By Barbara Woodworth, Seattle, WA USAI have twin boys, survivors of a PPROM pregnancy. I had a difficult pregnancy from the start. I had an ultrasound around seven weeks that showed three heartbeats. We expected to have twins, since they run in my family and we had done IUI plus Follistim. But we were shocked when we found out it was triplets! We were just starting to get used to the idea when I started bleeding bright red blood at nine weeks. I was out of town at the time, visiting my family for Christmas. I was able to get in to see an OBGYN. He said I had a subchorionic hematoma on Baby C's placenta. He said there was about a 50-50 chance of losing one or all of the babies. I actually felt a little reassured by this, and went home to rest.
PROM at 25 weeks + 3 days. Delivery at 29 weeks + 5 days.
Story added: 2008-03-11
That night I bled like you would not believe-soaking through a huge maxi pad every half hour. I was terrified. We were scheduled to fly back to Seattle that weekend. I was already scheduled to see a perinatalogist right after the new year because of the triplet gestation. The bleeding had begun to ebb, fortunately, and we headed back home on a plane. The whole time I was extremely anxious, but somehow knew I was still pregnant. I just wasn't sure how many of the babies had survived.
I went to see the peri for my first appointment. Unfortunately, the ultrasound showed Baby C was demised. I had suspected as much. I was sad but hopeful for the other babies. I was ordered home on bedrest. There was a huge mass of blood still in my uterus around the demised triplet. The peri said it could threaten the other two babies. So bedrest it was!
After a few weeks, they said I could return to work part time because the blood clot was shrinking. I continued to bleed, but the blood was brown-old blood. On the night of February 13th, I started bleeding bright red again. I was so scared. I had an appointment with the peri the next day. The ultrasound showed that now Baby A had a subchorionic bleed. Even worse, Baby A's AFI was only three. I was only 15 weeks.
The peri was grim. He said the chances for survival of both babies or even one was not very good. He said Baby A's lungs might not develop if the AFI did not increase. However, it did not look like my membranes had ruptured. He thought it was related to the placental issue. He said there was some hope IF Baby A's AFI went up- 50/50 again-and I went back home on bedrest.
I drank more water than I have ever drunk in my life-over a gallon a day that whole week. The bleeding subsided and I went back to the peri the following week for another ultrasound. Baby A's AFI was up to six! We were so happy. The peri was guardedly optimistic.
Over the next few weeks the AFI gradually went back to higher levels. However, my ultrasound had showed some anomalies-pylectesis and echogenic bowel-that made me want to get an amnio. I would not have terminated based on the results, but I was so anxious I needed peace of mind. At 19 weeks Baby A's AFI was back to normal levels (AFI=11) so the peri said they would do an amnio. Keep in mind that this practice had a 1 in 4000 chance of miscarriage from amnio-very low. I couldn't get the immediate results (FISH test) because of all the blood in the babies amniotic fluid. So we had to wait two weeks.
By this time I was back at work. But three days after the amnio, I started bleeding bright red. Luckily I was at the hospital where I work which is also my delivery hospital. I went to L&D triage. They said there was nothing they could do-they didn't even do an ultrasound! They sent me home on bedrest again and said I should follow up with my peri the next day. The ultrasound the next day showed more bleeding on Baby A's placenta-and the AFI was down again. I went home on bedrest and waited anxiously for the results of my amnio, drinking gallons and gallons of water.
Let me pause here and say a couple things: in retrospect, I would not have gotten the amnio. I think it put me at higher risk. In fact, my peris said later that there might have been a tiny leak after the amnio. I had a little fluid discharge, but I had brown bleeding all the time so I just thought it was the clot dissolving.
Baby A's AFI wnet up and dwon over the next week, usually hovering in the six to nine range. Baby B maintained normal levels for the most part. The bleeding started subsiding, and they said I could go back to work part time again. Things were fairly stable until April 24th, my husband's birthday. I woke up in the morning and went to the bathroom, and felt a fairly large gush come out. Keep in mind I often had brown fluid coming out because of the clot, but this did seem like slightly more than usual.
