***Warning*** If you have just experienced pPROM, or are currently on bed rest from pPROM I suggest you not read the blog entry below, unless you can pull yourself far enough out of the equation that it does not diminish your hopes. If you are like me and can do this, information is helpful (even when it is grim).
pPROM, or premature rupture of the membranes, is largely looked at as a rare occurrence. When pregnant you are told your chances of miscarriage before the 12th weeks of gestation are range from 75% – 5% based on the gestational week (see chart below). Once you surpass the 12 week mark your chances of miscarriage drop significantly to less than 3%.6 Most women know this fact, or are made aware of it at the time of pregnancy. This is why many women wait until after 12 weeks to announce their new bundle of joy on the way.
My question is, why are we never made aware of pPROM? Until it happened to me, I didn’t know it existed. After speaking with other women, a mix of those who have themselves experienced pPROM and those who have not, the general consensus is that they were unaware of its occurrence as well. I conducted a poll, in which 67 women responded. Of those 67 women, approximately 88% were unaware you could even have your water break before a term delivery. Of those who were aware, many worked in the medical profession.
After my loss, I joined a group of over 500 women who have experienced pPROM, and subsequently lost their child/ren. This got the old scientifically trained brain wondering. Just how many women are affected by this? So, I did what I love to do. I researched the topic. Below you can read my findings. Before I start in though, I want to stress that I am NOT a doctor, nor am a professional in any field related to pPROM. This is purely my own small sample of research.
First I decided to research miscarriage. Of women who find out that they are pregnant, usually around 4-6 weeks pregnant, 12 % will end in a miscarriage. This equals out to be somewhere in the range of 1 out of 8 pregnancies in the US. This percentage, unfortunately, is much higher in those who do not ever find out that they are pregnant. Usually those pregnancies are chalked up to a late period.6
So, what about pPROM? pPROM occurs somewhere in the range of 3-5% of pregnancies in the US and accounts for around 25-40% of all preterm deliveries.3,1 More than 140,000 pregnancies annually are complicated by pPROM and is the primary contributor to perinatal morbidity and mortality.1 It is a sad fact that even with immediate assistance at a hospital, those women who are in their 2nd trimester have between a 50-60% chance that they will go on to deliver their baby (usually before the gestational age of viability) within 1 week of rupture.4 With my twins, I beat the odds, and went on to have 7 weeks of bed rest before a c-section was scheduled due to a suspected infection (which turned out to be nothing and I could have carried them longer).
When I questioned many doctors about pPROM and management, many times I was given different answers. There was no general consensus. Even asking on my support group, women were given much different answers by each doctor. Why is this?
I found a study conducted that surveyed 508 different MFM (Maternal Fetal Management) providers that represented all 50 states and covered 13 countries. Of those 508 providers, only 30% reported that they had a formal departmental protocol for management of those women who experience pPROM. This seems unacceptable to me. Quick decisions are what could possibly save the life of these tiny babies still trying desperately to grow! The most commonly used protocols were steroids (99.4%) and antibiotics (99.6%). Both of which I was immediately put on in the hospital when I ruptured. After the initial dose of steroid shots, repeated dosing was uncommon at only 16%. This is due to research that confirms multiple dosing shows no significant advantage in lung development.7
So, why did I put this out there? I want to raise awareness. If you have experienced pPROM, do your research and make sure you are getting the best possible treatment. Take your management plan into your own hands; ask questions, why are you choosing not to do this or that? I did.
Likelihood of miscarriage by Gestational age2
1-2 (before missed period) : 75% – This includes fertilized eggs that never implanted
3-6 : 10%
6-12 : 5%
2nd trimester : 3%
3rd Trimester – This is no longer considered a miscarriage, but a still birth (usually beyond 1 lb and 24 weeks of gestational age)
- Aagaard-Tillery, Kjersti M. MD., PhD., Nuthalapaty, Francis S. MD., et al. “Preterm Premature Rupture of Membranes: Perspectives Surrounding Controversies in Management.” American Journal of Perinatology 22.6 (2005) 287-297 Print.
- Roy, Deanna. “Statistics.” Facts about Miscarriage. N.p., n.d. Web. 22 Feb. 2013.
- Tavassoli, Fatemeh, Ghasemi, Marzieh, Mohamadzade, Ashraf, and Sharifian, Jamileh. “Survey of Pregnancy Outcome in Preterm Premature Rupture of Membranes with Amniotic Fluid Index <5 and >5.” OMJ 25 (2010) 118-123 Print.
- Mercer, Brian MD “Preterm Premature Rupture of Membranes [High-Risk Pregnancy Series: An Expert’s View].” Obstetrics & Gynecology 101.1 (2003) 178-193 Print.
- Mercer, Brian MD, Goldenberg, Robert L. MD, Moawad, Atef H. MD et al. “The Preterm Prediction Study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome.” American Journal of Obs. and Gyn 181.5 part 1 (1999) 1216-1221 Print.
- “Miscarriage.” NHS Choices. NHS, 5 Oct. 2011. Web. 22 Feb. 2013.
- Ramsey, Patrick S. MD, Nuthalapaty, Francis S. MD, Lu, George MD et al. “Contemporary management of preterm premature rupture of membrances (PPROM): A survey of maternal –fetal medicine providers.” Journal of Obs. and Gyn 191.4 (2004) 1497-1502 Print.