By Andrea Creighton, Brisbane Australia
PROM at 19 weeks + 6 days. Delivery at 29 weeks + 4 days.
Story added: 2013-05-15

Most mums experience feelings of anticipation and excitement as each pregnancy milestone is reached - 12 week scan, finding out a baby's gender at 20 weeks and reaching the final trimester. The normal excitement I was expecting changed to frustration, stress and anxiousness as one complication after another occurred. At 8 weeks I was admitted to the Emergency Department at the Mater Hospital, Brisbane following a heavy bleed. The next day an ultrasound was conducted, which identified a large subchorionic haematoma (internal bleed) within the uterus measuring more than half the size of the fetus. Heavy bleeding from the haematoma continued until I was 11 weeks; after which time I was referred to a specialist to commence a course of progesterone injections twice weekly. The bleeding settled down once I started the progesterone injections and after four blissfully uneventful weeks from 15 to 19 weeks, we thought we were in the clear. One day before my scheduled 20 week morphology scan at 19 weeks and 6 days, I experienced a complete Preterm Premature Rupture of Membranes (pPROM). I had my ultrasound as planned the next day, and knew that something wasn't quite right - the images from the scan were coming up very grey and blurry, and I couldn't see the distinct black outline around the baby's face and limbs. The Staff Specialist advised that my membranes had ruptured and due to there being no fluid around the baby, the ultrasound could not determine any morphology features of the baby - we were sent to the Mater Mothers' Hospital for assessment. The next few hours were incredibly stressful and upsetting - we were painted the picture that I would go into spontaneous labor within the next 24 hours to 11 days, and that contracting an infection was almost guaranteed. As the baby was only 20 weeks, we were advised to prepare for the worst, as the baby would not survive if born at this stage. After blood tests and swabs were taken I was sent home, waiting for the inevitable. Somehow, the baby and I made it through nine weeks without any further complications - I didn't go into labor and I managed to avoid infection. I put myself on 'couch' rest, didn't leave the house and restricted my movements. I was incredibly lucky to have the support of my husband and mother-in-law who stayed with us for over 2 months to care for my eldest daugher Elyse, who was only 18 months at the time. An Unexpected Arrival: Monday 12th September 2011 started like most days during this pregnancy, however this morning I noticed significant bleeding from the night before. My husband had just left the house on his way to work, so I rushed to the phone and asked that he come back and take me to the hospital. He dropped me off at the Assessment Unit at 9am and I waited for a midwife to see me - at this stage I wasn't too concerned about the loss. While waiting for the registrar and obstetrician, I had further significant loss, enough to cause my midwife with 30 years experience to raise her eyebrows. I was placed on a CTG machine to monitor the baby, and the midwife urgently paged the Neonatal and Obstetric Teams. Within the next 30 minutes, it was decided that I needed an emergency c-section due to the continued blood loss; which was indicating a possible placental abruption. I called my husband and advised him that he better leave work and come to the hospital, otherwise he might risk missing the birth! At 10.30am I was prepared for theatre and wheeled into the operating room. About 15 minutes into the operation, our little baby girl was delivered - she let out a little cry and was taken into the Resus room next door. The Neonatal Team assessed her and organised her breathing apparatus and transport into the Neonatal Intensive Care Unit (NICU). Our baby had been born at 12.11pm, weighing 1120g and was 35.5cm long - 29 weeks and 4 days gestation. We named her Charlotte. During the afternoon, the Neonatal Specialist came to provide an update on Charlotte. At 2pm we were advised that her lungs were 'very bad' and that following delivery, she was intubated on 100% oxygen and nitric oxide – unable to breathe on her own. Charlotte had also sustained a collapsed left lung which resulted in a drain being placed into her chest to try and drain the air. By 5pm, we were advised that Charlotte had been coping well and that her oxygen requirement had been reduced to 35% (21% being normal air), and that the nitric oxide had been reduced to the lowest level possible. Charlotte was also placed on a high frequency oscillatory ventilation system, which provided tiny vibrations through her body to assist in keeping her lungs open and reduce the amount of energy it took for her to breathe. NICU and beyond: Charlotte spent 80 days in NICU (Neonatal Intensive Care Unit), moving through each level of assisted ventilation due to Neonatal Chronic Lung Disease - intubated, CPAP (Continuous Positive Airway Pressure), Humidified Nasal High Flow, Low Flow subnasal oxygen and following discharge, home oxygen. We were incredibly lucky in that Charlotte went from strength to strength while at the Mater Mothers’ Hospital in Brisbane - the only setback being the requirement for a blood transfusion early in her admission. The inconvenience of carrying around an oxygen tank and 9 meters of tubing around the house pales into insignificance when I think back to the grim picture the specialists painted for us during those 9 weeks before Charlotte's birth, when she only had less than 3cm of fluid to help her lungs develop. From the beginning of May 2012, Charlotte had her Home Oxygen requirements weaned from 24 hours a day to only needing the supplemental oxygen while she slept, and then further reduced oxygen requirements to nocturnal oxygen from September 2012 to January 2013. On the 25th March 2013 Charlotte underwent an Open Reduction and Salter Osteotomy on her right hip to correct DDH; being placed in a hip Spica cast for 6 weeks. We are adjusting to life with the cast’s limitations and look forward to when Charlotte is free to start moving again. She is a very precious miracle and we have many friends and family to thank for their continued prayers, as well as the expertise of the doctors and nurses who took care of her for nearly 3 months at the Mater Mothers’ Hospital as well as the Orthopaedic Surgeons who are currently monitoring her hip. Charlotte is now 18.5 months old (15 months corrected) and is a gorgeous little girl. She is 8kg and 76cm long. Not walking or talking yet, but very bright, happy and an absolute joy!