By Bronwyn Rose, WA Australia
PROM at 15 weeksDelivery at 29 weeks + 5 days.
Story added: 2011-01-16

Blake Michael Rose was born at 29 weeks 5 days gestation at 5.09pm on Wed 10/11/10 weighing 1.3kg, 40cm long

I am 40yo, married with a 9yo son and live in Perth, Australia. I had two first trimester miscarraiges (9wks and 11wks) before my first son was conceived and born at 38wks in 2000. I had severe pre-eclampsia then which resulted in an emergency c-section.
We tried for nine years to have a second baby unsuccessfully, did IUI but never IVF. As I was turning 40 in 2010 we decided to give IVF a try for six months. Due date, 21st January 2011.

The day before I got to 12wks we had the pre-screening test for downs syndrome. I ended up being high risk due to the blood test results. I had a 1:160 chance of having a baby with downs. We made the decision to have an amniocentesis.

Friday 30th July was the day of the amnio. I was 15wks gestation. All seemed to go smoothly and I was told to rest for the remainder of the day. Test results came back later as clear of any abnormalities. 3 hours after my amnio I got up off my bed and started leaking clear fluid. My obstetrician’s office was closed for the day so I rang the hospital who told me to rest and call back if I lost more or if I started contracting. I didn’t lose any more that day or the next. Sunday morning I woke up with what felt like contractions. I rang the hospital and was told to come in immediately. I had blood tests and my obstetrician did an ultrasound. He confirmed that I had ruptured my membranes (my waters broke) as a result of the amnio and told me we would just have to wait and see what happened. He told me the biggest risks of preterm premature rupture of membranes (pPROM) was infection and/or preterm labour. Infection was due to fluid being able to come out therefore bugs can get in. Preterm labour is because it is the natural thing when your waters break. I was put on antibiotics. Two days later there was no more fluid loss and no more contractions so I was discharged from hospital and sent home on strict bedrest (bathroom priviledges only). The option of staying in hospital was given to me. I chose to go home.

10 days went by before I lost any more fluid. Another 10 days went by, I saw my obstetrician and he thought I had resealed and said I could go on modified bedrest (take it easy). I was ecstatic for 3 hrs before I had a big gush of fluid. Another 4 days with no loss then I had loss tinged with blood. I really thought I was losing our baby. My obstetrician saw me that day and the baby was still healthy. By now I was 18w3d. My obstetrician had a serious discussion with us about the risks of pPROM, the high chance that I would lose the baby or have the baby extremely prematurely. He went into great detail about the risks of a micro premmie (23+4 to 25+6). He asked us to consider the option of terminating the pregnancy as after 20wks in Western Australia we no longer had the right to terminate. That was a day of tears and endless discussions with my husband. We decided that while our baby was healthy inside me, there was no way we could end it’s life. Our obstetrician was supportive of our decision. I continued to leak on and off almost daily thereafter.

I was finding strict bedrest very hard. I own a professional business employing three staff and was trying to run this from my bed. I had a 9yo who was missing his Mum not being able to be a Mum. I was tired, my back ached, I couldn’t really concentrate on anything, I couldn’t handle visitors. At approx 22wks I started looking online for support. I found an Australian website. Someone there referred me to this website which provided me with information that I had thought about but never voiced, such as do you hold a funeral if your baby dies before viability, do you hold your stillborn. The kanalen site had a link to a facebook support group. That in turn sent me to a USA site. I have to say that all these sites, in particular the facebook site, helped me immensely. To know that there were other mums sacrificing their lives in order to try to create a life under the most extreme of circumstances gave me huge support. I could laugh and cry with them, share information and learn.

My obstetrician decided to refer us to a high risk obstetrician. The private hospital where I was booked to deliver wouldn’t deliver before 32wks, so I had to be delivered by the only hospital in the state that would do so. The new obstetrician suggested that I start on another round of antibiotics again which I did. I am so grateful that I got that referral as my new obstetrician was amazing. He seemed to have a lot of knowledge about pPROM. I saw him for the first time at 22w3d. He told me that an amnio rupture was significantly different to a spontaneous rupture. Chances of survival for a 15wk spontaneous rupture are 18% but an amnio is close to a normal pregnancy. He was amazed at my AFI (amniotic fluid index). Normal AFI at my gestation was between 7 and 20 and I had 11. He expected something closer to 3 based on my history of leaks. Given that I was obviously following strict bedrest at home to have that high an AFI, he decided to allow me to stay at home rather than being admitted to hospital. He also said he was pretty confident I’d get to the early 30's (weeks) maybe even the mid-late 30's. His only other general overall comment was "the more vertical you are the more you will leak”. My first sense of hope in the entire pregnancy.

