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If you've found this page because have just experienced a preterm premature
rupture of the membranes (PROM), you're probably shocked, confused, and terrified
about what this means for your beloved baby or babies.
The members of the PROM list know that you are in urgent need of information
about what to do next, what to ask your health care team, and what to expect.
We have created this page as a resource for you based on our own experiences,
and what we wish we had known when we PROM'd.
Our first message to you and your family is the most important:
.
Your health care team may know little about PROM and may tell you that your
baby's chance for survival is so grim that it isn't worth trying to save him
or her. Although we don't know the specifics of your situation, there are many
stories on this website of babies who have survived despite PROM. Know that
miracles happen.
Our second message is:
.
If something doesn't feel or sound right, ask for a clarification or an explanation.
Ask more than once. Even if you think you understand the information, allow extra time for it to
sink in, and to act on what you are told.
PROM is a pregnancy crisis and the shock of the trauma may make it difficult
to think and express yourself clearly, absorb new information, and - most importantly
- make decisions. Don't feel pressured to make any decision immediately, and
don't just "go along" with what your health care team is recommending if you
aren't completely sure that it's right for you and your family.
If you are uncertain about a procedure or diagnosis, wait before acting and
get another opinion. Find out what the range of options is. You are entitled
to get a second, third, or fourth opinion. Don't be shy about searching
for other doctors who specialize in pregnancy complications to consult about
your situation. University hospitals are often a good source for maternal/fetal
specialists with advanced training. If you need help finding a doctor to consult,
ask the PROM list for recommendations. If you feel
a different course of action is more appropriate for you, discuss with your
health care team whether it is possible to take the alternative course.
PROM can leave you feeling completely helpless. However, you may find empowerment
in the fact that you are your baby's advocate. Be as active as you can
in the decision-making process. If you are uncomfortable making requests or
asking for another opinion, remind yourself that you are doing this for your
baby, and that your baby's health is the most important thing.
- Keep asking questions if you don't understand something or don't
have all the information you need. Wait until you feel that you have all the
information you need before you make a decision. Unless your health care team
tells you that your health or safety are in immediate danger, don't make decisions
quickly or hastily.
- Don't worry that you are being a pest by asking the hospital staff
to monitor you closely.
- Insist on being seen any time you feel that something is not right,
even if you have left the hospital. If your health care practitioner will
not schedule an appointment, go to the emergency room.
- To the extent possible, keep a written log of what you are told, by whom,
and the date and time you received the information. A written log is also
useful for keeping track of your medications, fluid intake, bathroom visits,
and pad changes (if applicable), as well as the names of the members of your
health care team.
- Join the PROM list for support as you
advocate for your baby.
- Get a laptop and research PROM on the web. See the FAQs
on this website as a starting point for information, as well as the Resources
section of this article.
- Join the PROM list for information and support.
Join the PROM list
- Read the PROM stories to find out what has helped others who have
PROM'd. Print out stories of babies who have survived to educate your health
care team about the possibilities and options. Many health care practitioners
don't know or don't believe that babies survive despite PROM.
Use the information on these pages as a guideline for what to ask and what
to consider when making decisions about your baby and your pregnancy.
- Confirm that you have ruptured. Do not rely on the "fern" test. Insist
on an abdominal ultrasound (not trans-vaginal ultrasound) to confirm that
you are losing or have lost fluid.
- Write down your baseline amniotic fluid index (AFI). Use this as
a reference to gauge whether fluid is reaccumulating.
- Test for and treat an infection. In particular, look for:
- Group B Streptococcus (GBS) - your health care practitioner will almost
certainly treat GBS if it is present in your urine; discuss whether to
treat if it is only present in your vaginal flora.
