By Marion Currie, Musselburgh (nr Edinburgh) Scotland
PROM at 18 weeks + 4 days. Delivery at 19 weeks + 2 days.
Story added: 2002-07-23

This was my 2nd pregnancy. My first had been trouble free with a vaginal delivery. We had been trying to conceive (not too hard) for nearly 3 years and had accepted we were not to be blessed with another child when the hpt was positive, we were both surprised but happy. I'm not sure exactly when, but on one or two occasions after sex I noticed a little blood present, just a little pink tinge. It disappeared within a few hours so I did nothing, assuming it was just cervical erosion. I mentioned this to the midwife @ my 13w appointment, as the blood was appearing more often and seemed to be more like light spotting. She took a HVS which came back clear as did the following MSU for chlamydia. At 17w+3 there was a lot of brown coloured mucus on waking and with hindsight I wonder if this was my mucus plug, but nobody has been able to answer that question. On waking from an afternoon nap, the following day there was more blood present on wiping. I attended the pregnancy assessment centre @ the local hospital and a cervical polyp was found. With a belly US scan the baby was fine, with plenty fluid, and the placenta was high and to the front. As I'm rhesus negative I was given a shot of anti-D just in case. 4 days later after more fresh blood on waking the polyp was removed without the aid of colposcopy. Histology results on the polyp later came back normal.There was not much blood afterwards and I assumed things were settling down. 2 days later there was a little more fresh blood, but not as heavy as a period. As it was a Sunday and assuming it was from the site of the polyp I did nothing. That night my uterus was a little tender to touch, but this had gone when I woke. The following morning after passing a clot I was back at the hospital and on examination they could not see where the blood was coming from, so I was admitted for observation and yet another shot of anti-D. Since the US scan 6 days earlier had shown no problems with the placenta it was not repeated. Later that afternoon, as I got up from the bed to go to the toilet, my membranes ruptured. Now I was leaking bloody fluid and I was given an oral antibiotic (erythromycin). US scan the following day confirmed that the baby now had no amniotic fluid. A more detailed scan 2 days later (now @ 19w) confirmed the absence of fluid but the Doppler showed good blood flow through the cord. The next morning, the bloody fluid stopped for a few hours, so it was suggested I try lying with legs elevated, as this seemed to help in some cases of rupture after amniocentesis. Willing to try anything I agreed to give it a go and spent the most uncomfortable 24h wearing a pair of TEDS lying flat on my back praying. All of the HVS taken at this point (3 I think) came back clear with no sign of infection, but from the blood tests C-reactive protein level had started to rise and was I advised to consider inducing a termination as the baby would probably have very under- developed lungs and minimal chance of survival. After much soul searching and a tearful discussion with my husband we opted to induce. On examination, the cord was found to have popped out the cervix and the baby now had no chance. We had to wait over 2 hours, until a delivery room and midwife were free, before I was moved to the labour suite. A prostaglandin pessary was inserted. With my first labour I found the early stages were characterised by the need to have frequent bowel movements, uncomfortable but not paticulary painful. This labour was no different. After just over 1 hour while sitting on the toilet the baby was born, too fast for me to catch and as the midwives were in the middle of a shift changeover, they were caught unawares as well. After helping me back to bed, the cord was cut. The baby looked to be male, so we called him Jonathan and we were left alone with him until a theatre became available because the placenta would not separate. When I came round from the general anaesthetic, my husband went home to bed and I spent a most uncomfortable night on the delivery couch, still wearing my by now, very bloody TEDS. The following morning more blood was taken and another shot of anti-D given before I was released. 5 days later there was a phone call from the midwife, at the post mortem he was really a she. So we had to think of another name for our baby. My husband suggested Lesley, as this was the name his mother had picked for him because she was convinced she was having a girl. The blood tests came back clear, there was no identifiable infective agents present. The post mortem on Lesley showed she was normal for her gestational age. There were definite signs of chorioamnionitis, but this was expected due to the rising CRP levels. Whether this caused the rupture or happened afterwards they could not tell. They felt, on the balance of probabilities, that the cause was an infection, even though at no point were they able to culture anything from the vaginal swabs that were taken over 5/6 weeks.
This means my next pregnancy will be treated as high risk, but as they don't know the cause of the pPROM, they don't know what treatment they will advise.
It is now 10 weeks since the membranes ruptured and we have decided to try for another baby. I will be 40 in just over 2 months and I feel I don't have any more time to waste, if I want to give my son a sibling.