Week 17 Nightmare

I woke up in the middle of the night one night and noticed a pool of water in the bed. I was so tired I was not sure what it was. I woke up my husband and told him I either peed the bed or my water broke. I was 17 weeks pregnant. I felt fine so I laid back down and went to sleep. I called the on-call doctor at 7am just to get reassurance since I was not experiencing any signs of labor. They had me come into the office when the opened at 8:30am. The doctor did a few tests on me and said that it does not look like amniotic fluid and I probably peed the bed. They offered for me to do an ultrasound later that day, and I declined, I was too busy at work to come back plus the doctor reassured me that she felt all was well. Three weeks later (week 20) I go in for a routine ultrasound and I have almost no fluid. I am told to go straight to the hospital for testing. I stayed over night and managed to pass all tests for leaking of amniotic fluid. I went in to a hospital ultrasound and they told me she was perfect, growing fine, but all my amniotic fluid was gone. My doctor came in and told me that my water did indeed break at week 17. They believe that I am leaking amniotic fluid all day. Offically I had Preterm premature rupture of membranes (PPROM). Our options were a late-term abortion or bed rest at home. We did not have to think twice. We were not killing our perfect baby girl. I went home and did home bed rest for 3 weeks thinking that at any minute I was going into labor. I never did. Then at week 23 my high risk OBGYN sent me to the hospital until Mattie is born… 14 weeks later

From a medical standpoint (my thoughts in bold):

PPROM in the Second Trimester

Premature preterm rupture of membranes (PPROM) prior to fetal viability is a unique and relatively rare problem that is often difficult to manage. It occurs in less than 0.4% of all pregnancies. (AWESOME, JUST MY LUCK)

The major morbidity in the fetus with midtrimester ROM is lethal pulmonary hypoplasia from prolonged, severe, early oligohydramnios, which occurs in about 20% of cases. Other morbidities such as RDS (66%), sepsis (19%), grade III-IV IVH (5%), and contractures (3%) also occur with high frequency, resulting in intact survival rates of more than 67%. Fetal death is common and occurs in more than 30%.With appropriate therapy and conservative management, more recent studies have reported less than 40% delivering in a week and more than 30% remaining pregnant after 5 weeks. (MATTIE MADE IT 14 WEEKS)

The risk of infection increases with the duration of PPROM. Outpatient management of PPROM prior to viability is appropriate in the well-informed and educated patient. After viability is reached, inpatient management needs to be considered. (HELLO ROOM 311)

Midtrimester (13-26 wk) PPROM has a poor prognosis, although more recent studies have reported better outcome. Expectant management may be appropriate in select patients who are well informed and educated about the risks and the dismal prognosis for the neonate. (OR PATIENTS WHO HAVE FAITH BECAUSE OUR DOCTORS DID NOT HAVE ANY).

Survival varies with gestational age at diagnosis (from 12% when diagnosed at 16-19 wk, to as much as 60% when diagnosed at 25-26 wk). (MATTIE HAD A 12% SURVIVAL CHANCE… SHE IS OUR MIRACLE!)

To read the full medical article click here

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