I have twin boys, survivors of a PPROM
pregnancy. I had a difficult pregnancy
from the start. I had an ultrasound
around seven weeks that showed three
heartbeats. We expected to have twins,
since they run in my family and we had
done IUI plus Follistim. But we were
shocked when we found out it was
triplets! We were just starting to get
used to the idea when I started
bleeding bright red blood at nine
weeks. I was out of town at the time,
visiting my family for Christmas. I
was able to get in to see an OBGYN. He
said I had a subchorionic hematoma on
Baby C's placenta. He said there was
about a 50-50 chance of losing one or
all of the babies. I actually felt a
little reassured by this, and went
home to rest.
That night I bled like you would not
believe-soaking through a huge maxi
pad every half hour. I was terrified.
We were scheduled to fly back to
Seattle that weekend. I was already
scheduled to see a perinatalogist
right after the new year because of
the triplet gestation. The bleeding
had begun to ebb, fortunately, and we
headed back home on a plane. The whole
time I was extremely anxious, but
somehow knew I was still pregnant. I
just wasn't sure how many of the
babies had survived.
I went to see the peri for my first
appointment. Unfortunately, the
ultrasound showed Baby C was demised.
I had suspected as much. I was sad but
hopeful for the other babies. I was
ordered home on bedrest. There was a
huge mass of blood still in my uterus
around the demised triplet. The peri
said it could threaten the other two
babies. So bedrest it was!
After a few weeks, they said I could
return to work part time because the
blood clot was shrinking. I continued
to bleed, but the blood was brown-old
blood. On the night of February 13th,
I started bleeding bright red again. I
was so scared. I had an appointment
with the peri the next day. The
ultrasound showed that now Baby A had
a subchorionic bleed. Even worse, Baby
A's AFI was only three. I was only 15
weeks.
The peri was grim. He said the chances
for survival of both babies or even
one was not very good. He said Baby
A's lungs might not develop if the AFI
did not increase. However, it did not
look like my membranes had ruptured.
He thought it was related to the
placental issue. He said there was
some hope IF Baby A's AFI went up-
50/50 again-and I went back home on
bedrest.
I drank more water than I have ever
drunk in my life-over a gallon a day
that whole week. The bleeding subsided
and I went back to the peri the
following week for another ultrasound.
Baby A's AFI was up to six! We were so
happy. The peri was guardedly
optimistic.
Over the next few weeks the AFI
gradually went back to higher levels.
However, my ultrasound had showed some
anomalies-pylectesis and echogenic
bowel-that made me want to get an
amnio. I would not have terminated
based on the results, but I was so
anxious I needed peace of mind. At 19
weeks Baby A's AFI was back to normal
levels (AFI=11) so the peri said they
would do an amnio. Keep in mind that
this practice had a 1 in 4000 chance
of miscarriage from amnio-very low. I
couldn't get the immediate results
(FISH test) because of all the blood
in the babies amniotic fluid. So we
had to wait two weeks.
By this time I was back at work. But
three days after the amnio, I started
bleeding bright red. Luckily I was at
the hospital where I work which is
also my delivery hospital. I went to
L&D triage. They said there was
nothing they could do-they didn't even
do an ultrasound! They sent me home on
bedrest again and said I should follow
up with my peri the next day. The
ultrasound the next day showed more
bleeding on Baby A's placenta-and the
AFI was down again. I went home on
bedrest and waited anxiously for the
results of my amnio, drinking gallons
and gallons of water.
Let me pause here and say a couple
things: in retrospect, I would not
have gotten the amnio. I think it put
me at higher risk. In fact, my peris
said later that there might have been
a tiny leak after the amnio. I had a
little fluid discharge, but I had
brown bleeding all the time so I just
thought it was the clot
dissolving.
Baby A's AFI wnet up and dwon over the
next week, usually hovering in the six
to nine range. Baby B maintained
normal levels for the most part. The
bleeding started subsiding, and they
said I could go back to work part time
again. Things were fairly stable until
April 24th, my husband's birthday. I
woke up in the morning and went to the
bathroom, and felt a fairly large gush
come out. Keep in mind I often had
brown fluid coming out because of the
clot, but this did seem like slightly
more than usual.
