Ruptured membranes - very low fluid - not sure what to do

[Worriedandunsurewhattodo]

I am 21+4wks pregnant (my third baby). At 18wks I woke with a big gush of leaking clear fluid. I went straight to hospital. Had a scan and speculum and everything seemed fine.

I was given the okay to go home but had a funny turn and was admitted with an (undiagnosed) infection and went home after two days. The infection could be what caused me to leak.

Since then I have been in with leaking and then blood loss. Again no concerns with the speculum.

I had my 21wk scan on Tuesday. My fluid levels were below 1.5. I was sent to maternity and whilst I was waiting I had lower abdominal pain and a substantial amount of blood loss. A speculum showed I was leaking from the cervix and the doctor said she was sorry. I stayed that night due to blood loss and was moved to delivey suite.

The bleeding stopped and after my second night there they sent me home. I had a scan yesterday with a fetal medicine specialist. The fluid levels were the same. Membranes ruptured. She said baby can't develop properly and I will likely go into labour. Baby is not viable yet. She offered termination where I take a hormone tablet first so my body doesn't fight against labour once I'm induced 48hrs later.

I asked what would happen if we made it to 24wks and she basically said he would likely have severe problems and a slim chance of survival.

I'm home now. Still bleeding every now and then and will go in if it becomes an active bleed again. I know I may go into labour anytime. But I'm not sure I can force labour. I will be 22wks when I give birth if I opt to take the tablet and be induced. His heartbeat has always been strong when they've checked.

If I don't go to the hospital for the hormone tablet then I will have another scan Monday afternoon. I'm sure it will be exactly the same as yesterday.

I'm not sure I can terminate my little baby boy.

Has anyone been in this situation? Please share your stories. Thank you

I haven’t been in this exact situation but I had to terminate a pregnancy due a non compatible with life defect around the same time - ours was very black and white so we knew there was absolutely no chance of survival which made it easier for me.
I think you should wait for the scan - you need to be 100% sure in your mind, even if the scan shows the exact same outcome. Talk
to as many of the medical professionals as you can - I found that once I had the situation clear in my head it made it a lot easier to come to a decision.
I’m so so sorry this is happening to you, I wish there were something I could say that would genuinely help or make it better for you but I’m
here if you want to chat.
All I can say is don’t feel like you have to rush into any decisions.

Sending all the love and thinking of you x

My membranes ruptured post amniocentesis at around 16 weeks. I was sent home with rest and wait and see. I continued leaking for a few weeks. I went into hospital via A&e with raised temp and they offered me a termination. I said I would wait and see consultant at next appt which was only a few days later.
Very luckily for me my membranes sealed and the fluid level went up.
Had a few random bleeds for rest of pregnancy and very regular check ups/ scans. But baby arrived safely.
Wishing you all the best

What a heartbreaking choice to make. I think I would wait and see if I were you.

Thank you for the responses and for sharing your stories.

Menomadnessthe specialist I saw said nothing about the membranes resealing. We mentioned that we read that fluids can replenish and she basically said because the membranes ruptured it would just keep leaking. I wonder why they don't try and give any potential what-ifs! Thank you for sharing.

I will wait and see. Bump for any other stories and sorry to all who have been through this

OP

I had similar at 24 weeks with DD1. Membranes ruptured, I was leaking and bleeding. I spent 6 weeks in hospital being monitored almost constantly, with regular scans. Infection here too.

At 30 weeks it suddenly stopped and fluid levels stabilised. Ended up giving birth at 37 weeks.

Did you see a Consultant? Could always ask for a second opinion.

NukaColaGirl perhaps we will be under constant supervision if we make it to 24wks as well. Here's hoping and although you were further along your story still provides me with hope which is keeping me going.

I think once I tell the fetal medicine specialist tomorrow that I don't want to terminate I will be having appointments with a consultant. I've seen one before when I had an appointment following my first leak and he worked in the antenatal clinic alongside the midwives so fingers crossed I can get an appointment there again asap.

And further experiences from posters appreciated.

No experience but absolutely speak only to the consultant - can they manually replace the fluid for a while? I recall reading something about this with a woman who had no fluids

Also can they do a stitch in your cervix?

flumpybear I think as my membranes have ruptured I will leak whatever is inserted. I am also doubtful that my hospital would offer a stitch but I will mention it. Thanks for your suggestions

I am so sorry OP. Of course you don't have to take the option of termination if that's not right for you.

Can I ask though have you been given really clear instructions that you understand of signs or symptoms that mean you should present back at the hospital? Ruptured membranes can mean a risk for infection which could be very serious for both you and the baby. If you don't have a clear list of warning signs to look out for, please ring your doctor or midwife and ask them to tell you when you seek urgent medical care (eg fever).

As for your actual question, I'm afraid I don't have any advice other than to try to ask every question you have at your appointments, ask to be referred to a more senior doctor if necessary and maybe write things down before and during your appointment. It sounds like you are in an agonising situation, so please try to take care of yourself and your mental health as well - perhaps ask the hospital what mental health support you can access.

I'll keep my fingers crossed for you and best wishes.

I don’t have any experience of this but I’m very sorry to hear what you are going through.

I think if it was me I’d go for the wait and see approach too. Every day you manage to keep your baby inside you is another vital day of development. Your problems started at 18 weeks and you’ve made it to 21+4.

I really hope it goes well for you.

I'm really sorry OP
To be blunt it sounds very much as though this pregnancy will not continue well but it depends on whether your membranes have fully ruptured, sometimes fluid does build up again if only part of them have ruptured.

