Treatment strategies for women whose water breaks prematurely from the 37th week of pregnancy onward


This fact box can help you to weigh the benefits and harms of treatments strategies after a premature rupture of membranes without onset of labor. The information and numbers are based on the best scientific evidence currently available.

This fact box was developed by the Harding Center for Risk Literacy.

What is premature rupture of membranes?

During pregnancy, the baby in the uterus is surrounded by a thin membrane filled with amniotic fluid (amniotic sac), which protects it from infections. Shortly before labor, this membrane bursts (ruptures) and amniotic fluid leaks out [2]. If the contractions have not started by this time, the membrane is said to have ruptured prematurely (PROM). Worldwide, that happens each year in about eight out of every 100 births [1].

Premature rupture of membranes can endanger the mother and baby, as pathogens can arise and lead to infections. Complications such as inflammation of the fetal membranes, of the uterine lining (endometritis), or of the amniotic fluid are possible. In the worst case, it can lead to sepsis (blood poisoning) of the mother or to an infection of the baby. Such an infection can cause brain damage or death of the child [3]. 

What are the treatment options?

Medical assistance is necessary after the membranes rupture. For a medical examination, it can be helpful to record to what extent  and how quickly the fluid leaks. A description of the fluid, including its texture, color, and the amount, can also be informative [3].

Urinary incontinence occurs in about half of all pregnancies, so the leaking fluid might be urine [3].

There are two treatment options for premature rupture of membranes from the 37th week of pregnancy onward. Labor is either induced, thus initiating planned preterm childbirth, or the mother is monitored closely until labor begins naturally.

There are multiple ways to induce birth by medication. Considered here are oxytocin given through the vein and prostaglandins (as a tablet or vaginal suppository) [1].

© Harding Center for Risk Literacy

What does the fact box show?

The fact box compares the benefits and harms of treatment strategies for premature rupture of membranes from the 37th week of pregnancy onward. Pregnant women whose water broke prematurely without the onset of labor were either monitored until labor started on its own, or labor was induced.

The table may be read as follows:

An infection of the lining of the uterus and/or the membranes surrounding the baby occurred in 11 out of 100 women with expectant management and in 5 out of 100 women with induced labor.

The numbers in the fact box are rounded. They are based on 22 studies with 8,615 participants and their babies [1].

What other aspects should be considered?

The studies that were used in the review are mainly from Pakistan, China, and Europe. 

Do the results provide proof (evidence) for the benefits and harms of induced labour?

Overall, the evidence is of very low to moderate quality:

It is very likely that further research will affect the findings regarding the occurrence of an infection of the uterine lining and the fetal membranes, as well as the number of caesarean sections (low quality of evidence).

The results regarding the number of babies with neonatal sepsis are not trustworthy (very low quality of evidence).

Further research might affect some findings regarding the death rate among newborns (moderate quality of evidence).

The authors did not assess the quality of the findings regarding the administration of antibiotics or the admission into a special or intensive care unit.

Last update

April 2018

Icon Array visualizing the data

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Information in the fact box was obtained from the following sources:

[1] Middleton P, Shepherd E, Flenady V, et al. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2017(1):CD005302.

[2] Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Schwangerschaft und Geburt 2018 [Available from: https://www.gesundheitsinformation.de/was-kann-man-tun-wenn-sich-eine-fruehgeburt.2686.de.html?part=geburt-ev].

[3] Schmidt S. Vorzeitiger Blasensprung. Frauenheilkunde up2date 2009;3(03):211-24 doi: 10.1055/s-0029-1224500

Fact Boxes

The idea of fact boxes was developed by Lisa Schwartz and Steven Woloshin. In several studies they demonstrated that fact boxes were effective tools for informing the general public about harms and benefits of medical treatments. Read more in the overview.


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