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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.
Next
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Article by Kay Squires, january 2005, updated 2007
Special thanks to the members of the PROM list
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