If there is no or very very low fluid around baby, unfortunately the baby's lungs cannot develop. They breathe this fluid in and out and so if they are born very preterm their lungs will not be developed past the time that your waters broke. Generally a pregnancy that is below 23 weeks is not going to end with a healthy baby, and most would advise not intervening at delivery. After 23 weeks things change.

If there is infection there this is worse both for you and the pregnancy - but it might be that the infection was the cause of the rupture.

Without knowing the details it's hard to say and I know it's nice to hear good outcomes, but the likelihood of a good outcome at this early stage IF (I must emphasise if) your membranes have ruptured and the fluid has practically gone, is extremely low. The priority must then be to prevent you becoming unwell as a result as you can get unwell very fast with this. I would think if this was the situation your hospital would want to monitor things very closely.

My waters went at 27 weeks so i was already viable but at theay point i joint little heartbeats.

www.little-heartbeats.org.uk

There is also a Facebook support group and I've seen woman who's waters have gone earlier than yours delivery healthy babies of course this isn't always the case but medical proffesionals are usally very negative. Please get in touch with them, they helped me so much.

I really hope things work out alright and sorry to be negative but it sounds as though they have confirmed both on speculum and a scan it was the amniotic fluid leaking and the membranes have ruptured. In the past in your situation I have seen people refuse termination or induction because of course this is a much wanted pregnancy but they have been monitored pretty closely for signs of infection, sepsis, bleeding/clotting problems that can happen if it goes on too long. Usually if it is coming to an end it will do so of its own accord and you would start having contractions, and the cervix would open, but sometimes not, and in those cases they'd want to step in and do something actively to manage it once the risk is sufficiently high to you. It's fine to let things happen naturally/ see how things go at home, as long as you are aware of the risks and that you need to go straight back if you start to feel unwell.

No advice but really hoping you get all the information you need and can make an informed decision. No idea what I'd do in this situation but if you don't want a termination, no one can make you. Best of luck and please keep us updated x

No one can make you do anything that you don't want.

My waters broke at 23 weeks, continued to leak until I went into labour at 33 weeks. Was monitored and scanned every 2nd day.

I have been in this position but my membranes went at 16 weeks. It was a pretty straightforward although totally heartbreaking decision for me to terminate the pregnancy. I am a healthcare professional so had seen first hand the potential complications which is why I made the decision I did. I think I would have struggled if I was closer to 24 weeks though.

I had a single dose of misoprostol and delivered a few hours later - so may have spontaneously miscarried anyway. I was able to spend time with the baby and managed to get footprints and photos which I treasure.

Good luck whatever you decide. X

This happened to me at 25 wks, but I was put on complete bed rest, not sent home. All turned out well.

Thank you sycamore54321. They told me if I start to feel unwell or experience bleeding/cramping/pain to call triage.

Topbiscuit for you. What are the complications you have witnessed if you don't mind sharing?

Thank you for the information you have provided leghoul which I will certainly bear in mind. When I was admitted with an infection at the start of May I had a few rounds of IV antibiotics and then discharged with Erythromycin for 10 days. The course ended on 21st May. I hope this will help prevent another infection occuring at least for a little while but I know there is still a big risk.

Thanks for all the responses.

The main worry as others have said is overwhelming infection for you (this is why they should not offer you a stitch by the way) this can be life threatening (as in the well publicised case of Savita Halappanavar in Ireland)
There are certainly women who have successfully continued a pregnancy or taken a wait and see approach but then comes the worries with the baby - if your liquor pool remains low then the fetal lungs will just not develop properly and even if born many weeks down the line may not survive. Similarly the development of arms and legs may be restricted just because of lack of space. The baby keeps making liquor so levels may go up and down (it’s mainly wee) but it just keeps leaking out.

As someone said earlier obvs & gynae doctors are pretty pessimistic about mid trimester pprom for these reasons, but you’ve held on for 3 weeks now and the stats would say 70% would miscarry in that time so you never know. You have to live with your decision and I know how hard that is so really wishing you all the best.

Thanks Topbiscuit for sharing. I will definitely take all this into consideration.

Can I ask if you know anything about why my amniotic fluid is bloody? After several clear leaks at the start of May my liquid turned pink and then a couple of days later, red. I am still getting a few light watery bleeds and although they haven't said that my amniotic fluid is bloody (they haven't really offered much insight into why I have been bleeding) I strongly suspect it is my fluid.

Amniotic fluid is often pinky coloured, mine was. It can be totally clear or slightly yellow too. It’s very common when monitoring prolonged membrane rupture to have on & off little bleeds. I would worry if it became smelly or loads of fresh blood but otherwise it sounds “normal”

How has today been OP?

Morning Rachie1986 and thanks for checking in.

I started to have very mild cramping yesterday which were coming and going. My bleeding thickened as well and I'd not felt baby move for hours so I went to triage.

They put me back on delivery suite and my cramping got stronger. Just uncomfortanle and strong enough to stop me getting some sleep so I was given codene which helped. The cramping has since settled. I really thought they were contractions but the midwife said my stomach didn't feel hard so who knows.

The registrar has put me on antibiotics. My blood results showed that my infection markers have been fluctuating for a while and they were up again yesterday so she didn't want to take any risks and would rather over medicate me. So I'm pleased about that.

I am starting to feel really worried about becoming very unwell now and this is something I don't want to risk because of my DDs and DP so I feel so torn right now. I'm going to speak to my doctor this morning because it's not just a case of my membranes rupturing. I've been bleeding for over a week now and I've had an infection and they don't know exactly why but it's all starting to make me feel very vunerable.

But while his heartbeat is still so strong it's making this decision so difficult. I almost wish nature would take over so I at least don't have to make a decision. But I feel so guilty for him that I'm even thinking that

I'm so sorry you are going through this, it sounds so stressful and worrying.

I hope you get some advice and support from the doctors today