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PPROM, what did you differently in next pg

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bluegirl07 Posted: 08-03-2010 9:46 AM

I am pg again after going through PPROM with my last pregnancy.  I was only 15 weeks when my water broke and we lost our son 3 days later.  The autopsy results came back fine.  There was an infection which they think may have caused it but we'll never know that for sure.

For those who had PPROM with a previous pregnancy what did you do differently with the next pregnancy?  Did the OB check for infections on a regular basis?  I am really nervious about the second trimester and that my water will break early again.  So far the only difference this time around is that they are going to check my cervex at 12, 15 and 18 weeks just to make sure that isn't the problem.  They don't really think it was but they want to make sure. 

I was just wondering if anyone else had some advise. 

Me (32) & DH (31)

TTC #1 since May 2007

Angel Feb 2008, 11 weeks, misoprostol

Angel Aug 2008, 5 weeks, natural

Angel Jan 2009, 7 weeks, ectopic, laparotomy (lost right tube)

Various tests, 6 cycles of Clomid, 1 IUI, several cancelled IUI due to Nest on the right side and now onto IVF.

IVF #1 -  Feb 2010 transferred 2 embryos - BFP with one

Angel Baby Boy May 6, 2010, 15.5 weeks due to PPROM, Owen Michael, forever in our hearts Sad 

Baby Boy Nathan born March 1, 2011


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oceanview replied on 08-03-2010 10:18 AM

I'm so sorry for your loss :(.

I had pPROM much later than you - 35w4d - but I am also freaked out at the prospect of another premature baby.  I want to make it to 37 weeks.

My pPROM was likely caused by my cervix which was measuring short from my anatomy scan onward.  At 30 weeks I was down to 1.8cm and funneling....  I had steroid shots because my Peri said I was at high risk for PTL or pPROM.

This pregnancy I am being monitored bi-weekly with t/v cervical ultrasounds.  I am also taking 17P shots to help keep me from having any contractions (BH or otherwise) that could aggravate my cervix.  Other than that I am just taking it a little easier than usual.  No vigorous exercise or super long days on my feet.

So far my cervix is doing better than last time.  I'm hopeful for a full term baby this time!

One note...  I would request a cervix screening a little later than early 2nd tri.  My cervix with my last pregnancy was over 4cm at 16 weeks...  so there was certainly nothing alarming about it then.  Have them do a t/v scan at your 20 week ultrasound and then possibly another one at around 25 weeks.  For me, that is when the change starts to happen. 

Keep Calm and Have a Cosmo: adventures with two under two while my husband is deployed

Lilypie Second Birthday tickers Lilypie First Birthday tickers

My daughter was concieved thanks to IVF with ICSI.  She was born at 35w4d due to pPROM.

My son was concieved by *surprise!*, naturally, the month after I weaned my daughter.  He was born at 39w4d after 17P shots and Procardia.  Proof that miracles do happen after the long road of infertility and losses.

Angel Kate's twin - 10w1d - 2009 ~*~*~*~*~*~ Angel Missed Miscarriage - 10w4d - 2007

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Scoutie replied on 08-03-2010 10:27 AM

We've chatted before, but I'll write things out for future reference.

I'm seeing a peri

I'm getting more u/s, more cervix checks, and being seen twice a month instead of once (as oceanview said, see if you can get a cervix check earlier)

I'm requesting to be tested for UTIs

I'm getting P17 shots (this is a fairly new therapy that has decreased premature births by 30%)

I'm monitoring any weird discharge, keeping an eye on cramping, leaking, etc.

I'm advocating for myself.

Maxwell Davis born 2/24/05 after infertility

Riley Elizabeth born 8/11/07 after infertility

Blighted ovum 11/08

Daniel Dwight born too soon at 21 weeks 10/31/09: Always in my heart

Gabriel Thomas born after injectibles 1/2/11

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oceanview replied on 08-04-2010 10:53 AM

I ran across and interesting blog post yesterday that discusses pPROM and the possible causes/treatments.  THis blogger lost her baby at 19 weeks due to pPROM.  I thought you might want to read it:

http://ourbabyh.blogspot.com/2010/08/dr-miracles.html#comments

Keep Calm and Have a Cosmo: adventures with two under two while my husband is deployed

Lilypie Second Birthday tickers Lilypie First Birthday tickers

My daughter was concieved thanks to IVF with ICSI.  She was born at 35w4d due to pPROM.

