By Pj Nelson, San Diego Usa
PROM at 29 weeksDelivery at 34 weeks.
Story added: 2010-10-18

My wife’s membranes ruptured at 29 weeks. It was a traumatic experience for both of us and one that I wish on no one. If you are reading this I assume that you are in a similar boat. The doctors told us that my wife would likely go into labor within seven days. For people who deliver before 29 weeks that 7 day period is likely to be longer and for those after 29 weeks shorter. This assumes that there is no infection of course. My wife did not have any of the know risk factors for PROM; smoking, low weight, diabetes, nutritional deficiencies, pulmonary disease, etc. However, she did have bleeding in the first trimester. When we arrived she was not dilated nor did she have an infection. She was managed according to the American Congress of Obstetricians and Gynocologists guidelines (see ACOG Practice Bulletin or ask the hospital for a copy - http://www.acog.org:80/). I suggest getting familiar with the guideline as there are a lot of things to understand; infection risks, current therapy recommendations, delivering at 34 weeks vs. not doing so, etc).

I’m writing this as I once sat in your shoes, looking for a glimmer of hope. Our experience was tumultuous at times, but everything worked out great. My wife was put on bed rest in the hospital and was able to hold on until 34 weeks (5 full weeks), until labor was induced. The publication below will explain why she was induced early.

Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):126-30.
Premature rupture of membranes at 34 to 37 weeks' gestation: aggressive versus conservative management.
Naef RW 3rd, Allbert JR, Ross EL, Weber BM, Martin RW, Morrison JC.
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Abstract
OBJECTIVE: Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks' gestation with expectant management.
STUDY DESIGN: In this prospective investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were randomized to receive oxytocin induction (n = 57) or observation (n = 63).
RESULTS: Estimated gestational age at rupture of membranes (34.3 +/- 1.4 weeks vs 34.5 +/- 1.4 weeks) and ultrasonographically estimated fetal weight (2230 +/- 321 gm vs 2297 +/- 365 gm) were equivalent between groups (not significant). Chorioamnionitis occurred more often (16% vs 2%, p = 0.007), and maternal hospital stay (5.2 +/- 6.8 days vs 2.6 +/- 1.6 days, p = 0.006) was significantly longer in the control group. Neonatal sepsis was also more common in the observation group (n = 3) than among induction patients (n = 0), but the difference was not statistically significant.
CONCLUSION: Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications.
PMID: 9465815 [PubMed - indexed for MEDLINE]

At 34 weeks, we had our son. He had a lot of the typical problems that other preemies have like breathing difficulties for a few days (surfactant really helped here), feeding issues (the nipple response doesn’t kick in until 35ish weeks), and jaundice (he just needed a little sun bathing). I’m not going to lie, it was not easy. However, he is now 2.5 years old and thriving. He speaks well, is extremely coordinated, has great vision, is really smart, and is a true joy to be around. He loves hanging on monkey bars, climbing up things, and going down slides.

My wife and I were a bit skeptical about having another child, as statistics tell you that women who delivery prematurely have a 16%-34% chance of having a second premature child. Nonetheless, we found out that progesterone shots after the first trimester cut this risk in half, so we decided to try for another child. My wife will be 36 weeks tomorrow with our second child. We have not had any issues to date…knock on wood. She is now 37 years old and we are looking forward to growing the family. Advances in medicine and technology now allow neonative intensive care units (NICUs) to do some amazing things. Preemies as early as 24 weeks can do well. My son was born at UCSD Hospital (a teaching hospital with a fantastic medical school) in San Diego and spent ~ 2 weeks in the NICU before we took him home. UCSD holds an annual NICU picnic on the bay. My wife and I took my son last summer and couldn’t believe how many beautiful rambunctious graduated preemies we saw running around.

Remember to keep your chin up, support your wife, and give your baby a lot of love! Everything will be fine.