It had been a perfectly normal
Thursday , I had worked from home,
but suddenly started feverish in the
evening. My husband was out on a work
dinner so I ate early and decided to
go to bed. I went to the kitchen to
put my plate back when I suddenly felt
a gush – I thought I was bleeding, but
there on the kitchen floor was a pool
of colourless liquid. My first thought
was I wet myself, but looking at the
liquid, I knew it had to be amniotic
fluid. I was only 14 weeks 5 days,
this couldn’t be happening!!
It had been a long journey for us
already. In 2000 I lost my first baby,
a boy to a rare inherited genetic
disorder called Severe Combined Immune
Deficiency (www.scid.net). He was 8
months of age and after his death we
were told that I had a 50%:50% risk
of having another affected child if it
was a boy. A girl however would be
healthy or at most a carrier like
me.Scid is not treated in India.
We moved to the UK from India in 2001,
but it wasnt till May 2004, that we
decided have another baby. In Jan
2005 I was diagnosed with
endometriosis which had created large
cysts in both ovaries . A laparoscopic
surgery followed; 2 cycles of clomid,
but 18 months later I still wasn’t
pregnant. The only resort was IVF and
we decided to do one privately with a
consultant Mr S (who had performed my
laparoscopy)in August 2007. Then I
found I was pregnant in July! We were
delighted that finally it had happened
and that too naturally.
At 6 and 7 weeks I had some minor
bleeding, but scans in the Early
pregnancy diagnostic unit (EPDU)unit
showed us a nice little sac and a
heartbeat. I was prescribed Clexane
injections throughout the pregnancy by
Mr S as I had high protein C. This
stopped the bleeding. Mr S was also a
NHS doctor and he asked me to come to
his maternity clinic in Farnborough
hospital. I consider myself lucky to
be under the care of excellent staff-
a positive and good doctor as Mr S , a
caring GP and midwife,a sincere EPDU
nurse, other staff such who were all
sympathetic about my background.
With the first trimester ending I
assumed things would go normally; my
nuchal scan in Kings college, London
had also gone well so my only worry
was the sex of the baby for a boy
would carry a risk of having Scid. I
was to have a scan at 15 weeks in
Kings to check for the sex of the
baby. Depending on what we saw, we
would decide if we would do an amnio
to check for Scid.
But at 14 weeks 2 days, I once again
had some bleeding and made frantic
visits to the EPDU and Mr S- both
scans showed baby swimming in fluid.
Mr S did ask me (it was only the
evening before) if I had fever as he
thought the bleeding might be from an
infection- but I had been fine.
When my husband returned that Thursday
night he found me burning with fever.
After that gush, I continued to leak
even though I was lying flat.I had to
wear a sanitary pad as liners weren’t
working and my pants got soaked.
Strangely neither of us thought of
going to the hospital- I meant to call
the midwife in the morning and take
her advice.B
She couldn’t believe that it was a
fluid loss so early on, and suggested
I try to meet Mr S through the GP. I
got an emergency appt at the surgery
and met my GP- She listened to the
baby’s heartbeat and to my relief it
was loud and clear! After checking my
urine sample she prescribed me
antibiotics as she thought it might be
an UTI . She also fixed an appt with
Mr S in a private hospital and he came
to see me even though he didn’t have
clinic that evening.
A scan showed minimal fluid and we
could hardly see baby now- no more
little flips and hand waves. Mr S did
a swab and got some bloods taken to
check for infection, I was prescribed
oral Metronidazole, for a suspected
vaginal infection .
The urine culture was negative, and
the swab showed a bacterial infection.
We went for a scan with Mr S 5 days
after the rupture and had naively
thought the fluid would have increased
since there had been hardly any
leakage following that incident. But
the scan was again fuzzy. Reality hit
me as I listened to Mr S telling us
that this was quite a serious
condition with a risk of prematurity
etc etc - I fainted in shock as it
sank in that this pregnancy would
probably never get back to being a
normal one. He prescribed erythromycin
as a general antibiotic to be
continued.
We went to Kings for the sex check
scan, but the appointment was now
focussed on the premature rupture and
fluid levels.The reaction we got there
was worrying to say the least. I was
scanned thrice by different levels of
doctors- and each of them pronounced
the worst. The main risk was pulmonary
hypoplasia , and there were many other
smaller issues to contend with. On top
of that, it looked like it was a boy
even though the scan wasn’t clear due
to the lack of fluid – so we had the
additional risk of Scid. King’s
advice was we would need to terminate
the pregnancy , but on other hand
since my AFI was 1.2 and I was
infection free they agreed that we
needn’t take a decision that very day.
I was given an appointment in 2 weeks
though the senior consultant said, 'I
don’t think you will be back’.
As it happened we were back. Baby had
grown and the detailed scan to check
his heart, kidneys etc was all good.
