Hospital Day 10 – 25 weeks and 2 days pregnant
I wanted to address a few questions that have been asked by friends and family. I gave a short overview in a previous post and some of this information may be repetitive, but I wanted to give a little more detail to help people understand what’s happening a little better.
Why are you in the hospital? When can you go home?
I have been diagnosed with Preterm Premature Rupture of Membranes, meaning the amniotic sac surrounding the baby ruptured, or in other words my water broke. This happened when I was 13 weeks pregnant. Standard procedures were followed once the rupture was confirmed. This included weekly doctor visits with ultrasounds, self monitoring for any signs of labor or infection, and minimal restrictions on activity levels (no heavy lifting, etc).
I was admitted to the hospital once I reached 24 weeks gestation. This is the point where the baby is considered viable, and this is standard practice in the U.S. and many other countries when someone has a prolonged rupture (their water has broken but they haven’t gone into labor). I will not be able to go home until after the baby is born, and I will explain why below.
How are you being treated?
I spent the first two days here on IV antibiotics plus an oral antibiotic, followed by a week of another oral antibiotic. This is to prevent an infection called chorioamnionitis, which I will discuss more below. I also had two rounds of an antenatal corticosteroid injection called betamethasone which was given to promote fetal lung development.
I spent two days on constant monitoring of fetal heart rate, and because everything looked good I was taken down to twice daily monitoring. The fetal heart rate can indicate developmental maturity, and it can also be an indicator when something is wrong. If the heart rate is too high, it can be one of the first signs of infection. If there are frequent decelerations in heart rate, it can show a problem with umbilical cord compression. I also have my vitals taken several times per shift and all other symptoms tracked in order to monitor for potential complications.
What happens next?
There are a few things that are possible. I’ll talk briefly about the three that are most likely. It’s possible that any one of these may occur individually, or that more than one of the below could occur simultaneously.
Possibility #1 – Chorioamnionitis:
While I have completed antibiotics in order to prevent a chorioamnionitis infection, it is still very likely that I may develop this infection. It is an infection of the uterus, which I am very prone to with a broken bag of waters. Some studies suggest that as many as 70% of women with prolonged rupture of membranes may have complications from this infection. It can cause complications including maternal sepsis, which is sometimes referred to as blood poisoning and can be fatal if not treated immediately and aggressively. Chorioamnionitis is also associated with fetal complications including sepsis, chronic lung disease, and brain injury leading to cerebral palsy. The only way to treat chorioamnionitis includes delivering the baby immediately.
Symptoms of the infection include fever, abdominal tenderness or cramping, foul smelling discharge, or elevated fetal heart rate.
When it is time to deliver, I will most likely be having a c-section for several reason. We are hopeful that Dan will be able to get here quickly enough to be in the room, and that I will be able to have an epidural or spinal so that I can be awake for the surgery in this scenario.
Possibility #2 – Placental Abruption
A placental abruption is when the placenta begins to detach from the wall of the uterus prior to birth. This could compromise blood flow to the baby and cause fetal distress or even death. While many women experience some degree of placental abruption, any abruption after rupture of membranes is considered more serious. If an abruption is suspected I would need to deliver the baby.
Symptoms of placental abruption include vaginal bleeding, cramping or abdominal tenderness.
Again, when it comes time to deliver I will most likely have a c-section and will hopefully have enough time for Dan to arrive at the hospital, and to have an epidural or spinal so that I can be awake for the surgery.
Possibility #3 – Labor
It is very possible I could go into labor at any time. My water broke 12 weeks ago. The vast majority of women go into labor within one week of their water breaking, and my doctor has never seen anyone go more than 10 weeks before me. I am already a statistical time bomb.
You know those grueling 72 hour labor stories? That’s not going to be me. With a labor this premature and a baby this small (1 pound 6 ounces at last estimate) labor would be expected to go quickly. The baby is also breech which makes things more complicated. If I were to dilate just a few centimeters the baby could start to slip out foot first and become stuck part way out, or the umbilical cord could prolapse cutting off oxygen supply to the baby and stopping his heart. Once labor starts, doctors may only have minutes to act.
The urgency of this possibility is the primary reason I cannot go home until after the baby is born. If I went into labor I would not have time to make it from my house back to the hospital. The sense of urgency is so great that I need to keep an IV in my arm at all times, even though I’m not currently using it. In this scenario, we wouldn’t have time to have someone put in a new IV. We might not even have time for a spinal or epidural. If I go into labor I could be given general anesthesia and could easily be in and out of surgery before Dan could even get to the hospital.
So what will happen with the baby?
We don’t have the answer to this, and we will not have an answer until after he is born.
I am very hopeful, but I do want to be honest and realistic with everyone. The odds are not in our favor.
In order for a baby’s lungs to develop, they need amniotic fluid. They “breathe” the fluid in the womb. I have had no measurable fluid on any ultrasound since my water broke. This puts the baby at an extremely high risk for lungs so severely under-develped that he would not be able to survive outside the womb.
Lungs cannot be seen on an ultrasound because they do not inflate until after birth. This means there is no way for us to measure the level of lung development prior to birth.
Statistic vary by study because there are so many different variables involved for women with PPROM (gestational age at rupture, cause of rupture, amount of measurable fluid, etc). I cannot provide an exact number, but let’s just say that our odds are so poor that we had been advised to terminate the pregnancy. We opted to continue with the pregnancy because we believe that any chance is worth fighting for. I’ve met other women in an online support group that overcame similarly terrible circumstances and have heathy babies at home now. Miracles do happen, and that is what we are praying for.
Aside from lung development, what are the other concerns for the baby?
That depends on how early he comes. The more premature, the more potential issues we may face. Lungs are obviously our primary concern, but if there is enough lung tissue for survival we will be likely to face other complications associated with prematurity. Some of the more common and more serious concerns are related to heart and brain development and can require surgery and are potentially fatal. There are other minor concerns such as cerebral palsy and limb contractures as well.
My doctors have already been working with the neonatal team prepping them for the complications we may face after the baby is born. In addition to my doctors and nurses, there will be NICU doctors and nurses on hand in the delivery room mobilized for immediate action. We have an amazing medical team here. I am impressed by the level of teamwork and communication that occurs between my OB, maternal fetal medicine, the nursing staff, and the neonatology team.
Please let me know if there are any questions I have not answered. I want our friends and families to be as confident as we are that we are receiving the best medical care possible.
I want to take a moment to publicly thank my husband. He has been so supportive of my choices. He is an amazing listener. He takes such good care of me and both of our sons. He has been doing the work of two people around the house for weeks, allowing me time to rest as much as possible. I know now, more strongly than ever, that I could not have married a better man. I love you Dan.
I also want to thank everyone that has been cheering us on, praying for us, and sending their support during a very stressful time in our lives. We could not do this without you.