My son was concieved by *surprise!*, naturally, the month after I weaned my daughter.  He was born at 39w4d after 17P shots and Procardia.  Proof that miracles do happen after the long road of infertility and losses.

Angel Kate's twin - 10w1d - 2009 ~*~*~*~*~*~ Angel Missed Miscarriage - 10w4d - 2007

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Sadin2009 replied on 08-04-2010 1:52 PM

A friend of mine had PPROM her last pregnancy (was leaking amniotic fluid and didn't know it) and lost the baby at I think 20 weeks. This time she said her cervix started opening at around 20 weeks. She got a cerclage put in and is on total, strict bed rest for the rest of her pregnancy.

ETA: She also gets weekly intramuscular progesterone-in-oil injections in the hopes that they will prevent preterm labor. She gets tested regularly for bacterial cultures and watched for infections, since the doctors aren't sure why it happened last time--did she get an infection that caused the PPROM, or did the PPROM cause the infection? (Her baby was healthy but the pregnancy had to be terminated due to the dangerous, very potentially fatal risk of infection to mother.)

32 years old, EDD 01/12/11; first pregnancy ended in miscarriage at 6 weeks 5 days (subchorionic hematoma); Hashimoto's thyroiditis

Thyroid--175 mcg Synthroid daily

Homozygous for MTHFR mutation--2 copies of C677T, heterozygous for PAI-1 (4g/5g). Had to stop Lovenox injections at 5 weeks gestation due to intrauterine bleed, which thankfully cleared after 2 weeks strict bed rest; switched to daily low-dose (baby) aspirin, prescription prenatal vitamin (PreNate Elite), 2 tabs of generic of Folgard and 3 tablets of 800mcg folic acid (generic drugstore brand)

Acupuncture once a week for 3 months seems to have helped with luteal phase defect/ problem with corpus luteum

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bluegirl07 replied on 08-04-2010 2:02 PM

Thank you for your replies.  I found that blog very frightening as the doctor seem to say that all PROM is due to problems with the cervix.  I was really hoping that wasn't my issue.  To me that would mean that it will definitely happen again without intervention.  It is difficult to know what to believe as other things I have read indicate that not all PROM is due to incompetent cervix. 

I had asked about the 17P shots but it didn't seem like they do those in Canada or that it was an option for me, I'll bring it up again.  I think I will probably be able to get my cervix checked later as well if I ask.  Since my water broke at 15 weeks that would probably mean that if I did have an issue with my cervix that it would present itself early, correct?

Do you know if it is even possible to check the cervix at 12 weeks.  When I had my last u/s the technician seemed to think that was way to early to check the cervix.  She said that you really couldn't tell until 18 weeks.  Do you know if that is true?  I would think the peri would recommend it if it weren't possible to do that early.

It is just terrifying to think that this could happen again.  Currently I am just seeing my RE due to the RPL.  I am only 7.5 weeks so there is still a long way to go before I am out of the first trimester.  I am hoping to see the OB and peri at 12 weeks.  I just want to be doing everything I can to prevent this from happening again.

Me (32) & DH (31)

TTC #1 since May 2007

Angel Feb 2008, 11 weeks, misoprostol

Angel Aug 2008, 5 weeks, natural

Angel Jan 2009, 7 weeks, ectopic, laparotomy (lost right tube)

Various tests, 6 cycles of Clomid, 1 IUI, several cancelled IUI due to Nest on the right side and now onto IVF.

IVF #1 -  Feb 2010 transferred 2 embryos - BFP with one

Angel Baby Boy May 6, 2010, 15.5 weeks due to PPROM, Owen Michael, forever in our hearts Sad 

Baby Boy Nathan born March 1, 2011


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Scoutie replied on 08-04-2010 2:48 PM

Bluegirl--I'm obviously not a doctor, but I can't see how the doctor can say that. All cases of PPROM simply cannot be linked to an incompetent cervix. In my case, my cervix was long and closed a full week after my water broke. I was contracting, and it still wasn't opening.  In fact, my PPROM WASN'T caught early because my cervix was long and closed. After my water broke, I went to the OB and then to Labor and Delivery, where I was sent home because my cervix was the appropriate length and still closed.  

