By Elke Overton, Saint Louis, MO USAAt 17 weeks, I was visiting my sisters in Phoenix and my brother-in-law (massage therapist) gave me a body massage. He was not specifically trained in pregnancy massage, and I later learned that massaging the feet and ankles can stimulate labor. I don't know if this was related to my rupture, (I certainly don’t blame him!!) but it did happen the next morning (just for your information).
PROM at 17 weeksDelivery at 29 weeks + 5 days.
Story added: 2006-04-03
I had bleeding starting at about 11 weeks, but no specific issues. When I suddenly produced an abnormal amount of brown fluid – very watery (overflowing a maxi pad and wetting my pants over a period of 1.5 hours) I called my doctor. He apparently thought I was bleeding again and told me that if it continued that heavily into the evening, I should go to the hospital. He said that if it stopped, I was probably okay. I don’t think he considered PROM. Well, it stopped and so I didn't think much of it until 4 weeks later at a regular exam/ultrasound. This was also careless on my part, but I had not idea you could rupture that early.
I was now 21 weeks and was informed that I had no fluid (less than 1 AFI). They advised bed rest at home until 24 weeks when the baby was considered viable. We also spoke with a neonatologist who showed us some statistics of 100% mortality rate for PROM and he suggested that we consider terminating the pregnancy. They said she would probably be born and maybe live 2 hours at the most. After this conversation, my husband and I just couldn’t believe that there was nothing the doctors could do... with all our amazing advances in modern medicine!! So we went home and my husband got on the WebMD website and found out about amnioinfusion. We went back to the doctor the next Monday and asked him why he hadn’t mentioned it. He said it was hospital protocol to administer amnioinfusion within one week of the rupture. He also said that if we wanted to specifically request it, he would try it, even though it had already been over 4 weeks (with no infection or miscarriage). We made two attempts (four days apart) and checked me into the hospital after the second infusion. I was almost 24 weeks by this point. The amnioinfusion had apparently not been successful – according to the ultrasounds I did not retain the pockets of fluid that the doctor put in (at least 250 ml each time!!). My AFI dropped back to 1 or 2 within 24 hours after each infusion. I argued with the doctor that no fluid had come out of me (I would have felt myself lose that amount of fluid – and I was wearing a pad that stayed dry), but he said because of the risk of infection and starting labor, he didn’t advise continuing to try based on the results he could see in the ultrasound. I WOULD ADVISE ANY WOMAN TO TRY THIS METHOD IF IT IS AVAILABLE TO YOU. I still think my body retained some of the fluid and that is what saved my daughter’s life.
During this entire ordeal, our baby’s head was down and the doctors said that hopefully she was breathing any tiny bit of fluid that might be near my cervix. She stayed in this position until she was born. I remained on bed rest for over 5 weeks in the hospital (luckily no IV) and took only some antibiotics to help prevent infection. I did have a few scary moments where I felt some contractions at about 25 weeks, but they started me on a mild muscle relaxer to control the contractions (pill form – Procardia). I stayed on these until the real labor began.
I was told that the baby probably wouldn’t be able to tolerate natural delivery, so I would probably have to have a cesarean section (something I was adamantly opposed to). Four days before my 30th week, I started very strong labor pains. They progressed quickly and they took me back into the monitoring area, put me on magnesium sulfate and began 24 hour monitoring. From this point on, my husband didn’t sleep a wink. He was fixated on the monitor. The next morning, they thought they had the contractions under control (I was unable to focus or function well on the magnesium – nasty stuff!!) and they sent me back to my room. At 5:30pm the next evening, the labor started very heavy again and we called in my doula. Somewhere around 6:30 or 7pm (I wasn’t really watching the clock!!) I could feel the baby move down. At this point, the doctors still had me in the “monitoring room” and were still trying to decide whether they were going to try to stop my labor. I told them there was no going back and she was coming out!! I was very lucky to deliver naturally – 4 or 5 pushes and she was out!! She weighed only 3 pounds and was 15.5 inches long. They immediately rushed her out of the room (okay by me!!) and took care of her. They brought her back in about 20 minutes later hand-bagging her (so she could breathe) so that I could see her, but we told them to get out and get her stabilized!! They had previously told us that if they could get her to process any oxygen at all, they would transfer her to a higher level facility. If not, they would give her to us to hold her for her short life. After about an hour, they said they would be transferring her to the children’s hospital. At that point I thanked God, because knew she at least had a chance of living.
