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PPROM: When Your Water Breaks Too Early.

I’m going to try not to get too ‘science-y’ with this article.  I really want you all to understand everything possible about PPROM, but I want you know that this is not just a condition that happens – it is emotional.  It can be terrifying. Mothers who have experienced PPROM often must let go of birth expectations and give in to medical options, lots of them.  Some mothers will not bring home their baby. There is a time for medical intervention, and if your water breaks too early, you need to understand the possible interventions and outcomes.

You probably found this article because:

  1. You are currently on bed rest with PPROM
  2. You have a PPROM baby or loss already
  3. You are pregnant and learning about everything (I applaud you)

If you are currently on bed rest, I am sorry you are experiencing this, but do not give up.  The funny thing about odds is that there is a whole lot of luck mixed in. Maybe you will be a lucky one, and maybe not.  I do pray that you will hold and bring home your baby when the time is right, and not a moment sooner.

What is PPROM?

Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. It is when the sac that holds the amniotic fluid surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.

Labor may or may not begin on its own following PPROM. Depending on how far along you are, labor may or may not try to be stopped.  If your water breaks but labor does not naturally begin, your birth team will begin a protocol to keep baby in the womb as long as possible.

PPROM increases the risks of certain pregnancy complications, including:

  • Preterm Delivery
  • Placental Abruption
  • Prolapsed Umbilical Cord
  • Infection in the uterus or baby
  • Miscarriage

Not all PPROM ends the same

If your water breaks before 37 weeks, it is considered PPROM.  This means that a woman whose water breaks at 18 weeks is suffering the same condition as the mother experiencing it at 36 weeks.  While technically true, the outcomes can be severely different.

Your odds of bringing home a healthy baby depend very much on gestational age at time of rupture, the onset of labor, science, and luck. The closer to full term you can get, the healthier the outcome should be.  While medicine is amazing, a baby born before or near 24-weeks gestation typically does not survive; however, miracles do happen.

Are You At Risk?

While there is no known cause for PPROM, research has found that certain women are at a higher risk of experiencing the condition.

Factors that may increase your chance of PPROM include:

  • PPROM in earlier pregnancies
  • Nutritional deficits (Poor gut health)
  • Infection in the amniotic sac
  • Other infections in mother such as chlamydia or bacterial vaginosis
  • Preterm labor
  • Amniocentesis
  • Bleeding during the second and third trimester
  • Certain procedures used to treat abnormal conditions of the cervix
  • Lung disease during pregnancy
  • Connective tissue disease
  • Low body mass index
  • Poorly developed placenta (Breus Mole)
  • Smoking

Seeing that nutritional deficit made the list makes PPROM a risk for so many pregnant women.  As nutrition is what feeds the gut, and the gut health is what feeds the entire body, of course our gut health plays a huge role into the health of our pregnancies.  I urge you to please consider on working toward healing your gut.  Even if you think you have no real issues, there is always room for improvement.

 

Possible Medical Treatments

There is no ‘Standard of Care’ when it comes to PPROM.  Each doctor and hospital may have a different protocol.  More research needs to be done to ensure that all is done for as long as possible before delivering the baby.

You see, a doctor may choose his own course of action and abandon treatment any time after 34 weeks gestation, even if the treatment is doing what it should and prolonging the pregnancy.  The following are results from a study that compiled over 500 doctors and how they handle PPROM:

Only 30% of the doctors reported a formal departmental protocol for managing women with PPROM.

99% use steroids and antibiotics

Here’s where it gets tricky:

Doctors can decide if the antibiotics should be administered. Some doctors only administer if PPROM occurs prior to 32 weeks, while others administer any time it occurs prior to 34 weeks gestation. There are some doctors who give repeat dosages. Each doctor has their own opinion on why they administer as they do. This needs to be further researched, as antibiotics and steroids are a double-edged sword. They could potentially save the baby, but they can cause severe problems as well.

