by Krystal Roark
Originally featured on Mommy of Twin Angels
***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)
9/3/2014 11:31:00 am
I am sorry you were one of the many people who has been impacted by pProm. It is a devastating and frustrating pregnancy complication. We offer support and assitance to families going through pProm, from a Regimen and Perinatal/Neonatal Plan moms can follow to help them advocate for their care to One to One Support through the pregnancy, NICU stay and beyond. We have a Registry moms can join to help better understand success rates and what contributes to a successful outcome.
12/5/2019 11:41:35 am
I would love this information
9/7/2020 12:42:09 pm
I would love this information too. I just experienced pPROM and sadly lost our twin boys born prematurely at 24w, 2 days this past July. They only lived a couple hours. I’m terrified of a future twin pregnancy and that we’ll never have more children. Please help.
12/11/2020 04:18:14 pm
I would love this information currently pregnant after prrom and don’t know what to do .
12/24/2020 06:01:28 pm
I would very much like to receive any information you have on pPROM and statistics. My wife's water broke at 21 weeks and has been in the hospital since 22.4 weeks. She is currently 24.4 and they gave her antibiotics and a round of betamethasone for lung development. I have been researching pPROM because I have never even heard of this until it happened to my wife.
4/3/2019 05:35:30 am
I recently experienced PPROM at 23 weeks and unfortunately, my daughter did not survive past 3 days in the NICU. My husband and I would like to get pregnant again in the future, but I am terrified by the fact that you are more likely to have PPROM again in the future if it has already happened to you. Do you have any information on the rate of women who experience this again in their next pregnancy?
8/25/2019 02:24:35 pm
12/4/2021 06:01:52 am
I just suffered my second pprom at 20 weeks. I've had four specialists work on me and none of them really knew what they were doing. The exact same time frame as before and not one of them was ready with a plan. I'm terrified of going through this again
12/22/2019 05:34:45 pm
I currently am 23 weeks pregnant and 6 days and I am going thru PPROM only difference is I went thru PPROM at 18/19 weeks and it sealed on its own cause they sent me home to miscarry. Now I’m back and fluid was leaking again. I’m now on bed rest and am currently going to be here for idk how long. I’m sorry for your losses and was wondering is there any information about PPROM breaking once healing and then doing it again? Does this make the chances higher or lower I would love to know. I haven’t found anything on the web.. I got fingers crossed 🤞 and I pray every night
1/2/2020 06:13:16 pm
This is totally new to me I never knew a women water can break so early I had 3 full term pregnancies and this is my 4 which I PPRom at 12 weeks am currently in the hospital at 24 weeks and I will stay until baby decides to come out . I had so many negative comments my doctors telling me after my water broke so early the baby would not make it but look at me now 12 weeks later am now 6 months . I been in the hospital for about 5 days now giving me all the proper care just Incase my baby was to be born early . I call this a miracle only God knows the purpose for my baby being here and I can tell you this is so overwhelming I have 3 others one at home but I know I have to do the right thing and stay here for baby to come out healthy .
1/2/2020 06:24:39 pm
I know how u feel I have been here for little over 2 weeks now and I am 25 weeks now. Things are looking bettEr but there is still always that risk ! My inducement date is the 2nd of March so fingers crossed he waits until then. And lez I know how u feel I have another one at home and I’m the worker in the family so stress has got me going crazy in here wondering how I will get thru paying rent for next two months. It’s hard but we have to stay positive 😇 I will pray for you and your baby as well ❤️🙏🙌🏼
1/13/2020 12:03:32 pm
My wife and i are currently going through pprom. Her water broke at 17 weeks. We were told that the baby was dying so we set an appointment the next morning to induce and terminate. We did an ultrasound that morning and the baby had turned around and had a strong heart beat. We did not want to kill our baby and put it in Gods hands. Instead we went to Phoenix and they did some tests and told us to come back in three weeks and to monitor temp and discharge and so forth. Our baby is still alive and we pray constantly for her survival to viability. We go today for another ultrasound and will each week. In two weeks we go back to Phoenix to see whats next. We are so lost and scared. Hoping for the best but knowing the potential risks makes it so hard. We realize the chances are not good. Still we have hope and pray. I wish we had more information and or support. This is terrifying.
3/15/2020 07:16:33 pm
My waters broke at 20 weeks. I went in for hospital bedrest at 25 weeks with second weekly rotating antibiotics. I delivered at 35+5 weeks to a healthy baby boy who has just turned one. Have hope! Xx
5/3/2020 04:46:57 pm
My water just broke on Monday (6 days ago) when I was 17+6 weeks. I am so scared. This is my fourth child and first son. I have never heard of anything about it and it seems like nobody knows anything, not even the doctors. The doctors make it seem like the end of the world and tell me there’s nothing they can do besides terminate (I’ve been to two different hospitals and one specialist already). It’s almost like they are urging me to kill my baby. I can not stress this enough... I am terrified. I am a single mother of 3 girls under the age of 9. I don’t know what to do. The only thing I know is that I’m not giving up on my child.