We got to see Lisette about 1.5 hours after she was born. She was connected to a respirator (down her throat) and was not really responsive. She was so tiny and frail and extremely bruised. Her head was totally purple, probably from being stuck in my cervix for so long. She was moving her little arms a legs a bit, and we were immediately in love. They took her to the children’s hospital during the night. My husband followed her over there and I checked out the next morning. During the night, my husband relayed what they were doing to try to save her life... here’s some of the detail he wrote around the third day after her birth:
Her underdeveloped lungs are the biggest concern and she initially had problems getting enough oxygen to keep her blood saturated. She has both pulmonary hypoplasia and hypotension. They have her on a high pressure ventilator that is providing oxygen for her. They're also giving her nitric oxide (NO) to help dilate the capillaries in her lungs to get maximum oxygenation to her blood. Unfortunately, although necessary in the short term, the high pressure can cause damage to her lung tissues and puts her at a higher risk for chronic lung disease in the future. Monday afternoon she collapsed a lung because of the pressure and they had to insert a tube into her chest cavity to relieve the pressure caused by the leaking lung. Fortunately, after they put the chest tube in, she made a wonderful turn towards improvement. She's still on the ventilator, but they've been able to cut the pressure down almost in half. They've also been able to dial down the percentage of oxygen in her ventilator from 100% to 58% (they'd like to get it down to as close to normal (21%) as possible). They've also noticed that she's out breathing the ventilator which means that she's sneaking in a few breaths on her own and they've turned down the number of breaths per minute the ventilator puts out to less than 20 (down from 60). They're still giving her NO and will continue that until her oxygen comes down a bit more. Just this afternoon they took the chest tube out and she's no longer leaking air (by chest x-ray). The fact that she was able to repair the leak that quickly is a good sign. They've been drawing blood on a regular basis to assess her blood gas levels. They use this information to determine the rate at which they can wean her off of the ventilation support. As a result, she's been given 2 transfusions (15mls each) to replenish her hemoglobin levels. She also has a central line in her umbilical vein where she gets her nutrients (glucose and electrolytes for now). On Wednesday they did a head ultrasound that came back normal. They initially had her on both dopamine, dobutamine to get her blood pressure up and they also had her on a course of hydrocortisone for her blood pressure and to stimulate lung development. Fortunately, they've been able to wean her off of all of these and her blood pressure is now stable and looking good. She's no longer considered hypotensive.
They tried the regular respirator, the high-speed oscillating respirator and they even hand-bagged her for 5 hours (all the nurses taking turns!). They were amazing. At about 7am they added NITRIC OXID to her oxygen and suddenly her oxygen levels flew up!! THAT WAS THE KEY. THAT SAVED HER LIFE. We later found out that 10 or 15 years ago she would not have survived. It also turned out that the statistics that the neonatologist gave us were 10 YEARS OLD!!!
SO DON’T GIVE UP. MODERN MEDICINE (WITH THE HELP OF GOD, OF COURSE) CAN DO WONDERFUL THINGS. REMEMBER THAT MY AFI WAS LESS THAN 2 AND I RUPTURED AT 17 WEEKS!!
Lisette was on a respirator for 1.5 weeks, then a CPAP (pressurized nasal tube) for 4 more days. I didn’t get to hold her for the first week and a half. After two weeks, she was transferred out of intensive care and into the special care nursery with just a nasal canula with some extra oxygen. They had started giving her breast milk on day 2 after her birth (through a feeding tube) and then I began breastfeeding in the hospital at about 5 weeks. We used a combination of breast and bottle from then on, but mostly breast once she came home.
She remained in the hospital 9 weeks (came home one week before her due date – fairly typical). When she did come home, she was still on extra oxygen (we had a huge tank and a 50 foot tube to carry her around the house) and a heart/breath monitor for another 7 weeks. THE ONLY REAL PHYSICAL ISSUE SHE HAD WAS SEVERLY UNDERDEVELOPED LUNGS. Other than that, she developed amazingly quickly and well during her stay at the hospital. At every return visit to the doctors for follow-up exams, they would tell us how they were still discussing her case and how amazing and miraculous it was. I think they learned a lot from Lisette and I’m glad they can save other babies’ lives with this knowledge!!
The doctors who took care of me also learned a lot about what is possible. Luckily, two of the doctors at my hospital had reassured me that they had a very few similar cases previously who also had babies who survived. They gave her a 2-5% chance of survival. Then I also found this website while I was on bed rest at the hospital. I immediately gave it to the doctors. It really kept me going and believing that our baby could live.
Lisette just turned two years old and is a totally normal, feisty little toddler. She is absolutely beautiful and loves to sing and dance. (We played music for her in the womb and in her hospital bed during her entire stay.) I am convinced that she has a special purpose in this world.