- Urinary tract infections (UTIs)
- Bacterial vaginosis/gardnerella
- Citrobacter freundii - treatable with gentomicin-family antibiotics
- Yeast infection
- Learn the signs of cord prolapse. Ask your health care team to describe
the signs indicating that your baby's cord has prolapsed. If you believe the
cord has prolapsed, get in a position on your hands and knees with your hips
in the air and shoulders down to help take the pressure off the cord until
you can get medical attention. If you don't have someone to take you to the
hospital immediately, call an ambulance.
- Ask whether you will remain in the hospital, or go home on bedrest.
If you will go home, ask about home monitoring for preterm labor.
- Ask if you are a candidate for corrective procedures such as amnioinfusion,
fibrin injections, or the amniopatch. You may need a different hospital and/or
a different doctor for the procedure.
- Ask to start antibiotics immediately. Some members of the PROM list
have reported starting antibiotics immediately after they PROM'd, even though
no infection was present. Although some health care practitioners will not
prescribe antibiotics because they worry that antibiotics will "mask" an infection,
several recent studies have shown antibiotics increase the possibility of
a positive outcome. (see Resources section)
- Ask if/when you can receive steroid shots to help your baby's lung
development. Members of the PROM list have reported receiving steroid shots
as early as 23.5 weeks.
- Ask for tocolytic drugs if you are having preterm labor. Members
of the PROM list have reported receiving magnesium sulfate and/or terbutaline
as early as 17 weeks.
- Consult with doctors in other specialties before your baby is delivered,
if applicable. For example, if you are 24 weeks or beyond, you should meet
with a neonatologist to talk about what to expect if your baby is delivered
preterm.
- If you are NOT showing any signs of infection or active labor and your
baby is not in distress, but your health care team is still recommending
that you induce labor or terminate your pregnancy, find out how much time
you have to decide whether to follow their recommendation. Find out the consequences
of not inducing labor or terminating your pregnancy. Take as much time as
you need to feel comfortable with your decision.
- If your health care practitioner has already told you that you have no
choice but to induce labor or terminate your pregnancy and you know that your
baby will not survive long after birth, click
here for guidelines on what to consider before you begin the procedure.
- If your baby will be taken to the NICU immediately after birth, read
Preparing for a PROM Preemie.
- Discuss options for delivery (vaginal or c-section) and pros, cons,
and risks of each. Find out whether your health care practitioner or someone
else will be attending the delivery, and express your preference for who you
would or would not like to have attending you.
- Begin working on your birth plan. See "Resources"
section.
- Ask what to expect or watch out for in the first 24-72 hours after PROM.
For example, more fluid leakage, bleeding, cramping, or fever.
- Learn the signs of infection. Signs of infection include fever, abdominal
tenderness, foul-smelling discharge, and elevated white blood cell count.
Ask your health care team for more details on each of these signs. Keep in
mind that women on the PROM list have reported discovering infections after
delivery, even though they were asymptomatic before delivery.
- Limit exposure to infection. Insist on sterile speculum exams rather
than internal vaginal exams. If your health care practitioner believes an
internal vaginal exam is necessary to determine the texture of your cervix,
insist that the exam be done only with sterile gloves (these come in
a sealed package, and not out of a big box of gloves).
- Some research indicates that daily vaginal disinfection with povidone
iodine may prolong the period before delivery. Discuss with your practitioner
if this is right for you.
- Establish your options if infection develops, and how much time you
will have to make decisions if you begin to develop an infection.
- Ask for hospital bedrest if you feel that it is appropriate for you.
Hospital bedrest is usually available after 24 weeks. Some hospitals will
admit you earlier, especially if your hospital is a long way from your home.
- Monitor for preterm labor. Talk to your practitioner about home uterine
activity monitoring and self-palpation.
Staying well hydrated is one of the most important things you can do for your
baby. It helps keep your temperature down and fight infection.
Staying hydrated will also help replenish amniotic fluid, because the more
you drink, the more urine your baby will produce. By 27 weeks gestation, your
baby produces about 500 ml of urine into the amniotic sac each day. While much
of this fluid may leak out again, pockets of fluid may accumulate and help with
lung development.