He was in a breech position and my
placenta was also low, though they
expected it would move up as the
pregnancy progressed.
Thus it continued throughout the
pregnancy- 2 weekly scans in Kings, 2
weekly checks by Mr S , weekly blood
tests to check infection levels.Though
the doctors didn’t think bed rest was
of any help, I wanted to do the best I
could to keep baby and it just seemed
a safer option to not move around. My
parents came over from India to help
us and this was a godsend. I drank
litres and litres of water, cranberry
juice, probiotic yogurt to keep myself
infection free. I was also a member of
the prprm group and hung on to the
stories of hope. It was only due to
some of the positive stories I read
that I decided to disbelieve the
King's doctors and hold on to
baby.Everytime we went for a scan, I
would look at the fuzzy shape and
silently tell him 'Baby, you hold and
I will hold'
Inspite of the doom and gloom
predicted by Kings (one consultant
guaranteed us that this pregnancy
wouldn’t work!!) my AFI increased
slowly, it was just short of 5 by
about 24 weeks, plus there were
pockets of fluid near the cord and
face which wasn’t being included in
actual index calculation. Mr S
remained positive and assured me he
would do his best to give baby the
best chance possible.
Things remained steady till I reached
24 weeks 3 days. At 2 am on Dec 19th I
had a little bleeding -enough to send
us to the hospital. Once again a
heartbeat monitoring showed baby was
fine and happy, but I had to stay in
for observations for a minimum of 24
hours.
Two days passed without incident, but
just when I was about to be
discharged .I suddenly felt another
huge gush and found my pad soaked with
bright red blood. Placental abruption
was my first thought! The nurses told
me to stay calm and just rest; I had
an appt with Mr S in outpatients, so
my husband sent him a message about my
bleeding. He came to see me and
assured me it was a case of my low
lying placenta moving , and not an
abruption, I was put on complete bed
rest .
But the next day, the doctor on ward
duty got me checked with a speculum
and thought I was 1.5 cm dilated. He
made arrangements to transfer me to a
hospital with level 3 NICU. Inspite of
my insistence of getting Mr S
opinion before being sent off to a
hospital across town, the doctor
didn’t pay any heed and in a few
hours we were in an ambulance headed
to Queen Charlotte hospital.
My arrival was an anticlimax as the
staff there were waiting to deliver a
24 weeker, but found me fine with no
contractions! They did another
speculum check and thought it was
normal, in fact the doctor said that
no one ‘see’a dilation without doing
an internal examination.The general
opinion was that I was sent off as
they didn’t want to take a risk of my
complex case during the holidays
season. I had to stay as Queen
Charlotte didn’t intend to send me
back till 28 or 32 weeks, if I made it
to then .
Weeks went by. The fetal medicine
consultant , Dr S assured me the risk
of pulmonary hypoplasia was small as
my AFI had never really been below 1,
he couldn’t however rule out any
underlying lung issues. Queen
Charlotte was a much nicer hospital
with excellent staff, my only problem
was that they didn’t prescribe
erythromycin . Mr S had continued me
with it as erythromycin prolongs a
pprom pregnancy and secondly he didn’t
want the baby to be born with an
infection in case it was a Scid baby.
I have to confess I continued my
antibiotics on the sly as I trusted M
S’s judgment.
I stayed in Queen Charlotte till 28
weeks without any major incident.My
placenta moved to a normal 5 cm from
the cervix; the fluid levels were now
on the low end of normal and baby’s
growth was perfect. There was a scare
that I might have gestational
diabetes , but the fasting test came
out negative. They decided to transfer
me back to my local hospital
Farnborough. This time I insisted I
had to be under the care of Mr S and
team ; I was discharged after four
days of observations as things were
normal.
My follow up protocol included blood
tests twice a week , monitoring in the
day care unit, appointments with Mr
S. I was back on erythromycin and my
clexane was to continue till the
delivery. Apart from the protein C
clexane also had an inflammatory
effect which might have helped in
keeping my womb infection free.
We went for one more scan in Kings at
30 weeks, my fluid levels were on the
low end of normal around 10. They told
us we needn’t be monitored by them
anymore and could be scanned at the
local, strangely they did not seem
pleased to see me carry the pregnancy
so far!!I don’t think I really sealed
for I had a few drops of something
every now and then- I hoped it was
urine! My CRP remained consistently
below 5 or 10 , though the WBC
remained inflated throughout. A date
for a C section had been fixed at 37
weeks, since baby was still breech a c
section was inevitable.