Most Common Treatment Plans:

34 weeks or longer of gestation

The doctor may:

  • Monitor the baby’s heart rate
  • Induce labor by giving you medicines
  • Possibly give antibiotics

32-33 weeks of gestation

The doctor may:

  • Induce labor if your baby’s lungs have matured enough
  • Give antibiotics
  • Possibly give steroids to help your baby's lungs develop faster
  • Try to delay delivery until 34 weeks gestation

24-31 weeks of gestation

The doctor may provide treatment with antibiotics and steroids. The doctor may attempt to delay delivery until 34-weeks gestation.  (Bed Rest)

Less than 24 weeks of gestation

The doctor may admit you to the hospital for bed rest and to monitor you and your baby. Twenty-four weeks of gestation is about the youngest a baby can be born. The doctor will discuss the risks and benefits of your treatment options.

Remember that you have a say in your treatment plan, and every extra day inside the womb is good for your baby.

 

Being on Bed Rest Does Not Mean Giving Up

There are still things you can do help prolong this pregnancy while you are on bed rest. Always talk to your doctor about what you would like to try, but remember to bring the research with you.

  • Studies show water intake relates to amniotic fluid level, so increasing the amount of water you drink should be a must!
  • Research the benefits of taking extra Vitamin C, Vitamin D, Fish Oil (Omega-3), Collagen (Types 1&3), Calcium, and probiotics.
  • Exercise, even in bed.
  • Eat well, avoid processed foods.
  • Change your pad often to avoid bacterial growth.

 

Emotional Scars

Depending on your PPROM experience, there is a chance that you may carry emotional scars that change your outlook on pregnancy, birth, and children.  You have the right to heal in any and every way possible.  One of the best ways to do so is by feeling supported and pursuing information to be educated and educate others.

Join groups like LittleHeartbeats for support.

 

Future Pregnancies

PPROM is held accountable for approximately one third of preterm births in the United States. It occurs in approximately 0.7-2% of all pregnancies nationally, and has a reported recurrence rate of 21%.

Yes, your chance of having another PPROM pregnancy are there – they are real.  And this is what scares so many couples away from trying for more children. But, there is also the chance that the next pregnancy is normal.

There are also things you may decide to do different with another pregnancy.  Exercise, diet change, all-around healthier lifestyle, better supplements, anything may make a difference.  Not to mention, that you will have a plan with your birth team on how to handle this pregnancy.

 

Words of Wisdom:

Lindsey, mom to 3 (2 PPROM babies <33w and 35w> and a 38 week baby with progesterone shots weekly) says:

“Nothing is ever for certain. Each pregnancy is completely different, all the way around. There is no guarantee a baby will stay in full term or past a certain week. The only guarantee you have is doing everything healthy and the way as a mother that you see fit for you and the baby.  Don't ever be scared for the unknown. The unknown hides blessings, and without overcoming our fear, we would never be as strong and blessed as we are.”

pprom

“I was scared with each pregnancy after my first. The first one is always scary because of the unknown. And after a PPROM, the fear is there. But you have to shut the fear down, because once you are pregnant, you make the acceptance to be in for the long haul, and be healthy, and do what is right in your book.”

Kimberly, mom to two:  My water broke at 33 weeks, 2 days and she was born at 33 and 6.

“It's scary. I totally panicked when it happened because every worse-case scenario went through my head. But, don't let your panic overtake your plans and desires. As soon as my water broke I started researching...what was happening, what it meant, what my options were. And I asked every doctor and nurse questions until I was comfortable with the answer. In the end, the most important thing is a healthy Mom and a healthy baby. I had a great group of doctors and nurses and the NICU team was amazing. We were very blessed.”

pprom4

 

References:

http://europepmc.org/abstract/med/2222633

http://www.ejog.org/article/S0301-2115(04)00669-4/abstract

http://www.mountsinai.org/patient-care/health-library/diseases-and-conditions/preterm-premature-rupture-of-membranes

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