Before 24 weeks PROM occurs in fewer than 1% of pregnancies. Prognosis is primarily determined by complications related to prematurity such as necrotizing enterocolitis, intraventricular hemorrhage, and cerebral palsy. Signs and symptoms
Most women will experience a painless leakage of fluid out of the vagina. They may notice either a distinct "gush" or a steady flow of small amounts of watery fluid in the absence of steady uterine contractions. Loss of fluid may be associated with the baby becoming easier to feel through the belly (due to the loss of the surrounding fluid), decreased uterine size, or meconium (fetal stool) seen in the fluid. Risk factors
The cause of PROM is not clearly understood, but the following are risk factors that increase the chance of it occurring. In many cases, however, no risk factor is identified. Infections: urinary tract infection, sexually transmitted diseases, lower genital tract infections (e.g. bacterial vaginosis), infections within the amniotic sac membranes (chorioamnionitis)
Tobacco use during pregnancy
Illicit drug use during pregnancy
Having had PROM or preterm delivery in previous pregnancies
Polyhydramnios: too much amniotic fluid 
Multiple gestation: being pregnant with two or more fetuses at one time
Having had episodes of bleeding anytime during the pregnancy
Invasive procedures (e.g. amniocentesis)
Nutritional deficits
Cervical insufficiency: having a short or prematurely dilated cervix during pregnancy
Low socioeconomic status
Being underweight

Pathophysiology
Weak membranes
Fetal membranes likely break because they become weak and fragile. This weakening is a normal process that typically happens at term as the body prepares for labor and delivery. However, this can be a problem when it occurs before 37 weeks (preterm).
In cases of pre-viable PPROM, chance of survival of the fetus is between 15 and 50%, and the risk of chorioamnionitis is about 30%. Chorioamnionitis
Chorioamnionitis is a bacterial infection of the fetal membranes, which can be life-threatening to both mother and fetus. Women with PROM at any age are at high risk of infection because the membranes are open and allow bacteria to enter. Women are checked often (usually every 4 hours) for signs of infection: fever (more than 38 °C or 100.5 °F), uterine pain, maternal tachycardia, fetal tachycardia, or foul-smelling amniotic fluid. Elevated white blood cells are not a good way to predict infection because they are normally high in labor. If infection is suspected, artificial induction of labor is started at any gestational age and broad antibiotics are given. Caesarean section should not be automatically done in cases of infection, and should only be reserved for the usual fetal emergencies. Outcomes
The consequences of PROM depend on the gestational age of the fetus. When PROM occurs at term (after 36 weeks), it is typically followed soon thereafter by the start of labor and delivery. About half of women will give birth within 5 hours, and 95% will give birth within 28 hours without any intervention. The younger the baby, the longer the latency period (time between membrane rupture and start of labor).