PPROM: when the waters break before 37 weeks

Some women feel a pop followed by a gush of fluid. Others notice a trickle or feel damp, and it can be hard to tell leaking amniotic fluid from urine or vaginal discharge. Fluid from the waters is a watery liquid that keeps coming and you cannot stop by squeezing your pelvic floor, as Tommy's describes. If you are unsure, assume it could be the waters and call your maternity unit or triage line.

Do not wait for contractions. Even if you feel well, you need to be seen the same day, because the protective barrier around the baby has been breached.

The RCOG leaflet explains that staff will usually examine you with a speculum to see fluid collecting at the cervix. If this is not clear, a swab test of fluid may be used. An ultrasound scan measures the pool of fluid around the baby, and the baby's heart is monitored. Blood tests, a urine test and your pulse, temperature and blood pressure are checked for signs of infection.

Often no reason is found. Infection or inflammation, placental problems and increased pressure in the womb are possible causes. Tommy's lists risk factors including a previous PPROM, bleeding in pregnancy after 12 weeks, a short cervix, smoking, recreational drug use, a womb with an unusual shape, a low BMI, connective tissue disorders, a multiple pregnancy and invasive procedures in pregnancy such as amniocentesis.

Antibiotics are given to lower the chance of infection in the womb, and they may delay labour. Intravenous antibiotics are used if labour begins. A course of steroid injections is offered to speed up the baby's lung maturity; the NHS notes they may not be offered after 36 weeks because the lungs are likely to be ready by then.

If the baby is likely to be born very prematurely, magnesium sulphate through a drip can reduce the risk of cerebral palsy. The NHS states it is offered between 24 and 29 weeks and may be offered at 30 to 33 weeks. If a woman receives it for more than five to seven days, or has repeat courses, her baby may have extra checks because of rare bone problems.

If you and your baby are well and there are no signs of infection, you may be advised to continue the pregnancy towards 37 weeks, with regular reviews. You might stay in hospital for a few days, then go home with a schedule of visits and a reliable way to get back quickly.

• A high temperature or shivering.

• Green, brown or foul-smelling fluid.

• Vaginal bleeding.

• Tummy or back pain, or tightenings that become regular.

• Your baby moving less or differently.

The main danger is infection of the womb, called chorioamnionitis, which can cause labour to start and can lead to sepsis. Other possible complications are cord prolapse, placental abruption and, with very early rupture, underdevelopment of the baby's lungs. The earlier in pregnancy the waters break, the more serious the outlook.

If infection develops or the baby's heart rate shows distress, birth may be advised sooner. In an otherwise well pregnancy, waiting until 37 weeks is a common plan, while someone who carries group B strep may be offered birth from 34 weeks. A neonatal unit will usually be told if you are at risk of giving birth early.

Having PPROM raises the chance of another preterm birth in a future pregnancy, but it does not make it certain. You can ask for a referral to a preterm birth clinic, which may arrange cervical-length scans. Mental health matters too: Tommy's notes that about 1 in 5 people have mental health problems in pregnancy or in the first year after birth, and a hospital stay full of uncertainty can add to this.