NHS Guidelines for PROM

[EmmaHealy23]

Apologies for the long post if it’s nothing...I’m a FTM, finally 22 weeks after previous miscarriages so safe to say I’m nervous!

When I was 20 wks i went to the EPU with a suspected ROM, Dr did a speculum test and said ‘yes I think you are leaking’...literally the worst words that struck fear into my heart.

Was told to go home with antibiotics and come back for 20 week scan. The scan itself looked fine and fluid levels were normal.

My question is this...afterwards I thought there might be some kind of follow up but the nurse just said go home and try to get to 24 weeks...no follow up scan or appointment or check, just go away. I rang every department and spoke to everyone and anyone (as had my lovely midwife) but everyone I speak to seems to think I’m some hypochondriac and that I don’t need any follow up....am I just being neurotic? Could the first Dr’s diagnosis be wrong? She also said I had severe thrush but the swab came back negative for thrush is infection...how reliable is the speculum test? I’m so so scared of getting an infection as the original Dr who saw me said it can cause pre term labour or even death. She scared me to death and now I can’t speak to anyone to our my mind at rest and I’m so so upset and anxious...we have tried for so long to get here and I’m terrified it’s going to be ripped away from me xx

Anyone?

Bit strange to have been told you have pPRoM then not follow up.... if liquor levels are Normal then would be unlikely to have ROM but not impossible. I would ask your midwife for a consultant appt, absolutely reasonable to have a chat as otherwise you’re in a bit of limbo

Thank you for replying! Spoke to my wonderful midwife but as it really needs to be a doctor who refers me to a consultant she has sadly come up against the same brick wall as me. If things are fine I’d just love to know it and try to enjoy things a bit more. I’m scared stiff of getting an infection, if there is no tear I can at least put that fear to the back of my mind. Limbo is exactly right xx

Ring and speak to supervisor of midwives / involve pals. The management of pprom vs not are totally different and you need a doctor to decide whether this is or is not the diagnosis.
It's total rubbish that you need a doctor to refer to a consultant (well it is in any of the 6 hospitals I worked in prior to becoming a consultant).
Get cross!!

Yes agree with pp. you do not need a doctor to refer you to consultant. I am a midwife and can assure you this is your midwives role.
Supervisor of midwives don’t exist anymore unfortunately, I would suggest another route is to try and get in touch with your antenatal/community matron or even delivery suite matron for some assistance. Another option if you’re struggling is to rock up on delivery suite to be seen

Nan0second thanks for your response! I’ll give them a call I just didn’t want to go over my Midwife’s head, especially as she has been so kind. I have spoke to my midwife, GP, Fetal well-being unit, EPU and now Labour and Delivery...every time fobbed off, people seem annoyed that I’ve called, I’m just trying to get a definitive answer. Maybe because the levels of fluid were ok then there is no leak? But she seemed so sure when she looked at the speculum and told me all the worst case scenarios...then nothing, just treated like a nuisance FTM x

I had a PPROM at 27w5d and I was admitted overnight for observation and had steroids too. (Baby was born perfectly healthy six days overdue so a PPROM is not always as terrible news as it seems)

I was then seen weekly for a CTG, blood tests to check for infection, and had several extra scans to check levels of amniotic fluid and the baby’s growth.

I can only imagine that as you are not yet at viability they are taking a ‘wait and see’ approach but I wouldn’t be at all happy with that. It may be that once you reach 24 weeks they will then do more but I wouldn’t leave it - for your own peace of mind - I would try to get referred to a maternity clinic for more frequent checks.

Policies will differ between units so don’t get hung up on what exactly other peoples experiences are, but no follow up being put in place I can assure you is not correct from someone saying you have RoM. I know our policy would be to admit for a period of time to monitor for infection and commence on oral antibiotics. Steroids at 23+ weeks and deliver around 34-35weeks if all remains well. I would really be going out of my way to push for a consultant review and opinion

See this is what I Thought, I have read up on this (although I realise some of what I was reading was In the US, seems they have different practices) but all I can assume is that as the fluid levels were fine the next day then they just want me to go away and come back at 24 weeks. I’m only 22 weeks atm and was 20 weeks when this happened. It’s infuriating, I was in the room with my midwife when she was calling the hospital and I could hear them fobbing her off. I guess I could call labour and delivery again, maybe if I got a nicer person on the phone I could explain, but i feel like I’m asking for the world when all I want is someone to tell me I’m ok x

Called the labour ward, spoke to a lovely midwife who said I should go in immediately for them to check me over and monitor. Feel really scared now but I guess it’s best to know isn’t it.

Thanks again for giving me the confidence to question things. Will update. Fingers crossed xx

Personally I would just turn up to delivery suite if I was you and ask to be seen. If fluid levels are normal on scan then it’s likely (not impossible) that you haven’t SROM’d but that’s not the point

Thanks everyone for your helpful replies, eventually got seen last night by a doctor who performed a speculum exam, she agreed there was a lot of water there. She said the hospital are currently trialling a new test which she said would tell me if it was fluid or not which case back negative luckily. The doctor said she could have sworn it was my waters but said the test should be reliable enough for me to go home. I feel quite relieved I have to say but there is still a tiny nagging doubt, just from the way she said it...still, I think for now this will have to be enough to put my mind at rest and at least stop me going out of my mind with worry.

Thanks again everyone x

Glad you have been seen lovely. Heavy watery discharge is normal in pregnancy, and the fact on USS your amniotic fluid index was normal

Mummyme87 thanks for taking the time to come back to me, feel much better today. Like you say the waters seemed ok (going for a private scan this weekend anyway so will ask them just to double check) so I’m hoping that’s that awful episode over!

I know this is TMI but I just never expected discharge to me so ‘watery’ it just frightened the life out of me! X