Reading these PROM stories has been
very helpful to us. I hope our story
is, in turn, helpful to someone else.
I have received fertility treatment
for 3 years, and our PROM (and first)
pregnancy was conceived via In Vitro
in early July, 2007, when I was 36
years old. I’m beginning my story
much earlier, in case this history is
significant to my PROM, and I wonder
if any other women have had a similar
history.
In 1997 I began having exceptionally
heavy menstrual periods, where I
resorted to wearing diapers for two
weeks each month, and frequently even
they couldn’t contain the volume.
(Sorry, TMI!) The doctors were
dismissive, one (female) doctor even
said “You’re female; you have to live
with having a period.” Well, the
problem was that I nearly didn’t
live. Luckily by that time I was
under Kaiser’s care, and they have
always taken very good care of me. At
any rate, during one period I lost so
much blood that I ended up with five
transfusions, and nearly lost my
uterus, whereupon they discovered that
a large and highly invasive fibroid
was the culprit. This was removed via
myomectomy (like a c-section) in early
2001 and my periods returned to
normal.
I mention this because heavy first
trimester bleeding seems to be a very
common correlation among PROM cases,
and yet there is rarely an explanation
of why the bleeding happened. In
order for these women to know how to
avoid PROM in future pregnancies it
seems that we should back up a step,
and also work on trying to figure out
how to avoid the heavy bleeding. I
find little information on why very
heavy 1st trimester bleeding occurs in
cases without miscarriage.
Anyway, on to the pregnancy: We did
In Vitro because both of my tubes were
blocked. (I also have endometriosis,
but it hasn’t seemed to be
problematic.) Since it was an In
Vitro pregnancy, it was heavily
monitored during the first trimester,
and I received hormone therapy
(progesterone suppositories and
estrogen patches), with level-tests
via blood work every several days. My
hormone levels were always deemed as
very good, and I was weaned from the
support on their “standard” schedule.
I began spotting the very day of the
pregnancy blood test (4 weeks), and
for that reason, I was put on several
weeks of antibiotics by my In Vitro
doctor, (Dr. Schoolcraft at:
www.colocrm.com – he has an excellent
reputation, and I feel fortunate that
he happens to be local.) I spotted
off and on from week 4 through week
10, with occasional flow as much as
a “normal” period, but usually it was
very light. The heaviest bleeding
during this time was at about 8
weeks. I had a transvaginal
ultrasound at 6 weeks to confirm a
heartbeat, and count how many embryos
took. Three had been transferred, one
took, and especially since I had bled
a bit, they wanted to ensure that
another embryo was not developing
ectopically, (though I had no
cramping.) All looked good.
Then at exactly 10 weeks, I had a day
of very heavy bleeding, where I lost
several cups of blood and quite a few
clots, each about the size of a
chicken egg yolk. (Sorry, again
TMI.) This was very reminiscent of my
fibroid problems, several years
earlier. The bleeding happened to
start only ½ hour before my first
scheduled Kaiser OB visit, and so I
showed up to my visit bleeding
heavily. They did a transvaginal
ultrasound during all of this
bleeding, and said that baby looked
very good, right on track, and that
despite the bleeding, they estimated
my risk of miscarriage to be only a
few percent, ie just the national
average for that stage of pregnancy.
I went home and throughout the first
trimester, I did occasionally take off
from work, to stay on bed rest. But I
had a desk-job, so I wasn’t on my
feet, anyway.
At 12 weeks I again bled very heavily,
and this time the heavy bleeding
continued off and on for 5 days. On
the 5th and heaviest day, I went to
the emergency room, where they
inserted a speculum, and verified that
my plug looked very good. They also
listened to the heartbeat, and it was
good. Since I was scheduled for
a “First Screen” procedure two days
later, they didn’t do an ultrasound,
and sent me home on bed rest for the
day in between.
“First Screen” is an alternative to
amniocentesis that is less accurate,
but non-invasive. It involves a blood
test from the mother, and a very
detailed ultrasound, during which the
perinatologist measures the thickness
of the back of the baby’s neck….. I
don’t know much about all of this, I’m
a laser physicist, so nothing to do
with medicine…. But at any rate, we
had chosen to do a First Screen since
I am past 35, and it poses no risk to
the baby.
Our First Screen came out well, and
the perinatologist said that I should
go on light bed rest until one week
past the last of the bleeding, and I
did so. I never bleed after 12 weeks
and 5 days. Throughout the rest of
the pregnancy, I only occasionally saw
pale, pale pink on the toilet paper
when I wiped.
Between 12 weeks, 5 days, and 21
weeks, 6 days, everything went well,
and at 18 weeks we had a follow up
First Screen ultrasound, where we
learned that our baby was a girl, and
all looked excellent. I also went on
extended leave from my job at 18
weeks, and began doing only light
consulting from home. So for the last
month of my pregnancy I definitely did
not have much stress, either physical
or emotional.
The only “peculiar” thing: Very often
throughout my pregnancy, I would feel
abdominal pain after urinating. The
pain would begin about one minute
after I was finished going, and would
last about 2 to 4 minutes. It felt
sort of like my abdomen was
collapsing. However, I was tested for
urinary tract infections several
times, and never had one.
She began kicking at 19 weeks, and
almost always the kicks were very
low…. Only rarely did I ever feel much
that was tummy-height, typically it
was straight down, and it always felt
like she was kicking right down into
my crotch. Very, very weird feeling.
(At the birth, I learned that she was
breech, and was told this was actually
totally normal.)