I saw my new obstetrician weekly thereafter for an ultrasound. My AFI went from 11 that first week to 5 the next. I was warned that if it went any lower he would admit me to hospital. The following week it went back up to 9 then 10 the week after that. He did a more thorough look during those visits and came up with the probability of why I ruptured from the amnio in the first place. Apparently my placenta was funny (but was still working fine) which is why my fetal screening test came back with a high risk of downs syndrome and the funny placenta also meant that my membranes probably weren't quite right therefore I would have been prone to rupture anyway. He was surprised given that I was obviously ruptured (there was something torn against the uterus wall which is very common in ruptures membranes) that my AFI was high.

At 26w1d at 3am my little amnio rupture turned into a spontaneous rupture. I had cramping every 3-4mins and after half and hour lost so much fluid (more than I did when my waters broke at 38wks with my first son). I again thought, this is it. I went into hospital and surprisingly still had an AFI of 3.5. Of course there was to be no return to bedrest at home. I was given my first steroid injection that morning and another 24hrs later. I started antibiotics again. We also found out it's a boy. My obstetrician was overseas presenting at a conference so I was seen another obstetrician so it wasn't until 4 days later that I knew what his treatment plan for me would be. The treatment plan was for me to be in hospital for the rest of the pregnancy. He didn’t think I'd go into labour anytime soon but he went to only aiming one week at a time. I asked about how quickly infections develop. He said in 99% of cases is normally takes 72hrs for an infection to get to the baby. The first 24hrs your uterus will feel tender which is why he checked it everyday to see if I reacted to pressure on the uterus. The second 24hrs you will start to feel flu like/sick/temp increase. The third 24hrs the baby activity will start decreasing. Normally by this stage you will go into labour naturally. If not they tend to get the baby out.

The neonatologist visited a week later to fill me in on the stats etc and policies for this hospital. The good news is that at 27wks in this hospital the survival rate is 85%. The bad news is that they won't let my 9yo see him until he's in 3rd stage nursery which could be weeks after he is born. When I asked her how many babies they get here who have pPROMed so early she said I was "very special". Nice way of putting it.

At 27w1d I had my first lot of contractions in the hospital which were proved by a CTG. They started at 4am every 5mins and increased to 3mins lasting 40secs. They were stopped with a phenergan/morphine injection.

That week I started daily CTG’s where they measure your contractions, the baby’s heartrate and the baby’s movements. My obstetrician was still hoping to get me to 34wks before he would deliver.

I started to really feel the pressure of being in hospital. There was absolutely no privacy. My 9yo son was not coping so I was not coping. My high risk obstetrician even asked me if I wanted to see a psychologist. When I looked at him with raised eyebrows he explained that 50% of his patients see one because they couldn’t cope with not knowing what would happen to their baby. I explained that it was more because I was worried about my 9yo. He then allowed me to go on home visits once a week. This increased to twice weekly when it was seen to really improve my son’s happiness.

At 28w2d I was on an overnight home visit. At 2.30am contractions started every 7mins. I rang the hospital and was told to try a heatpack and panadol. It worked. Later that day back in hospital at 4pm contractions started again every 30mins increased to 8 mins. Again, stopped with morphine/phenergan.

My obstetrician’s earlier suspicions about my funny placenta became reality. At 29w5d Wed 10th Nov, at 2am in the morning I started bleeding heavily (home visit again). Things went into action. I had a CTG done in the morning and it took 2 hrs before anything was reactive (heartrate going 15 beats higher for 15 seconds) and the baby had a few low decels. The blood tests were taken and came back with no infection. My obstetrician visited me and told me that I would go into labour sometime soon. I forgot to ask how soon.

An ultrasound was done and showed AFI=0 but otherwise the flow of blood through my baby was fine. My obstetrician visited again and said that he hoped to get another 7-14 days out of me.

After that I started contracting and they did another CTG. At 2pm my obstetrician visited me again, and looked very serious. He said that he had reviewed my CTG results again and was concerned the low decels in the babies heartrate were happening at the same time I was contracting. He said he thought it was the placenta degrading so wanted to do a c-section (baby was breech). By 5.09pm my baby was delivered. He found a blood clot from the placenta as big as his fist so he was very happy with his decision.

The closest I got to Blake the day he was born was two metres away in the operating theatre. I didn’t see him again until late morning the next day. He was doing well in the special care nursery or neonatal intensive care unit (NICU) as it is now called. He was already coming off the oxygen ventilator and breathing on his own with the assistance of CPAP @ 21% oxygen (air level). It was day 5 before I got to hold him. Our NICU journey had begun.

I left my son behind in hospital after spending 78 days on strict home bedrest and 35 days in hospital. A total of 113 days where I was unable to live life. Leaving Blake behind was the hardest thing I have ever done in my life.

Blake spent 2 weeks in an incubator and 4 1/2 weeks on CPAP. He continued to have desats and bradys until he was discharged after 59 days. He came home a week ago on a respiratory monitor, although this has only gone off 3 times so far. Otherwise he is a healthy beautiful boy.