After 31 weeks though, I felt
increased leakage and it seemed cloudy
as if there were epithelial cells in
it. I was also increasingly
uncomfortable as I was very
constipated perhaps from a lack of
movement and high dosage of iron
tablets due to low Hb during the
pregnancy. I was 31 weeks 3 days when
I got a low backache and didn’t feel
enough movement from baby. I thought
of going to the hospital to be
monitored but knew they would keep me
back and another prolonged hospital
stay wasn’t appealing . But in the
middle of the night I went to the
toilet to find a very small clot of
red blood- again it wasn’t much but I
felt the familiar panic rising me. My
husband agreed we needed to go to
hospital specially as I still was in
pain.
I was immediately strapped on to the
heart monitor, and once again, baby’s
heartbeat was fine, though the graph
also showed up uterus tightenings.
They did a speculum but didn’t find
dilation. The doctor on duty Dr R, a
lady from Mr S team worried. She
wanted to keep me in, but the hospital
was full, so I would have to stay in
the labour room. My backache seemed to
have gone, and I mentioned we had a
scan with Mr S that evening privately
so somewhat appeased, she let me go
with the promise that I come back
immediately if I felt in the slightest
bit uncomfortable. We lived about 10
minutes away from the hospital.
The evening’s scan showed adequate
fluid around baby- but I was leaking
so much that as I got on to the scan
table, I felt my trousers were wet and
there was a wet patch on the chair. My
backache had come back , but not as
bad.Mr S was pleased to see I made it
so far and said he would do the C
section himself.
Later in the night though the pain
increased.Assuming it was
constipation I kept going to the
toilet in the hope it will make me
feel better I tried to sleep but the
pain was coming and going, I was
feeling very uncomfortable and
constipated. I couldn’t take it
anymore and we left for the hospital
around 2.30 am.
Before they put me on the monitor I
tried once more to go to the toilet-
as I was straining, there was a pop
and a lot of fluid came out again. A
second rupture?! This time when I was
hooked on the monitor they registered
clear contractions. At that moment my
husband I looked at each other and
thought.. this is the night then.. A
doctor came in to do a speculum and
through all the leaking fluid he
thought I was well dilated, they
would need to do an internal. It was
normally avoided in case of Pprom, but
considering I was to deliver the risk
of infection didn’t matter now.
Dr R came in, she was on duty that
night as well and I was relieved to
see her, she did an internal and then
quickly started giving instructions to
the team. M husband asked ‘is she 3
cm dilated or so?’ And the answer
was ‘Its much much more, we hardly
have time’ I could have delivered
vaginally if baby hadn’t been breech!
And I had gone through all that pain
not even knowing I was in labour, so
strong was my denial to have baby at
32 weeks.
The rest of the night was as if a
dream.I was rushed to theatre and
given a spinal. Outside it was snowing
very hard, in fact we had reached the
hospital in time for the snow was
creating roadblocks . After some 15
minutes the anesthetist told us baby
is out.
‘He’s out but hes hes not crying?’I
heard myself ask my husband.. hardly
had I finished the sentence there was
a loud cry and within minutes they
wheeled him out in a special
incubator. I just got a glimpse of a
little round perfect face.
My lovely baby Krish Varun Misra was
born at 5.05 am on 8th Feb 2007 on a
beautiful snowy morning.He was due on
the 8th April, so he was almost 2
months premature.
The pediatricians came round to me in
the recovery room. Krish was fine,
weighed 1.8 kilos which was good
considering his age , he was on CPAP
and apart from some dry skin he didn’t
have any of the problems cited by
Kings. He needed the CPAP for only a
few hours the first day, he did get
jaundice but recovered from it in a
couple of days. Within the first 8
weeks of life, he needed two inguinal
hernia operations but that was an
effect of prematurity rather than
pprom. He certainly has a good set of
lungs as he can scream very loudly!
It is another matter that as per
previous discussions between Guy’s
Hospital and Gosh, his cord blood was
sent for testing and we knew on the
evening of his birth that Krish had
SCID as well. At 5 days he was sent to
Gosh, London for a bone marrow
transplant.
He had a stem cell transplant from his
dad as door at 6 weeks, and since then
we have been in relative isolation at
home. His cell counts are now almost
normal and he has functioning T cells-
we go to Gosh for monthly checkups and
pray for the time he also regains his
B cells which would mean he wouldn’t
need any Immunoglobulins.
This is a very long story but I wanted
to write down all the details as
concisely as possible and hope it will
help others to retain faith that pprom
is not always negative. Everyday was a
big question mark and the stress was
excruciating but it was all worth
it.Pprom is an ugly condition and
theres no treatment for it and most
doctors are horrendously negative- I
felt that the bed rest, fluids,
erythromycin and lots of prayers
contributed to things working out for
me. Barring a few, I met some great
medical professionals who treated my
case with a lot of attention.
Indeed it is a real miracle that today
I have a very smiling lovely little
baby in my arms.
Feel free to email me if you have
questions and I will help if I can!
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