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RCOG provides new guidance for doctors and women on when to give birth if waters break early

News 18 June 2019

  • Waters breaking early are uncommon, but potentially serious for a woman and her baby
  • New recommendations will inform best practice in maternity units to improve outcomes
  • Updated clinical guidelines are launched during the RCOG World Congress in London

Pregnant women whose waters break early from 24 weeks, but do not go into labour, should be offered the choice to continue with the pregnancy until 37 weeks of gestation — as long as there are no signs of infection or complications, recommend revised clinical guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) published today.

Continuing with the pregnancy closer to term could reduce the risk of the baby being born prematurely which is linked to problems with breathing, feeding and infection, and being admitted to a neonatal unit.

A woman and her baby should be monitored closely for signs of infection and her individual circumstances and preferences taken into account, say the guidelines.

If there are signs of infection or complications, it may be safer that a woman gives birth straight away.

When a woman’s waters break early, but she does not go into labour before 37 weeks of gestation, it is known as preterm prelabour rupture of membranes (PPROM).

PPROM is a rare condition and affects up to 3 out of 100 (3%) pregnancies and is associated with 3-4 out of 10 (30–40%) of premature births in the UK.

Sometimes the baby is born soon afterwards - around 50% of women will go into labour within the first week after their waters break. But frequently it is possible to continue the pregnancy for weeks, or even months after the membranes have ruptured.

Every woman with PPROM should be offered antibiotics to reduce the risk of infection, such as sepsis, and to help the pregnancy continue, recommend the guidelines.  

The revised guidance covers the diagnosis, assessment, care and timing of birth following waters breaking early from 24 weeks and until 37 weeks of gestation.

Other new recommendations in the guidance include:

  • Where possible, a baby should be born in a unit with appropriate neonatal staff and facilities, and a woman and her partner offered the opportunity to meet a neonatologist to discuss their baby’s care.
  • Additional emotional support should be offered to a woman and her partner during these complicated pregnancies and after birth. 
  • In a subsequent pregnancy, women should be cared for by an obstetrician with expertise in preterm birth.
  • In some circumstances, a woman may be cared for at home, while others may be best suited to be in a maternity unit – this should be considered on a case by case basis. 

A new leaflet for women and their partners, based on the latest guidance, is also published today.  

Dr Andrew Thomson, Consultant Obstetrician and author of the RCOG clinical guidelines on PPROM, said:

“PPROM is an uncommon, but potentially serious condition with significant health risks to a woman and her baby. Evidence shows that waiting for labour to begin may be the best option for a healthier outcome, unless there is a reason for the baby to be born immediately. Every pregnancy will be different, and each woman’s individual preferences need to be considered when deciding on the timing of birth.

“All maternity units across the country are encouraged to follow these guidelines which should improve health outcomes for both mother and baby.”

Ciara Curran and Rachel Johnson, Directors of the Little Heartbeats support group, said:

“PPROM is associated with up to 40% of premature births, but women have rarely heard of it before it happens to them, and understanding of the condition and how to manage it is inconsistent across the medical profession.

“Little Heartbeats highlighted the continuing need for these guidelines and patient information leaflets. We thank the RCOG for their engagement, have valued the opportunity to assist with the drafting process, and are delighted that these resources are now available to benefit all women and their families going through PPROM today and in the future.

“When waters break early in pregnancy it can be a really emotionally challenging time for parents and the choices that need to be made can be extremely difficult. It is essential that women and their partners are provided with all the information they need to make informed decisions, and with ongoing emotional support.”

Note to editors

For media enquiries, please contact the RCOG press office on +44 (0)20 7045 6773 or email pressoffice@rcog.org.uk

The revised guidelines and information leaflet are being launched during the RCOG World Congress in London from 17 - 19 June. This event – one of the largest of its kind – will bring together experts from obstetrics and gynaecology and will be attended by 4,000 delegates from over 100 countries.

RCOG Green-top Guideline: Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation. 

Patient information leaflet: When your waters break prematurely.

The RCOG intends to develop additional guidance to advise best practice on the management of PPROM before 24 weeks.  

The revised guidance supplements NICE guideline [NG25] titled Preterm labour and birth (published November 2015). Relevant recommendations can also be found in the RCOG Green-top Guideline [GTG no. 36], Early-onset of Group B Streptococcal Disease.

About Little Heartbeats 
Little Heartbeats is a support group for all mothers, fathers, and families who have first-hand experience of PPROM throughout the UK and internationally. For more information, visit:  www.little-heartbeats.org.uk

About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high-quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. ​www.rcog.org.uk