 

Maxwell Davis born 2/24/05 after infertility

Riley Elizabeth born 8/11/07 after infertility

Blighted ovum 11/08

Daniel Dwight born too soon at 21 weeks 10/31/09: Always in my heart

Gabriel Thomas born after injectibles 1/2/11

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oceanview replied on 08-04-2010 9:56 PM

I think that particular doctor theorizes that the cervix (because it is a dynamic organ) can go back to "normal" once the water has broken.  And that the funnel that caused the pPROM wouldn't be seen on u/s after the event occurs.  Essentially he thinks that doctors who conclude it wasn't the cervix because it looks long and closed on u/s AFTER the event have no way of really knowing that.

I don't know what to believe either.  I DID have funneling before my pPROM so I am 95% sure that is what caused it.  But I was also in my 3rd trimester.  THis doctor attributes all 2nd trimester pPROM incidents to cervix issues.

Regardless of whether he is correct or not, I do think that cervical monitoring from EARLY is key. 

As for 12 weeks... I have no idea.  My peri started checking my cervix at 16 weeks.  I had an NT scan at 12 weeks but I'm not sure if they made any notes about my cervix at that time.

Keep Calm and Have a Cosmo: adventures with two under two while my husband is deployed

Lilypie Second Birthday tickers Lilypie First Birthday tickers

My daughter was concieved thanks to IVF with ICSI.  She was born at 35w4d due to pPROM.

My son was concieved by *surprise!*, naturally, the month after I weaned my daughter.  He was born at 39w4d after 17P shots and Procardia.  Proof that miracles do happen after the long road of infertility and losses.

Angel Kate's twin - 10w1d - 2009 ~*~*~*~*~*~ Angel Missed Miscarriage - 10w4d - 2007

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Posts 745
MILF replied on 08-04-2010 10:58 PM

I had PPROM with both of my children - 26 weeks with DD, and 22 weeks with DS.  Luckily, they made it; my membranes resealed after a week, in DD's case, and ruptured again at 34 weeks, when they delivered her.  With DS, I leaked nonstop until delivery at 35 weeks and 3 days - they wanted to keep him in there as long as possible, but get him out before anything went wrong, so he was a scheduled c-section.  They had no idea why my membranes ruptured with either of them, at the time.  At DS's birth, we did find out that I had tested positive for GBS at least 2 weeks before; that lab report somehow did NOT make it to my chart until they had to look something up when they were doing the paperwork on the day he was born.  As scary as it was to learn that, I had not tested positive for it before then.

Neither case was caused by an incompetent cervix, in my situation.  We suspect a uterine anomaly (uterus didelphys - 2 uterine cavities) put a lot of pressure on the sacs, causing pressure leaks, but we can't know for sure.  I also had spotting with DS until after PPROM, so we're considering that to be a possible factor.

I'm 12 weeks and 3 days now, and TERRIFIED.  I've had surgery to remove the dividing wall, to create one uterine cavity.  We thought it was pretty close to normal-shape, but it's bicornuate (baby is in the right horn).  I've had very heavy bleeding on a few occasions, so heavy that I was convinced I'd miscarried (clots, a lot of dark red blood etc.), and a lot of spotting.  I'm taking Endometrin suppositories, which I was supposed to have stopped a few weeks ago.  However, when I've tried to wean off of them, the spotting starts again - last time, it was more on the heavy side, with a few large clots.  Once I started the Endometrin again, the spotting went away.

I experience severe cramping with the spotting, so I'll be calling my OB, probably tomorrow, to talk to him about it.  There's no way I'm quitting the progesterone now, since the spotting causes contractions, and IMO, could very well lead to PPROM and/or PTL.  However, I don't know if I should be using suppositories much longer - I've been on total pelvic rest for the entire pregnancy so far, and will be until after it's over, and part of the plan is to avoid pelvic exams etc. as much as possible, so I'm wondering if it's safer to go with the shots.

