New guidance for doctors and women on when to give birth if waters break early

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).

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.

New recommendations 

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 has also been published.  

Dr Andrew Thomson, Consultant Obstetrician and author of the RCOG clinical guidelines on PPROM, said: €œPPROM 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.€œAll maternity units across the country are encouraged to follow these guidelines which should improve health outcomes for both mother and baby.€