The next two days I noticed more fluid than usual leaking out. I started to get concerned. Luckily, I was scheduled for a peri appointment on April 26th. The ultrasound showed NO fluid around Baby A. The peri said it was likely PPROM. She did a test on some of the fluid that had leaked out (but did not do a pelvic) and it was definitely amniotic fluid. I was immediately admitted to the Antepartum ward of my hospital. I was 25 weeks, 5 days.
They put me on IV antibiotics immediately and gave me a course of steroid shots. I had twice weekly ultrasound and fetal heartbeat monitoring three times a day. My hospital room was quite nice and I had lots of visitors. I made friends with other women on the floor. It was actually not bad! The worst part was worrying-what is going to happen to the babies-particularly Baby A? I knew having them at 25 weeks was very early. My peri said she thought I could keep them in until at least 28 weeks. She said that was the first goal, but every day I kept them in was to their benefit. The plan was get me as far as possible. If I made it to 34 weeks, they would induce.
I researched PPROM obsessively on the internet (that's how I found this site, of course) and went back and forth between feeling very hopeful to very discouraged. However, the doctors and nurses all were very encouraging. They kept reminding me the longer they stay in the better. My ultrasound never showed an AFI for Baby A greater than two.
On May 23rd, I had some light pink spotting. That night I was watching the season finale of "Lost" in my hospital room when I got a terrible backache. I took Tylenol and used a heating pad but it didn't get better. The nurse put me on the monitor, but there were no significant contractions. I went to bed, and woke up at 3 AM on the morning of May 24th with severe chills. The nurse took my temp and it was 102. They put me on the monitor and I was having regular contractions. I had an infection, and it was time to have the babies! I was 29 weeks, 5 days. (This is by my dates which I based on the ultrasound. The peris used last menstrual period, which only put me at 29 weeks, 2 days. However, they went by ultrasound dates when the boys were in the NICU, so go figure!)
They wheeled me to L&D after I called my husband at home. I was on IV antibiotics through the whole labor. I was also delirious with my fever (it got up to 104) and everything felt like a dream. At 6 AM, I got an epidural-then I was really out of it! Even though I was getting Pitocin, I wasn't progressing very well. At 12 PM the peri on duty came into my room. I was 3 cm dilated. She said that since I was infected she wanted to do a C- section if I wasn't at 10 cm by 1 PM. I was fine with that.
At 1 PM she came to check me and I was at 10 cm! They wheeled my to the OR- twins are always born in the OR, even if vaginal, because they might need to do an emergency Ceasarean. There were 25 people in the OR-nurses, techs, the two peris, the two NICU teams-it was crazy! I only had to push for about 20 minutes. Baby A came out with Apgars of 1, 5, 8. Baby B was a breech extraction-they pulled him out by his feet. His Apgars were 6, 8. Baby A was immediately intubated. They showed him to me briefly and then whisked him away to the NICU. Baby B was put on C- pap, showed to me briefly and whisked to the NICU as well. We named Baby A Truman Alexander, and named Baby B Spencer Aaron. Truman was 3 lbs. 8 ozs. and Spencer was 3 lbs. 9 ozs.- great weights for 29 weekers!
I was in the hospital for exactly 28 days before delivering. I went home two days after delivery. Truman got off the vent after a few days, but developed a pneumothorax. He had to have chest tube for a couple of days. When that healed, he was on C-pap, and then oxygen. His lungs were definitely compromised from the low fluid. He was on oxygen the whole NICU stay, and went home on oxygen. He was discharged from the oxygen after a month home. He also struggled with Group B strep infection which landed him back in the NICU after several weeks on the step down unit, and even had necrotizing enterocolitis (at 37 weeks adjusted gestational age) which was treated medically, not surgically, thank God!
Spencer's lungs were better, because he had normal fluid. He was vented for a day and on C-pap for a day, then didn't need any more help with breathing. He had a staph infection which landed him back in the NICU after several weeks in the step-down unit. Spencer went home on his due date, August 4th. Truman went home a week and a half later, on August 15th. They were in the step-down unit for most of their stay.
Today they are happy, healthy boys! I want everyone to know that there is hope after PPROM. Everybody's situation is different, but be aware that there are good outcomes-my boys are living proof.