM and PPROM is absolutely critical because it determines everything from your treatment plan to your baby's prognosis. When you've got prom in pregnancy, the focus is usually on getting labour started safely. With PPROM, it's more about trying to delay delivery while managing risks.

Now, you're probably wondering what on earth causes PPROM in the first place—like, why would your body decide to spring a leak weeks before your due date? The honest answer is that we don't always know, but there are several factors that can increase your risk. Infections are a big one—things like urinary tract infections, bacterial vaginosis, or sexually transmitted infections can weaken the membranes and cause them to rupture prematurely. Other risk factors include smoking during pregnancy (which we really shouldn't need to tell you to stop), previous history of PPROM, cervical incompetence, multiple pregnancies (twins, triplets, etc.), and even things like nutritional deficiencies or excessive amniotic fluid. Sometimes it's just bad luck—your membranes might be naturally weaker, or you might have experienced some trauma to your abdomen. The point is, prom in pregnancy isn't usually something you've done wrong—it's often just one of those things that happens.

So how do you actually know if you're experiencing prom in pregnancy? The most obvious symptom is, well, your waters breaking. But it's not always as dramatic as the movies make it out to be—sometimes it's just a small trickle rather than a gush. You might feel a popping sensation, or you might not feel anything at all. The fluid is usually clear or slightly pinkish, and it has a sweet smell (unlike urine, which has that distinctive ammonia odour). Other symptoms can include increased vaginal discharge, feeling wetter than usual, or even just a general sense that something's not quite right. The tricky part is that sometimes it's hard to tell the difference between leaking amniotic fluid and other types of discharge. If you're unsure, the best thing to do is get yourself to your midwife or hospital for a proper check. They can do tests to confirm whether it's actually prom in pregnancy or just your body playing tricks on you.

Right, so you think you might be experiencing prom in pregnancy—what on earth do you do now? First things first, don't panic. Easier said than done, we know, but panicking won't help anyone. The first step is to note the time when you first noticed the fluid leakage, and try to estimate how much fluid there was (was it a gush or just a trickle?). Then, give your maternity unit a ring and let them know what's happening. They'll probably ask you to come in for an assessment, which is exactly what you should do. While you're waiting or on your way to the hospital, it's a good idea to wear a sanitary pad (not a tampon) so they can see what the fluid looks like. Try to avoid having sex or putting anything in your vagina, as this can increase the risk of infection. And for goodness sake, don't try to drive yourself if you're in any doubt—get someone to take you or call an ambulance if necessary. Remember, when it comes to prom in pregnancy, it's always better to be safe than sorry.

Once you're at the hospital, the medical team will need to confirm whether you're actually experiencing prom in pregnancy or if it's something else entirely. They'll probably start with a physical examination to check your cervix and see if there's any fluid pooling in your vagina. They might also do a speculum examination (similar to a smear test) to get a better look. There are several tests they can use to confirm the diagnosis—the most common one is called a nitrazine test, which checks the pH of the fluid (amniotic fluid is more alkaline than vaginal secretions). They might also do a ferning test, where they look at the fluid under a microscope to see if it forms a fern-like pattern (which amniotic fluid does). In some cases, they might use ultrasound to check your amniotic fluid levels. The key thing is that they need to be absolutely certain it's prom in pregnancy before they start any treatment, because the management is quite different from other conditions that might cause similar symptoms.

So you've been diagnosed with prom in pregnancy at term—what happens next? Well, the good news is that at 37 weeks or more, your baby is considered full-term and ready to be born. The standard approach is usually to induce labour within 24 hours of your waters breaking, mainly to reduce the risk of infection. The longer your membranes are ruptured without labour starting, the higher the chance of bacteria getting into your uterus and causing problems. Induction methods can vary depending on your individual circumstances and how your cervix is looking—they might use prostaglandin pessaries to ripen your cervix, or they might break your waters artificially if they haven't already gone. In some cases, they might use a hormone drip (syntocinon) to get your contractions going. The important thing to remember is that while induction might not be your ideal birth plan, it's usually the safest option when you've got prom in pregnancy at term.

Now, if you're dealing with PPROM (before 37 weeks), the management is quite different and much more complex. The approach depends on how many weeks pregnant you are—before 24 weeks, the focus is usually on monitoring for infection and discussing the options with you. Between 24 and 34 weeks, the goal is often to delay delivery as long as possible while giving you steroids to help your baby's lungs mature. After 34 weeks, they might still try to delay delivery for a bit, but the risks of continuing the pregnancy start to outweigh the benefits of waiting. Throughout this time, you'll be closely monitored for signs of infection, and you'll probably be given antibiotics to reduce the risk. You might also be offered magnesium sulphate to protect your baby's brain if delivery is imminent before 32 weeks. The key thing with PPROM is that it's a balancing act between the risks of prematurity and the risks of infection—and every case is different. That's why it's so important to have a good medical team looking after you when you're dealing with prom in pregnancy before term.

Let's not beat around the bush—prom in pregnancy does come with some potential complications that you need to be aware of. The biggest risk is infection, both for you and your baby. Once your membranes have ruptured, bacteria can travel up into your uterus, potentially causing chorioamnionitis (infection of the membranes and amniotic fluid) or even sepsis. There's also the risk of cord prolapse, where the umbilical cord slips down into your vagina ahead of the baby—this is a medical emergency because it can cut off your baby's oxygen supply. Other complications can include placental abruption (where the placenta separates from the uterine wall), fetal distress, or the need for an emergency caesarean section. The risk of these complications increases the longer your membranes are ruptured without delivery happening. That's why timing is so crucial when managing prom in pregnancy—it's all about finding that sweet spot between giving your baby time to be ready and minimising the risks of waiting too long.

Dealing with prom in pregnancy can be an incredibly stressful and overwhelming experience, especially if it's happening earlier than expected. That's why having good support systems in place is absolutely crucial. Your midwife and obstetric team should be your first port of call—they're there to answer your questions, explain what's happening, and help you make informed decisions about your care. Don't be afraid to ask for clarification if something doesn't make sense, or to express any concerns you might have. Beyond the medical team, it's important to have emotional support too—your partner, family members, or close friends can provide that shoulder to cry on when things get tough. There are also some excellent online resources and support groups for women experiencing PROM or PPROM, where you can connect with others who've been through similar experiences. And remember, it's okay to feel scared or anxious—this is a big deal, and your feelings are completely valid. For more comprehensive pregnancy information, visit Amana Parenting, explore our Pregnancy category for more resources, or use our handy Pregnancy Week Calculator By Due Date Countdown Tool to track your progress.

References

• https://www.nice.org.uk/guidance/ng121
• https://www.rcog.org.uk/guidance
• https://www.nhs.uk/conditions/pregnancy-and-baby/premature-rupture-of-membranes-prom/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380070/