Other than that, I don't know what to do.  I'll be buying nitrizine paper to have on hand, to be able to check any leaking down there myself if needed.  But I really can't think of what else to do.

Me + DH = 1 girl ~ 5/30/97 @ 34 wks (living w/paternal g.parents) + 1 boy ~ 6/9/04 @ 35+3 wks (severe, low-functioning autism) ~  PPROM w/both babies (#1 @ 26 wks/resealed; #2 @ 22 wks, never resealed)

And finally, after 6 years of fertility surgeries, meds, RPL, TCM, and everything else we could possibly do...

Heart Baby Draven is here!!! Heart

Born January 28th, 2011, 9:00 a.m., @ 37 weeks + 4 days (my first full-term baby!); 6 lbs 4 oz., 18" long, perfect, adorable, and worth every moment and everything that it took to get him here!  Breastfeeding with supplements after multiple breast surgeries!

Feel free to ask me about my history of SIF, RPL, Stage IIII Endometriosis, UD and uterine reconstruction, and repeat PPROM and PTL!Flowers

See fertility history in bio...

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Posts 5,200
Scoutie replied on 08-05-2010 8:59 AM

Oceanview--I undersand that doctor's theory,but with so many of us being told our cervixes are long and closed, I don't understand how to solve the issue. Give every woman a cerclage?  I think there are other factors at play and to say "every" case of PPROM is due to an IC seems preesumptuous. I also agree that cervix checks are important. I do appreicate you sharing the blog, though! :)

Milf I'm sorry you're stressed about this too. Where do you buy the paper you mentioned?

Maxwell Davis born 2/24/05 after infertility

Riley Elizabeth born 8/11/07 after infertility

Blighted ovum 11/08

Daniel Dwight born too soon at 21 weeks 10/31/09: Always in my heart

Gabriel Thomas born after injectibles 1/2/11

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oceanview replied on 08-05-2010 10:34 AM

Yea... I also think it is somewhat presumptuous.

BUt what is MORE presumptuous IMO is that doctors are willing to let things happen 2-3 times before they will make a dx.  That they call things "flukes".  Spotting and infection both seem to pre-date pPROM and so this doctor is wondering what CAUSES that spotting/infection.  For many women it is a short cervix (cervix change causes spotting and can make it easier for bacteria to reach the amniotic sac).

I don't know if a cerclage is a solution for all women.  But what I do know is that NO doctor should let a woman who had pPROM in the 2nd trimester just move through pregnancy without looking for issues.  Cervix checks should be MANDATORY - even if the cervix was "high, long, and closed" after the PROM incident. 

Obviously some women have uterine abnormalities.  Some have placental abruption.  Some have babies that just don't make it and that triggers PTL.  But for women with NO KNOWN CAUSE I do think that he is probably right that the majority are cervix related.  Short cervixes dont' guarantee PTL or pPROM.  As a matter of fact, even with a really short cervix the vast majority of women will carry to term.  So to say "I had a full term pregnancy so I know I don't have IC or cervical weakness" is not accurate either.

Bottom line for me:  ADVOCATE for yourself!  Bring these new studies (even if you are skeptical) and talk to your doctor about them.  Get second opinions.  Don't just let a doctor say your loss was a "fluke".

Keep Calm and Have a Cosmo: adventures with two under two while my husband is deployed

Lilypie Second Birthday tickers Lilypie First Birthday tickers

My daughter was concieved thanks to IVF with ICSI.  She was born at 35w4d due to pPROM.

My son was concieved by *surprise!*, naturally, the month after I weaned my daughter.  He was born at 39w4d after 17P shots and Procardia.  Proof that miracles do happen after the long road of infertility and losses.

Angel Kate's twin - 10w1d - 2009 ~*~*~*~*~*~ Angel Missed Miscarriage - 10w4d - 2007

Top 500 Contributor
Posts 5,200
Scoutie replied on 08-05-2010 12:08 PM

I completely agree, Oceanview. "Fluke" is not a good enough answer as to why my baby died.  Advocating is definitely important. I was sent home TWICE after telling my OB and Labor and Delivery that I was leaking fluid.