Cynthia Leigh Garrett Phillips Wilson
1/2/2021 03:51:44 am
praying for you all
1/17/2021 02:19:22 pm
My wife had PPROM at 16weeks 3 days. This is our first child . she had lower abdominal pressure and that night she lost amniotic fluid we checked in the morning but did not think about PPROM since it’s new experience to us. Then the next day she started bleeding, we rush to the hospital they checked everything and find out that there is little bit amniotic fluid left and find out with infection. Dr.said baby survival chances are very low. Upon next day in ultrasound they found out fluid packs little bit better and infection under control. Dr sent home with antibiotics. We are just confusing if we keep this pregnancy is our child will be healthy when he born ?? I don’t want see him suffer in NiCU or having some disability rest of his life . We are having dr appointment next.
1/31/2021 03:53:23 am
Just came home from the hospital with PPROM. Waters broke at 18w+2 stayed in the hospital for a week with doctors encouraging me to do an induction but I had no bleeding or pain. Eventually I went into eminent delivery and had to be induced immediately.
2/16/2021 04:06:19 am
Hello, this is the first community I have found that has recent posts. I'm so sorry for all of you who are going through this or have experienced a loss. I too have just experienced PPROM, my waters broke at 12 +4 weeks after a small bleed at 8 weeks when I also passed a blood clot. Scans at 8 and 11 weeks were all considered very good, so at first the drs didn't take me seriously when I called concerned. As someone who has worried my entire pregnancy I just went with it and waited until my next scan 4 days later. The inevitable happened when I went - there was no visibility on the screen and my dr looked very worried declaring "there's no amniotic fluid, it's all gone". At 46 yrs this was my last chance at pregnancy, a total fluke but then again my "very rare" pregnancy complication has also been described as a total fluke. I feel very lucky that I had an uncomplicated pregnancy with my son who I delivered at age 39 yrs and I now look back and wonder if I was always at risk of PPROM even then. My dr has confirmed theres no issues with my cervix, clear genetic screening and nothing to suggest baby was abnormal in anyway. He said it would be easy to blame my age, but he has nothing to conclude this was the case.
5/27/2021 10:23:04 pm
Hello, Jemma! You certainly shouldn't blame your age or yourself at all. I am currently recovering after an induced labour at 17 weeks after I ppromed 5 days ago. I am 29 years old and have a perfectly fine pregnancy 3 years ago, giving birth to my daughter. I also had bleeding at 11 weeks where I thought I was losing my child for sure but when I came to the emergency, they told me everything looked OK. Doctors in my country have no experience of keeping a pregnancy last after a woman has ppromed like I did (almost all fluid had gone) and only thing they offered me was termination. No one could navigate or take care of me if I chose otherwise.
6/25/2021 01:51:00 pm
Same with me Sara. When I first got their a doctor gave me a script for an abortion pill and told me there’s no hope unless there’s divine intervention. They literally did nothing for me except keep track of my vitals. But I didn’t want to complain because what can they do if they know no better.
2/13/2021 09:35:55 am
Currently going through PPROM. It was discovered at 18+2. So far we have chosen expectant management and are at home currently on bed rest. Turning 20 weeks tomorrow and won’t be admitted until I reach the 24 weeks mark so we are being monitored closely for infection and all other risks. Praying I continue to stay healthy and baby will reach the 24 week mark at least. The outcome is so I know and we don’t even know if baby will make it once the baby is born. It’s been a heartbreaking situation and it’s so sad that there is so little knowledge on this situation and you have to just play the “waiting game” at home until baby reaches viability. The worst part is sitting at home everyday wondering if something is going to happen or your going to develop an infection. My husband and I are trying our best to remain hopeful but it’s so hard.
4/9/2021 08:53:57 pm
Hi all, I too experienced pprom at 15 weeks with both my twins (and made it 13 weeks post rupture on bed rest following the pprom regimen as best I could in Australia). My twin daughters were born at 28 weeks both weighing 2lbs and requiring NICU support for 106 days. They both survived and are now healthy and happy 18 month old toddlers (you can check us out on their profile @cooketwinsofficial on instagram if your needing some stories of hope). I noticed many of you looking for additional support and information on pprom and thought i would chime in to direct anyone who is interested to the facebook community that helped me get through the hardest journey of my life- (first pregnancy, twins and pprom full rupture oligohydramnious at 15 weeks) things were grim until I found- Little heartbeats Foundation (uk based but) have volunteers worldwide providing pprom awareness packs and support from other pprom Mums and Families all over with varied outcomes. They advocate "where there are heartbeats there is hope" and support all regardless of choice or outcome. I was sent a free info pack and teddies to record my girls heartbeats into so that regardless of my outcome I would always have that. Their founder and pprom loss Mama herself run a number of facebook pages for those currently on their pprom journey, those who have experienced loss and those who have pprom neonates and beyond. I hope this info can be of help to anyone in need, I know it was for me. I wish you all positive outcomes, mindset matters- stay strong and god bless.
12/8/2021 01:03:31 pm
2/9/2022 12:09:19 am
Hye ..i also suffered from same at 20 weeks..and i lost my baby boy...that was my first pregnancy..m also very terrified ... I dny know what to say or do something different for my next pregnancy..
2/9/2022 01:18:18 pm
Hello, you can see my post up there in the comments- I had PPROM in week 17 at the end of May 2021. I became pregnant in August and am now 29 weeks with no signs of complications.
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