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Loss Of Amniotic Fluid at 20 weeks

(147 Posts)
Tashymondo Sun 05-Jun-11 17:22:08

So Let me set the scene, it has not been an easy pregnancy but the day of my 20 week Scan was to make up for it. I booked the day off work and it was my sisters 24th birthday which mean that we would all go to dinner after. I couldn’t be happier.

Then we find out that what I thought was just me having an accident Saturday night a family party whilst waiting in the queue for dinner was actually me leaking all of my amniotic fluid. When the nurse taking the scan told me she just said I'm so sorry but it’s all gone. I'm so sorry I don’t know what to say, I can't get a good look at the baby as its not moving. Neither did I know what to say, I just cried how could this be? We were all so happy and now this.

It was explained to me that the baby was at high risk of being underdeveloped especially in the lungs area. There was little to no chance of it surviving and it was made clear to me that my strongest option at this stage was termination.

I did not for a second want that or think that was it. Everyone at the hospital was just full of apologies. What about the good news, where was the silver lining I kept thinking??

I was taken to the labour ward a doctor that I saw only weeks before said she couldn’t understand on the scan I had then everything was fine. She explained the risks to me and the baby and that there was little hope or little that we could do. My partner was in tears, to see him cry just felt like it was over. But I didn’t want it to be over!!! How can I fight this?? I only lost my waters 4 days ago surely there is hope???

I was asked to call my dad how was innocently making his way to the restaurant, he was egar to hear what the sex of his first grandchild was. I told him through tears that there is a problem and you must come to the hospital. My sisters where in bits in the waiting area. I felt awful for weeks the thought of bringing new life into the family kept me going made us all happy and now this.

My dad joined us, again I had the risks and outcomes explained. Then i was poked and jabbed with needles. Come back tomorrow they suggested you have been through enough today.....

That night I felt my baby or Peanut as we affectionately call it and in the morning we felt is heart beating away. Its then I decided that I should fight; I should fight because that is what my Peanut is doing. Through all the risks surely there is some hope. Surely there can be something we can do!!??

At the hospital I was sure to get answers, I found out that as long as I don’t go into labour before week 24 then they will revive my Peanut. A san showed that there were NO abnormalities as yet I am free from infection and today I have felt my wonderful Peanut kick several times. So the fight is on.

I am trying to be positive but I need to know what movements are baby and what feelings I should go to hospital for?? I.e. going into labour. This is my first baby so I have no idea what that would be like.

I am mostly worried that Peanut will try to come out earlier then 24 weeks and the doctors will not help him/her. I'm not ready to lose!! I really am not ready to accept what the doctors are saying neither is my partner nor is our Peanut. Am I crazy??? Any advice any one can give would be great!! xxxx

Owlingate Wed 08-Jun-11 10:08:33

Hi so sorry to hear this. My waters broke at 18 weeks and I went in to labour a week later after I got a serious infection (chorioamnionitis I think it was called). Unfortunately I was not scanned or given antibiotics. A clot caused the ruptured membranes. My waters turned pink straight away and I continued to bleed on and off throughout the week.

Please ask for antibiotics - you should at least have them to protect you from infection. I find they are very willing to write the baby off but at least will try to help you.

Your best chance is if the waters reseal / replenish themselves - this can happen. The best time for waters to go is 22 weeks plus because a key stage of lung development will have taken place by then. Having said that my baby's post-mortem found that process was already under way at 18 weeks, so there is a chance.

Make sure you are doing everything you need to do to feel you have given your baby the best chance - whether that is badgering the doctors or staying in bed.

Ask them for antibiotics for you - ask them to measure your CRP count. Ask them for steroids. Ask them what level the neonatal unit is in your hospital - you need a high one in case your baby is very early.

Tashymondo Wed 08-Jun-11 13:47:26

Hello again midori1999,

You are such a wonderful woman to stand up and help others!!!! I have read through the PPROM document in detail and made notes my next visit to the hospital is Friday which will be my 10th day of diagnosis. I am going to insist that I am given Eythromycin given all the good it can do to help both me and Peanut I think it only right that I don't wait any longer to have it. I really do want to give us both every fighting chane!!

I will also look into the steriod injections too!!!

Thank you so much

Tash & Peanut

Tashymondo Wed 08-Jun-11 13:51:03

Thank you to everyone else who has posted on here! I do appreciate all the messages!!!

ninedragons Wed 08-Jun-11 13:53:48

Wishing you both the very, very best of luck.

Tashymondo Wed 08-Jun-11 19:13:19

Hello midori1999,

Firstly thank you for the help you have given me so far. Secondly earlier you posted this

Re: the steroids. I was repeatedly refused steroids before 24 weeks. I was told they wouldn't help. However, the new guideline issued in Oct. 2010 (my twins were born in April) suggests they do help improve survivial rates in babies born prior to 24 weeks.

where can I find these guidelines regarding steroids issued in Oct 2010 as i want to use this evidence when I go for my check on Friday!!

I hope I'm not being annoying by asking.