The day before Thanksgiving, at 21
weeks and 6 days, I felt very
exhausted, out of breath, and a bit
queasy after having only swept the
kitchen floor! I thought “Gosh, am I
going to get to where even sweeping a
little kitchen wears me out?!” But I
thought nothing of it and felt better
later in the day. Then that night I
felt very grouchy but not at all ill,
and when I went to the bathroom just
before bed, I noticed (again TMI) a
very small amount of peach-colored
somewhat thick discharge. I thought
nothing of it, since the pregnancy
books all say to expect discharge.
Anyway, I mention this hoping that
women who see such a thing will
beware!! I had the same discharge in
small quantities once each evening
over the next three nights and I now
suspect that it was my plug. Then the
day after Thanksgiving, again in the
evening, I noticed my undies were
quite damp, and that it smelled
peculiar, though not really bad. I
now expect that this was amniotic
fluid, but very little of it… say
maybe only a teaspoon or two… and
there was no more of it until days
later, in the hospital. Saturday was
uneventful, and then on Sunday I just
felt ooky (how’s that for technical!)
I don’t tend to buy into the
whole “intuition thing” very often but
that evening I remember saying to my
husband: “I just don’t think we’re
going to have a baby.” I was still
awake at 12:20 am, and all of a sudden
developed a very bad lower back ache –
a new thing for me. It was bad, but
only lasted about 10 minutes. I feel
asleep and woke again at 2:30 am with
another very bad back ache. This one
was even worse, and lasted a little
longer, say 20 minutes.
My husband then drove me to the
hospital ER, and they took me directly
to labor and delivery, since they had
spare rooms and it was a quiet night.
By that time it was 4:30am and I felt
just fine, (and very silly for having
rushed to the hospital!) They put a
fetal monitor on my belly, and didn’t
see anything. My temperature and
blood pressure were normal, her heart
rate was normal, and they did an
ultrasound, where she looked happy as
a clam. The doctor on call (very nice
guy who seemed thoroughly competent)
said: “As a final check, we’ll go
ahead and put in a speculum, but I’m
thinking it is just gas, and you’re
probably just fine.”
Well, the dread crawled through me
when I saw his face as he stood up
after the exam. He put his culture-
samples down very quietly, and then
gently told us that I was 2cm dilated
and my sac was protruding. They
immediately tipped my bed back so I
was head-down, and started an IV drip
of antibiotic cocktails, and by that
time they had confirmed the presence
of amniotic fluid in the birth
canal. I was told I would not leave
the hospital until she was born.
Over the next 1.5 days we were told
all of the same stories that you all
were told about loss of fluid effects
on the baby, and risk of maternal
infection. Meanwhile I was having
mild contractions all along, and
during each one, I felt some amniotic
fluid coming out. It felt like a lot
each time, but when we would check, it
was less than it seemed to be. I was
told that they had a policy that they
would not administer labor inhibiting
drugs when membrane tear had
occurred. From reading this site, I
now see that many other hospitals are
willing to do so, and while it ends up
it wouldn’t have helped in my case, it
would be nice to have that
option.
Well, bad luck for us; I developed a
fever and elevated white blood cell
count later that day. Since I had now
developed a confirmed uterine
infection, they strongly urged that we
terminate the pregnancy, explaining
that these infections can progress
very quickly, and I was at risk of
death or at least of losing the
uterus. Furthermore, it was probably
only a matter of hours before our
little girl became infected too.
However, it was two days too early for
them to be willing to try to save
her. They said they absolutely do not
try to save babies before 23 weeks,
and since I was In Vitro, they knew,
down to the minute, that I was only at
22 weeks and 5 days.
In the time between confirming the
PROM and when they confirmed
infection, they had been careful not
to put in a speculum in order to avoid
infection, but now they did do so, to
check the progress of dilation. I was
at 6cm, so induction or not, I was
having the baby soon. In many ways, I
was relieved to know that it wasn’t
really a decision any more, though all
of our doctors were so very good about
helping us to make an informed
decision. Also, the hospital’s solace
councilor helped us to emotionally
prepare for the birth and beyond.
Everyone at Kaiser and the hospital
were fantastically helpful.
Niav was born on Nov. 27, 2007 and she
lived 37 minutes. We got to see her
wiggle and even stick her tongue out.
She looked so “right,” confirming that
the problem was with me, not her.
Ironically, the doctor had to actually
break her sack during the delivery,
despite the fact that I was losing
fluid with each contraction! So
heartbreaking!
Due to the infection, I had a D&C just
after the birth, and then another one
just over a week later. It is now 8
weeks since she was born, and
physically, I’m almost completely
recovered from the infection, though
it took much longer to heal than I’d
expected.
A few days after her birth, we met
with the perinatologist for a follow
up discussion. He said that the PROM
was most likely caused by the heavy
first trimester bleeding. He
mentioned three bleeding-related
factors: a) The blood within the
uterus weakens the membranes, as it
passes over them. b) Blood passing
through violates the plug/seal making
it easier for infection to get up into
the uterus. c) Then once the
infection reaches the uterus, any
remaining clots or small pools of old
blood serve as a host to the
infection. Then, of course, once PROM
occurs, the amniotic fluid also
enhances the likelihood of
infection.
So, I don’t know what came first. I
had no signs of infection when I
arrived at the hospital, though I’m
fairly certain that PROM had occurred
about 55 hours earlier. So either I
already had a sub-clinical infection,
days earlier, or the PROM caused the
infection. But given that I’d had
heavy first trimester bleeding, I’m
thinking that I already had a low
grade infection, prior to PROM, thus
explaining why I felt rather crummy
two days prior to PROMing.
Best wishes to all, and I’m so sorry
that you’re reading this because that
almost surely means you are or have
experienced it too. Though I wish
pregnant women knew to read this sort
of thing BEFORE it happens! I wish
I’d read these stories 4 months ago,
or so.
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