By Kendall, Denver, CO USAReading 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.
PROM at 22 weeks + 1 days. Delivery at 22 weeks + 5 days.
Story added: 2008-01-21
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.