Many, many thanks for the help you have given me so far!!!

Tash

midori1999 Wed 08-Jun-11 20:10:15

Not annoying at all.

You can find the info on the RCOG (Royal College of Obstetricians and Gynaecologists) link I posted earlier in the thread, in their Green Top Guidelines, the one referring to antenatal corticosteroids to reduce neonatal mobidity. Here in fact:

www.rcog.org.uk/files/rcog-corp/GTG%207.pdf

This is copied and pasted from part of the document.

"A retrospective cohort study on 181 infants born at 23 weeks of gestation revealed that thoseexposed to antenatal corticosteroids had decreased odds of death (OR 0.32, 95% CI 0.12–0.84),with no significant differences in the occurrence of necrotising enterocolitis among survivors(15.4% compared with 28.6%, P=0.59) or severe intraventricular hemorrhage (23.1% compared
with 57.1%, P=0.17). Only a complete course of corticosteroids was associated with a decreased odds of death (OR 0.18, 95% CI 0.06–0.54).4 The study concluded that neonates at 23 weeks of gestation whose mothers completed a course of antenatal corticosteroids had an associated 82% reduction in odds of death."

This is the Green Top guideline relation to the management of pPROM:

www.rcog.org.uk/files/rcog-corp/GTG44PPROM28022011.pdf

This is part of the document:

"Twenty-two trials involving over 6000 women with PPROM before 37 weeks of gestation were included in a meta-analysis.41The use of antibiotics following PPROM is associated with a statistically significant reduction in chorioamnionitis (RR 0.57; 95% CI 0.37–0.86). There was a significant reduction in the numbers of babies born within 48 hours (RR 0.71;95% CI 0.58–0.87) and 7 days (RR 0.80; 95% CI 0.71–0.90). Neonatal infection was significantly reduced in the babies whose mothers received antibiotics (RR 0.68; 95% CI 0.53–0.87). There was also a significant reduction in the number of babies with an abnormal cerebral ultrasound scan prior
to discharge from hospital (RR 0.82; 95% CI 0.68–0.98).There was no significant reduction in perinatal mortality, although there was a trend for reduction in the treatment group."

I would imagine the reason they are reluctant to administer steroids prior to 24 weeks is because if there is undectected infection (usually choriamnionitis) present, the steroids can make it worse which is then a risk to the Mother. Choriamnionitis is one of the biggest causes of matrnal death associated with childbearing/childbirth from what I understand and also with neonatal morbidity. However, the the first guideline published it does say that steroids choriamnionitis isn't always a total contra-indication to antenatal steroids, or something along those lines.

Also, please telephone Bliss and get as much informtaion on extreme prematurity as you can. If you post on their message board there are lots of ladies who have had pPROm and lots of ladies who have had babies around 23/24 weeks. Obviously ideally you'll be pregnant much longer than 24 weeks, but it's a good idea to know probable outcomes and potential disabilities associated with babies born so prematurely and whether you would want a child who potentially had those disabilities. (of course, they may have none and for the purpose of the statistics, wearing glasses is counted as a disability, believe it or not!)

Not all, but some hospitals are very difficult to convince to help babies born before 24 weeks. If your hospital is one of these, it might be worth asking about other hospitals that do specialise in babies born at the cusp of viability and at 23 weeks plus. Had I have had the option, I would have asked for my care to be transferred to one of these, but I am in Ireland, so my options were limited. These hospitals will be mor eopen to steroids before 24 weeks and also helping your baby if born before then. However, the Nuffield study does say that parenst wishes must be taken into account and if you have done your research and know what you are talking about an dinsist, any hospital would be on shakey ground legally if they refused to even assess your baby at birth after 23 weeks gestation. That is what we wanted, for the babies to be checked over and assesed for resuscitation and helped if they were showing good signs of life, not help for them at any cost. The neonatologist I saw just before my girls were born said I am the only woman who has ever quoted the Nuffield study to him whilst in labour! I genuinely believe it was because I knew what I was talking about and that I absolutely insisted (read: wouldn't take no for an answer!) that my girls were helped at all. Obviously we still didn't take a baby home, but the odds were against us, at least we know we did everything we could to give them the best chance. Survival rates for 23 weekers are improving all the time.

I hope this helps you. Keep your spirits up, a positive attitude must help in some way!

Owlingate Wed 08-Jun-11 20:12:00

Tash I think she might mean the updated RCOG guidelines - they are on the website but as a PDF which for some reason I can't currently open...have a look here.

Owlingate Wed 08-Jun-11 20:13:42

Cross posted. Choriamnionitis is what I ended up with. I'm assuming they have swabbed you for infection? (NB I didn't get it until a week after the waters broke)

imip Wed 08-Jun-11 20:44:03

5.5 years ago I was given a steroid shot at 23 weeks (midnight). Also I was not constantly on antibiotics as i was told that they masked true markers of infection. I think it affected your white blood cell count. You should be getting blood tests to ck this. I think bed rest is vital.