- Drink ten 8-ounce glasses of water per day. Drink more than that,
if you can.
- Drink milk and cranberry juice to help ward off infection.
- Drink chamomile tea if you are having preterm labor. Don't drink
more than 3 cups per day, and wait 3 hours between cups. Drink the tea around
the times that you are having the most contractions. Talk to your health care
practitioner if you are unsure whether you should drink herbal tea.
- Remain in a position where you leak the least. This may be sitting
instead of lying down.
- Lie on your left side if you are lying down, rather than on your
back. If you are uncomfortable lying fully on your left side, lie on your
back with a pillow propped up under your right side.
- Aim for strict bedrest, staying horizontal or in the minimum-leak
position as much as possible. Get up only for bathroom breaks or quick showers.
- In the shower, avoid letting hot water run on your breasts because
it stimulates the uterus. Also, sit down if you can (use a plastic lawn chair
if you don't have a seat in your shower).
- If you are on hospital bedrest, insist on frequent monitoring for
cord compression if your AFI is low (AFI<3).
- If you are on hospital bedrest, consider using a bedpan or bedside commode
instead of walking to the bathroom.
- If you are on home bedrest and you have small children, follow these
guidelines as best you can!
Because your health care practitioner will almost certainly require you to
end your pregnancy if you develop an infection, here are some ideas that might
help prevent infection. Be sure to talk to your health care practitioner
about dosage and safety of any supplements.
- Eat yogurt. Dairy or soy yogurt are both fine as long as they have
live cultures. If you don't like yogurt, take acidophilus or probiotic supplements.
If you are taking antibiotics, take them at least one hour, preferably two,
before OR after you have the yogurt or acidophilus (otherwise, the antibiotic
will kill off all the good bacteria you are trying to build up).
- Drink unsweetened or fruit-juice sweetened cranberry juice to discourage
urinary tract infections. Avoid cranberry juice that is sweetened with high-fructose
corn syrup as it may actually encourage the growth of bacteria. Try diluting
unsweetened cranberry juice with water or sparkling water. As an alternative,
take cranberry capsules with a big glass of water.
- Avoid caffeine (including chocolate).
- Use anti-bacterial wet wipes after using the toilet. Remember to
wipe front to back.
- Take Vitamin E, Vitamin C, and zinc supplements. Talk to your health
care practitioner about dosage.
- Don´t wear underwear. If you are leaking or spotting, lie on
a towel or chuck pad.
- Avoid sex.
- Talk to or sing to your baby.
- Celebrate each day that your baby is still inside you.
- Name your baby if you haven´t already done so.
- Write a letter to your baby.
- Work on a birth plan. For ideas, see the Resources
section of this article or do an internet search for "birth plans".
- Have someone else pack the following for your hospital stay. You
will need these items whenever you deliver:
- Birth plan and any supplies
- Camera, film, batteries, camera charger, video camera
- Address book and phone numbers of anyone you would like
to have with you at the hospital, including the name and phone number
of a representative from your faith if there is a religious or cultural
ceremony you would like performed at the birth.
- Baby clothing, blankets, and other items you already have for
your baby
- Laptop computer, charger, and dial-up number of your internet
service provider
- Toiletries (toothbrush, toothpaste, shampoo, hairbrush, hairclips
or ties, lip balm, lotion, makeup)
- Family photos
- Notebook and pen for writing down instructions or notes, and
keeping a log of medications, health care team names, and visitors
- Cell phone and charger (if permitted by your hospital)
- Change of clothes, bra, underwear
- If you know you will be on hospital bedrest, the following is a list
of items that may make your stay more pleasant:
- Nightgown, robe, slippers, socks
- Calendar
- Clock
- Books, magazines, craft projects
- Your own pillow and/or favorite blanket
- Earplugs and eyeshades
- Journal
- Scented soap
- Hard candy (especially if you'll be taking magnesium sulfate)
- Lined paper to make a sign-in sheet to hang on your door if you
are not up to seeing visitors
- Your own towels
- Air freshener
- Books on prematurity.