Maxwell Davis born 2/24/05 after infertility

Riley Elizabeth born 8/11/07 after infertility

Blighted ovum 11/08

Daniel Dwight born too soon at 21 weeks 10/31/09: Always in my heart

Gabriel Thomas born after injectibles 1/2/11

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Posts 745
MILF replied on 08-05-2010 6:52 PM

I buy the nitrizine paper at the local health food store; some drugstores have it as well, but I went insane trying to find it during my pregnancy with DS, and none had it.  I only found it by chance, when I wasn't pg.  The kind I get is just called pH paper, I think; it's in a flat plastic container, small and rounded, and it's a roll - you just tear off a strip in the length that you need, like they do at the hospital.

As for cervical incompetence, that was NEVER an issue for me - my cervix never started to shorten or dilate until well after my membranes ruptured.  There are so many reasons this can happen, and it's disturbing to think of any doctor attributing it to any one single cause for all women.  Some sacs just have a random thin or weak spot - it happens, not to every woman, but that's just one reason out of so many.  It's irresponsible to ignore all of the possible causes.

Me + DH = 1 girl ~ 5/30/97 @ 34 wks (living w/paternal g.parents) + 1 boy ~ 6/9/04 @ 35+3 wks (severe, low-functioning autism) ~  PPROM w/both babies (#1 @ 26 wks/resealed; #2 @ 22 wks, never resealed)

And finally, after 6 years of fertility surgeries, meds, RPL, TCM, and everything else we could possibly do...

Heart Baby Draven is here!!! Heart

Born January 28th, 2011, 9:00 a.m., @ 37 weeks + 4 days (my first full-term baby!); 6 lbs 4 oz., 18" long, perfect, adorable, and worth every moment and everything that it took to get him here!  Breastfeeding with supplements after multiple breast surgeries!

Feel free to ask me about my history of SIF, RPL, Stage IIII Endometriosis, UD and uterine reconstruction, and repeat PPROM and PTL!Flowers

See fertility history in bio...

Not Ranked
Posts 745
MILF replied on 08-05-2010 9:21 PM

The pH paper I found looks like this:

 

Me + DH = 1 girl ~ 5/30/97 @ 34 wks (living w/paternal g.parents) + 1 boy ~ 6/9/04 @ 35+3 wks (severe, low-functioning autism) ~  PPROM w/both babies (#1 @ 26 wks/resealed; #2 @ 22 wks, never resealed)

And finally, after 6 years of fertility surgeries, meds, RPL, TCM, and everything else we could possibly do...

Heart Baby Draven is here!!! Heart

Born January 28th, 2011, 9:00 a.m., @ 37 weeks + 4 days (my first full-term baby!); 6 lbs 4 oz., 18" long, perfect, adorable, and worth every moment and everything that it took to get him here!  Breastfeeding with supplements after multiple breast surgeries!

Feel free to ask me about my history of SIF, RPL, Stage IIII Endometriosis, UD and uterine reconstruction, and repeat PPROM and PTL!Flowers

See fertility history in bio...

Top 50 Contributor
Posts 8,850
ThreePrinces replied on 08-05-2010 11:12 PM

I have never had PPROM, but my SIL did with her third.  My niece was born at 34 weeks after he water broke.  For her fourth pregnancy, she did the 17P shots and made it all the way to 39 weeks, when she delivered a perfectly healthy full term baby girl.

TTC (this time) since February 2008.  Long history of Secondary Infertility.

June 13, 2011:  BFP on 12dpo!  Due exactly 4 years after I began TTC.

chart:  http://www.fertilityfriend.com/home/16c283

Being defeated is often a temporary condition. Giving up is permanent.


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Posts 5,200
Scoutie replied on 08-08-2010 11:11 AM

Milf Thanks for the info on the paper!

I also wanted to add that I took my first P17  (17P?) shot yesterday. It was super easy and relieved some cramping that I'd been having.

Maxwell Davis born 2/24/05 after infertility

Riley Elizabeth born 8/11/07 after infertility

Blighted ovum 11/08

Daniel Dwight born too soon at 21 weeks 10/31/09: Always in my heart

Gabriel Thomas born after injectibles 1/2/11

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