Also, my daughter's psot-mortem showed that at her birth (25+4) her lungs were gestationally correct. So her lungs continued to develop on little fluid. During a scan, whoever is doing the scan should be able to tell whether your baby is swallowing the fluid. This is the critical factor for lung development.

hth

Tashymondo Wed 08-Jun-11 21:30:14

Thank you again midori1999, xxx

I have had a swab test which showed I have an abnormally high level of good bacteria which can also be bad as ideally you should have a level amount of good and bad. They enquired with the lab as to either treat with anti biotics or leave it as it was not a major threat. the lab advised that treatment wasn't needed at this stage. The swap also showed that I had thrush which I suspected any way before I god the results and treated myself with a store brought pessary! I am worried about the thrush coming back though!!!

I have been checking my temperature on a daily basis and my results are normal.

I feel that I should get the anti biotics because of the benefits it offers my ickle Peanut. However I am very apprehensive about the steroid injections as the consultant said that the injections could throw me into early labour. this they would be happy with after 24 weeks but not before! So I am in two minds!!

midori1999 Wed 08-Jun-11 22:04:12

From what I can agther, the reason steroids may put you into early labour is that they may exacerbate an underlying and undetected infection. However, I could be wrong, but certainly my consultant's only concern was that they would make an underlying infection worse and that also they had no proven benefits prior to 24 or even 28 weeks, which the updated Green Top guideline disagrees with, but that was published in October, I had my babies in April, so it was too late for me.

Maybe ask for a second opinion about the steroids and early labour? Certainly I know of ladies with pPROM who have had them prior to 24 weeks and didn't go into labour and didn't have this cited as a reason not to have them.

Is the 'good bacteria' gardenerella? If so, I had an excess of this a couple of times and was treated with metronodazole.

Tashymondo Thu 09-Jun-11 13:09:30

Thank you again for your advise!!

I'm not sure what the bacteria is call. will find out tomorrow! xx

Coppernoddle Fri 10-Jun-11 09:55:54

Good luck for your appointment today x x be thinking of you with my fingers crossed for you. X x

Coppernoddle Sat 11-Jun-11 08:27:47

How did it go? Hope everything ok smile

Tashymondo Sat 11-Jun-11 11:18:26

At my appointment I was given a course of anti biotics, we spoke about moving the steroid shot to week 23 instead of week 24 but as I will still be on anti biotics steroids can mask an infection. So the plan is to finish my 10 day course and by that time I will be ready for a steroid shot. This will minimise risk to me and baby. So now I just have to sit and wait.

I have been having some very, very strange dreams and for some reason both my hips are causing me a whole world of pain when I go to sleep at night. This mixed with pain from my boobs means I am not sleeping very well at all. I worry that this is not good for the baby. What do you ladies suggest I do??

xxxx Tash xxxx

Rootatoot Sat 11-Jun-11 13:37:43

Do you sleep on your side? Try putting an extra quilt on bed for support. I wake up with stiff/painful hips now and I think I need some extra padding under me. I don't know about painkillers as such in your situation. I know they say paracetemol ok generally (but not asprin/ibuprofen).

I'm glad you have been given your anti-biotics. I would just suggest you rest even if you are not sleeping. Feet up on cushions, and relax as much as you can.

All the best.

Tashymondo Sat 11-Jun-11 14:18:43

Thank you, I have tried extra pillows under me but they still hurt!!

Safariboots Sat 11-Jun-11 22:03:51

Hi Tashi,
I've followed your OP but not posted as I have no insights or experience on this; I am keeping you in my thoughts and hoping that Peanut makes it safe. Coincidentally we share same EDD so I hope you can come through it ok. Best regards,

lollystix Sat 11-Jun-11 22:09:32

Yes thinking of you tashy - I'm about a week after u. Just take each day as it comes. Big hugs to you.

Just wanted you to know I am thinking of you- we have the same due date. I hope you and Peanut are doing nothing but resting x

Owlingate Sat 11-Jun-11 22:19:38

The lack of sleep won't affect the baby, only you I'm afraid. I know you can't have a bath or anything but what about a lavender pillow? I took cocodamol and paracetamol in my pregnancies.

For hips try pillow between your knees.

HTH

WhipMeIndiana Sat 11-Jun-11 22:21:19

good luck to you Tash xxx

imip Sun 12-Jun-11 22:05:23

You may be feeling more pain because of the lack of fluid. When my baby kicked me it was really quite painful because nothing was cushioning the blow. Also, are you moving a lot less because when you move you are gushing fluid??? That could also be the cause? Don't worry about the lack of sleep, it won't harm the baby. Hips might also be down to simply being pregnant???

PoppysMom Mon 13-Jun-11 03:41:30

Good luck Tash x

Tashymondo Mon 13-Jun-11 15:09:17

Thanks again for all the messages guys!!! As long as lack of sleep does not affect my baby I'm happy!! xxx

I tried the extra blanket on the bed by the way Rootatoot and its more comfortable then before so thank you for the tip! xx

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