- Back scratcher and/or reacher.
- Don't give up hope.
- Follow your instincts.
- We, the PROM list members, are here to support you.
Join the list!
- Miracles happen.
| This information was compiled by the members of the PROM list. Nothing
on this page should be taken as medical advice. A doctor should be consulted
before undertaking any of the medical treatments or methods recommended
by the members of the list. |
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E-medicine:
http://www.emedicine.com/
pPROM Diagnosis and Management (American Famly Physician): http://www.aafp.org/
Expectant Management of pPROM (OBG Management): http://www.obgmanagement.com/
Evaluation and Management of pPROM (OBG Management): http://www.obgmanagement.com/
ACOG Guidelines:
www.pubmed.com [search for
article ID: 9849720]
Survey of pPROM management practices (Am. J. Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 15507990]
Dr. Rose's Peripheral Brain - PROM:
http://faculty.washington.edu/
[for article, click on obstetrics/gynecology, then premature rupture of membranes]
Antibiotic therapy after pPROM (JAMA):
www.pubmed.com [search for
article ID: 9307346]
Effects of antibiotic therapy after pPROM (Am. J. Perinatology):
www.pubmed.com [search for
article ID: 11110340]
Antibiotics for pPROM (Cochrane Database):
www.pubmed.com [search for
article ID: 12804398]
Antibiotics for pPROM (Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 15516401]
Importance of avoiding digital vaginal exams after pPROM (Int. J. Gynaecol.
Obstet):
www.pubmed.com [search for
article ID: 1971232]
Benefits of daily vaginal disinfection (J. Obstet. Gynaeco. Res.):
www.pubmed.com [search for
article ID: 9798359]
Amnioinfusion general information:
http://www.thefetus.net/
Kentucky Post article - successful amnioinfusion:
http://www.kypost.com/
Amniopatch to repair second trimester pPROM (Acta. Biomed.):
www.pubmed.com [search for
article ID 15301286]
Abstract of amniopatch article (Clinics in Perinatology):
http://www.fsneo.org/
Amniopatch treatment after amniocentesis-related pPROM (USF Health):
http://health.usf.edu/
Amniopatch treatment after amniocentesis-related pPROM (Vox Sanguinis):
http://www.blackwell-synergy.com/
Amniograft after spontaneous pPROM (Am. J. Gynecol.):
http://pt.wkhealth.com/
Use of gelatine sponge to plug cervix:
http://www.indegene.com/
Safety of steroid use (BBC News):
http://news.bbc.co.uk/
Effects of antenatal steroids after pPROM (Aus. N.Z. J. Obstet. Gynaecol.):
www.pubmed.com [search for
article ID: 8717561]
Single vs. Weekly courses of steroids after pPROM (Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 14754695]
Beneficial impact of stress hormones after pPROM (Dr. Greene.com):
http://www.drgreene.com/
Embryologic Development of the Cardiopulmonary System:
http://www.salisbury.edu/
Pulmonary Hypoplasia (E-medicine):
http://www.emedicine.com/ped/topic2627.htm
Benefits of Vitamin C & E supplementation after pPROM (Int. J. Gynaecol. Obstet.):
www.pubmed.com [search for
article ID: 15907848]
Living through hospital bedrest (Sidelines):
http://www.sidelines.org/
Timing of elective delivery after pPROM (Am. J. Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 15167875]
Optimal gestational age for delivery after pPROM (Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 15625135]
Delivery at 32 or 33 weeks after pPROM (J. Matern. Fetal Neonatal Med.):
www.pubmed.com [search for
article ID: 15621544]
Delivery for pPROM occurring between 30-36 weeks (Obstet. Gynecol.):
www.pubmed.com [search for
article ID: 750133]
See Resources section of Preparing for a PROM
Preemie article.
Article by Kay Squires, january 2005, updated 2007
Special thanks to the members of the PROM list
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