The next two days I noticed more fluid
than usual leaking out. I started to
get concerned. Luckily, I was
scheduled for a peri appointment on
April 26th. The ultrasound showed NO
fluid around Baby A. The peri said it
was likely PPROM. She did a test on
some of the fluid that had leaked out
(but did not do a pelvic) and it was
definitely amniotic fluid. I was
immediately admitted to the Antepartum
ward of my hospital. I was 25 weeks, 5
days.
They put me on IV antibiotics
immediately and gave me a course of
steroid shots. I had twice weekly
ultrasound and fetal heartbeat
monitoring three times a day. My
hospital room was quite nice and I had
lots of visitors. I made friends with
other women on the floor. It was
actually not bad! The worst part was
worrying-what is going to happen to
the babies-particularly Baby A? I knew
having them at 25 weeks was very
early. My peri said she thought I
could keep them in until at least 28
weeks. She said that was the first
goal, but every day I kept them in was
to their benefit. The plan was get me
as far as possible. If I made it to 34
weeks, they would induce.
I researched PPROM obsessively on the
internet (that's how I found this
site, of course) and went back and
forth between feeling very hopeful to
very discouraged. However, the doctors
and nurses all were very encouraging.
They kept reminding me the longer they
stay in the better. My ultrasound
never showed an AFI for Baby A greater
than two.
On May 23rd, I had some light pink
spotting. That night I was watching
the season finale of "Lost" in my
hospital room when I got a terrible
backache. I took Tylenol and used a
heating pad but it didn't get better.
The nurse put me on the monitor, but
there were no significant
contractions. I went to bed, and woke
up at 3 AM on the morning of May 24th
with severe chills. The nurse took my
temp and it was 102. They put me on
the monitor and I was having regular
contractions. I had an infection, and
it was time to have the babies! I was
29 weeks, 5 days. (This is by my dates
which I based on the ultrasound. The
peris used last menstrual period,
which only put me at 29 weeks, 2 days.
However, they went by ultrasound dates
when the boys were in the NICU, so go
figure!)
They wheeled me to L&D after I called
my husband at home. I was on IV
antibiotics through the whole labor. I
was also delirious with my fever (it
got up to 104) and everything felt
like a dream. At 6 AM, I got an
epidural-then I was really out of it!
Even though I was getting Pitocin, I
wasn't progressing very well. At 12 PM
the peri on duty came into my room. I
was 3 cm dilated. She said that since
I was infected she wanted to do a C-
section if I wasn't at 10 cm by 1 PM.
I was fine with that.
At 1 PM she came to check me and I was
at 10 cm! They wheeled my to the OR-
twins are always born in the OR, even
if vaginal, because they might need to
do an emergency Ceasarean. There were
25 people in the OR-nurses, techs, the
two peris, the two NICU teams-it was
crazy! I only had to push for about 20
minutes. Baby A came out with Apgars
of 1, 5, 8. Baby B was a breech
extraction-they pulled him out by his
feet. His Apgars were 6, 8. Baby A was
immediately intubated. They showed him
to me briefly and then whisked him
away to the NICU. Baby B was put on C-
pap, showed to me briefly and whisked
to the NICU as well. We named Baby A
Truman Alexander, and named Baby B
Spencer Aaron. Truman was 3 lbs. 8
ozs. and Spencer was 3 lbs. 9 ozs.-
great weights for 29 weekers!
I was in the hospital for exactly 28
days before delivering. I went home
two days after delivery. Truman got
off the vent after a few days, but
developed a pneumothorax. He had to
have chest tube for a couple of days.
When that healed, he was on C-pap, and
then oxygen. His lungs were definitely
compromised from the low fluid. He was
on oxygen the whole NICU stay, and
went home on oxygen. He was discharged
from the oxygen after a month home. He
also struggled with Group B strep
infection which landed him back in the
NICU after several weeks on the step
down unit, and even had necrotizing
enterocolitis (at 37 weeks adjusted
gestational age) which was treated
medically, not surgically, thank God!
Spencer's lungs were better, because
he had normal fluid. He was vented for
a day and on C-pap for a day, then
didn't need any more help with
breathing. He had a staph infection
which landed him back in the NICU
after several weeks in the step-down
unit. Spencer went home on his due
date, August 4th. Truman went home a
week and a half later, on August 15th.
They were in the step-down unit for
most of their stay.
Today they are happy, healthy boys! I
want everyone to know that there is
hope after PPROM. Everybody's
situation is different, but be aware
that there are good outcomes-my boys
are living proof.
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