Pregnancy Loss: PPROM Awareness

July 30, 2017

By Sanda Rathamone

We never learned of what had caused Elijah's stillbirth and early water breakage at 20 weeks. Doctors stated on my discharge papers that what had happened was a Preterm Premature Rupture of Membranes (pPROM). What a mouthful of fancy words to say, "My water broke and I'm not even close to my due date!" Yet, what is pPROM exactly and why does this happen?

I decided to dig a little deeper and further discuss pPROM to spread an awareness of this "rare term and occurrence." (I put those words in quotation marks because after reading an astounding amount of web comments about other pPROM experiences, I had realized that "rare" is still a very large and ongoing number.) 

Before we jump in, there are two terms that I would like to clarify. PROM and pPROM. 

PROM: Premature Rupture of Membranes 

This is actually the more common rupture at 37 weeks or later in pregnancy. In this case, it is easier to manage because of the timing in pregnancy and baby has a higher chance of survival. (Some may consider 37 weeks to be full term.) PROM is onset to labor, meaning it happens before signs of labor. Though survival rates my vary, depending on other factors.

pPROM: Preterm Premature Rupture of Membranes

This is the more rare and complicated occurrence that happens before 37 weeks. In many cases, pPROM is the cause of perinatal death because this rupture happens at a stage in pregnancy where development is crucial and vulnerable. pPROM is also an onset to labor. Survival rates increases at 24 weeks or later, but depends on the amount of fluid loss, medication, infection, and other known or unknown factors. It is less likely that the chances of a baby under 24 weeks will survive. 

Both PROM and pPROM are "ruptures," meaning that the amniotic sac has a breakage, which causes amniotic fluid loss or the breaking of waters. They are both ruptures that are onset to labor, which will most likely need induction to speed up labor (if necessary). 

Notice that a rupture does not happen in the same way as a "normal" water breakage. A rupture is a tear of the sac and not a loss of mucus plug, that causes water leakage. 

Below, I have written a brief introduction to pPROM. Some information are based on my experience.
  • What causes pPROM? 
Many doctors and perinatal specialists do not know the direct causes of pPROM, but have stated that chorioamnionitis (bacterial infections in fetal membranes from vaginal or uterine infections), having twins or multiples, having had a cesarean-section prior to present pregnancy, incompetent cervix, STDs, or heavy smoking has been or could be linked with pPROM. 

However, pPROM can also happen spontaneously, without cause. 
  • What are the signs of pPROM? 
Main signs are water leakage, can be a trickle every now and then or a gush of fluid. Fluid may be clear or have discharge or accompany with bleeding.
  • What happens during pPROM?
When this rupture happens, both the mother and baby are susceptible and vulnerable to infections. Amniotic fluid is protection for both mother and baby from infections and when there is a leak, bacterias can easily enter the vagina and travel into the uterus. If there are large amounts of fluid leak, this can cause the mother to become ill or contract high fever. Baby may have increase in heart rate due to low fluid and underdeveloped lungs.

Doctors will or may perform ultrasound scan to check for fluid, swab vaginal membranes, and blood tests to check for any infections.
  • How is pPROM treated?
If large amounts of fluid loss, doctors suggest hospitalization and may also encourage induction, antibiotics, and delivery. If less amounts, doctors may send home with medication to stop leakage/early labor. However, treatment is based upon patient's needs and special circumstances.

  • Is there a way to prevent pPROM?
If there is known causes of pPROM, there are ways for prevention, but may or may not be successful depending on patient's case. Unfortunately, there are still many unknown factors of pPROM leading to less preventative measures, other than to seek care from high risk pregnancy specialists/experts and perinatologists.

Elijah and PPROM

If you have not yet read my loss story, let me reintroduce a little bit about what had happened.

My pregnancy showed normal at every scan and test (sonogram, ultrasound, nuchal translucency, blood tests, STD, pap smear). There were no complications or any signs of infections or malfunctions. We did not expect or suspect anything to go wrong. My last scan at exactly 20 weeks was perfect, until the next day of.

My husband and I was having an intimate moment when a large gush of fluid came flooding out from me. (My doctor had to repeatedly say that sex is NOT a cause of pPROM.) The fluid was uncontrollable and took awhile to stop. Minutes after the water breakage, there was blood present. Though the water stopped, the bleeding increased overtime and continued to flow (light to medium). I was told that after wiping, not to throw away any tissues so that nurses and doctors could keep track of this bleeding. It was not known whether or not this bleeding was from the placenta or uterus.

After a couple scans, doctors could not see any fluid surrounding baby. I had lost a large amount of fluid and it was unlikely that at 20 weeks, baby could survive without amniotic fluid. My doctors performed a swab test and started antibiotics (through I.V.) in case of infection. Overtime, baby's heart rate had increased to a high 180. I later had a small fever and started premature labor pains, which led to an induction for vaginal delivery.

During labor, contractions were present and before delivery, the placenta made a breech before baby. The placenta also had to be induced. Survival rates for my 20 week son was too low and he died after delivery. It was not clear to me whether or not he was breathing after birth, but was less likely because of his small size during this traumatic birth. However, he did have a heartbeat up until then.

To find out the cause and of my rupture, doctors began a blood test of three cultures. However, these cultures took a few days to incubate/perform. Doctors found a positive blood culture or infection present in one out-of-three blood cultures that under the microscope, looked very similar to meningitis (an infectious/viral bacteria). Doctors took the preventative measure to place me in insolation and even gave my husband a pill (in case of infection) until things were certain. Fortunately, I showed no signs or symptoms of meningitis, which called for a longer wait.

The positive blood culture turns out to be a form of a rare Neisseria bacteria (my doctors have never even heard of it), but not meningitis (which is part of the Neisseria family). It was also very clear that I did not have meningitis. Additionally, this rare bacteria did not seem to be harmless. YET, I was on antibiotics and it was not clear if I had contracted this before or after the rupture. OR, if it was just a contamination because it was present in only one blood culture. One of my doctors suggested that perhaps the sac just might have been weak and was on the verge of breaking, but still not a definitive cause.

My diagnosis was pPROM, Stillbirth, Positive Blood Culture, and Chorioamniontis. However, doctors are still uncertain of the cause of my early rupture. I was discharged after six days of medical care, with medication for the next week: cefuroxime (antibiotic for positive blood culture and in case I was really infected), HYDROcodone and ibuprofen for vaginal delivery.

This was also my first pregnancy and I am a relatively healthy female.

More about pPROM:
* Read the full story about Elijah:

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