All about Preterm Premature Rupture of Membranes
Glenda wrote this week about her granddaughter. At 27 weeks pregnant, she sprung a small leak, had contractions and went to the hospital. The hospital staff confirmed that she was trickling a small amount of amniotic fluid. They also told her that the amniotic membranes might seal back up and with pelvic rest (no sex, tampons or sticking anything else anywhere near the cervix), everything might be all right. Glenda had never heard that amniotic membranes could leak then repair themselves and wonders if this is accurate information. She's mighty worried about her granddaughter. I'll bet. I would be too. This is a scary, yet not all that uncommon situation.
Yep, it's true—sometimes membranes rupture then seal back up; especially if it's a very small tear or hole and up high in the uterus (called a high leak). This is called preterm, premature rupture of membranes. According to an article presented in the American Family Physician journal in February 2006, "Preterm premature rupture of membranes (PPROM) before 37 weeks' gestation occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries."
Now, I know that sounds really scary but wait, there's more and it's a little more reassuring. I'm going to cut to the chase here, Glenda. PPROM only leads to 1-2% risk of fetal death. I know that's what Glenda and her granddaughter are really worried about—is this baby going to die? The answer: Probably not. 98 to 99% of the time these babies don't die in the uterus. It might mean, however, that her baby is going to be born prematurely.
Glenda didn't tell me many specifics except the hospital staff told her granddaughter to take it easy and don't have sex. That makes me think they monitored her a while, probably did some ultrasounds to make sure there was amniotic fluid in the uterus; determined that the baby was safe, she wasn't leaking any more fluid or at risk for delivery (no contractions or cervical dilation) and then sent her home. She most likely got two shots (24 hours apart) of corticosteroids (called betamethasone or Celestone), to bump up the baby's respiratory maturity. She may have also gotten antibiotics to prevent infection.
It doesn't sound like her baby's going to be born this week. So, how about next week? A 28-week baby has a better chance of survival than a 27-weeker. Every week he/she develops in the uterus improves his/her chances for a normal, healthy infancy. If she gets as far as 34 or 35 weeks, there's very little to worry about. Most of these babies do fine. Sometimes they need a little extra help in the special-care nursery but most are self-sufficient little squirts all on their own.
What will happen if the baby is born too soon? He/she'll go to the neonatal intensive care unit (NICU) where miracles happen every day. It used to be that babies born at 27 weeks didn't stand a chance. Not so anymore. New technologies, better respiratory ventilators and all around superior care (not to mention the rockin' nurses) mean these babies can survive and thrive. They have some serious challenges ahead of them but it's amazing what they can do these days. Babies are incredibly resilient and thrive in challenging yet nurturing environments. NICU doctors, nurses and technicians are all about saving the babies. They're absolute heroes; dedicated, up-to-date and technically skilled with hearts of gold. They're just who you want on your side when your baby's born too soon.
Let's look at the worst-case scenario. What if Glenda's granddaughter's baby can't survive? What if he/she's born unable to breathe, with a seriously compromised immune system, cardiac problems or other issues that mean this baby will die? The health care team will be honest, direct and kind. They'll do all they can without doing too much—meaning forcing a baby who's not meant to live to undergo painful and futile procedures. I hate to say they have experience dealing with end of life at the beginning of life, but they do. They've been there and they'll take care of the baby, parents and family as kindly as possible. And then you'll grieve. Like I said before though, that's not likely to happen. The greater likelihood is survival. Much greater.
So, what if she starts leaking more fluid or has contractions? She needs to go to a hospital with a heavy-duty NICU ASAP. As long as she doesn't have any signs of infection or fetal distress, she's likely to be loaded up with labor-prevention medications like magnesium sulfate, maybe more antibiotics and whatever other medications the situation calls for. An obstetrician and a perinatologist, both of whom specialize in high-risk pregnancies, will manage her pregnancy. This isn't traditionally a job for a family practice doctor or a midwife.
Why do some women have premature rupture of membranes? A lot of the time, we don't know. Sometimes, it's caused by the group beta strep bacteria that almost all women are screened for at around 35 weeks gestation. Sometimes other bacteria or viruses infect the uterus or cervix and weaken the amniotic membranes. Smokers, women with sexually transmitted diseases and those who've had previous preterm deliveries or poor prenatal care are at higher risk too. Once again, the healthier you are before and during your pregnancy, the fewer risks you're likely to have. Sometimes though, stuff happens to healthy women and we don't know why.
Glenda, I'm thinking about you and your family and hoping everything turns out fine. I know you're worried and I would be too. Please let the take-home message be this though: Honey, it's more than likely going to be just fine; different than you expected and a whole lot of trouble, but just fine. Ultimately, isn't that the way it is with children? They're different than you expected and a whole lot of trouble but oh so fine. Give your granddaughter and soon-to-be great grandbaby a hug for me.
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