Second pregnancy after PPROM

[minipie]

Evening all

DD was born at 34 weeks after my waters broke suddenly and contractions followed shortly after.

I'm now pregnant again, nearly 20 weeks. I've spoken to a consultant who says that as my cervix was closed when my waters broke, it's not a cervical issue, and as my waters went before contractions started, it's unlikely to be irritable uterus or oddly shaped uterus etc. Most likely explanation is an infection got in through the cervix and weakened the membrane. So, no reason to think it will happen again and they will treat me like anyone else.

Sounds good in theory. But then, if I google, I get a lot of stories from women who were told much the same, and then it happened again anyway.

So, my question is: did you have PPROM and then a subsequent pregnancy? What happened next time round? Were you given any extra monitoring or treatment (I have read about progesterone treatment for example, but mainly in the US)?

Just not sure if I should be pushing for anything extra or not...

Thanks

Hi, it might be worth requesting a cervix length scan? I unfortunately had another prem birth after my first and I wish I had pushed harder for more minitoring now. However, it is unlikely to happen again though. Mine was at the same gestation (33 weeks)

Sorry forgot to add after a major scare at 26 weeks I was put on the hormone treatment and it worked. This is a trial drug and depends on the consultants views on it.

I had PPROM with my first, at 33 weeks and he was induced at 35. Cervix was closed for me, too, but I had no contractions. Only possible reason I was given was Ehlers Danlos Syndrome.
Baby number 2 was born at 42 weeks and baby number 3 at 40, both after much fuss during my pregnancies, but all was well.

Thanks both!

Checked notes and apparently they will scan my cervix as part of the 20 week scan but only externally... they would only do a more accurate internal one if the external looks worrying. Maybe I should ask for an internal one in any event (can't be a huge deal surely!?)

plenty do you know why your DC were prem? And your scare at 26 weeks, was that contractions starting or something else? Well done for holding on to 33 weeks.

NaiceHam that's reassuring that your later children were full term after PPROM. When you say "much fuss" do you mean extra tests/treatment or being classed as high risk?

Following as I also had prom and am interested to know my chances of it happening again. I was told at the time it was about 50 50 and that I would probably be given steroid injections in any future pregnancies.

MsBug that's interesting, nobody has said anything about steroids to me and they've been a lot more positive than 50/50. Do you know if your cervix was open or closed when you prom'd? It might be worth asking for a consultant to review your maternity/birth notes to see if they can deduce anything further about the cause ... unless you've done this already of course.

These were just comments made to me when I was still in hospital after having dd and I had a kind of birth debriefing. I'm not actually pregnant again yet and when I do get pg I expect I'll want to go through things in more detail.

No idea about the state of my cervix, probably closed as i hadn't had any contractions.

Ah gotcha. I'd recommend asking for a review with consultant (who has read your notes) as it has definitely helped rule out quite a few of the possible causes based on my history.

Though as you can tell from this thread it hasn't entirely set my mind at rest

I had a bleed at 26 weeks, more like brown discharge. I was sent home three times before they scanned me. I had a debrief after and they suspect I may have an abnormal shaped womb? I turned down a scan to confirm it as I am having no more children.

My cervix was closed, but I had funnelling hence the bleeding.

Gosh - sounds quite terrifying dramatic. Good that the hormones were able to slow the funnelling though.

Hi, i would be really interested in hearing people's responses to this. Mini pie I have a similar history to you, PPROM at 32 weeks wit DC1, no cause identified. He was quite poorly at birth and had breathing difficulties for 2 weeks afterwards. Currently 18 weeks with DC2 , my consultant has offered ( and I have accepted) cervical length scans at 16, 20 and 24 weeks and prophylactic steroids at 32 weeks. The cervix scans are transvaginal so not the most pleasant of things but will at least identify any problems I hope.
Good luck, I hope you get further on than last time x

Thanks flying you too! It doesn't exactly make for a relaxing 2nd pregnancy does it...

I will definitely ask about the internal cervical scan at 20 weeks, and about the steroids too.

Yeah I was classed as high risk but really had my heart set on home birth if i could make it to term. Phrases like "risk to life", "detrimental to yours and your baby's health", "against medical advice" and "in hospital you would be safer" were bandied about a lot.
I had regular scans with DC2, really quite frequently (i think it was every 2-4 weeks iirc), and I went along with it all despite finding it quite invasive. My cervix started to open around 35 weeks and was a good 5cms dilated by 41 weeks, with waters bulging but I still didn't labour until 42 weeks, then had a home birth with just one midwife because it went too quickly in the end. I had some minor complications immediately after delivery, but at the time it was just dealt with quickly and not an issue. It was all dredged up with dc3, and they really tried to bully me into a lot of things I didn't feel comfortable with, so I pretty much refused all consultant contact after the initial appointment.. I had HG and a lot of hospital stays, I then had a bleed at 30 weeks and I wa worried it would happen again, so I let them scan me and do speculums etc, which found everything was perfect.
I ended up birthing that one at home unassisted, beautiful perfect birth.
I think at least for me with my condition it is something that may or may not happen.. I do suspect it may have had a play in at least some of my miscarriages.

oh I see, you have Ehlers danlos, I assumed it was your dc1. I suppose that would make the medics jittery... fear of the unknown probably.. poor you though, it sounds like a lot of stress. great that you went full term with both the next two.

I had pprom at 33 weeks with DS1, and he was born at 34+1 weeks after contractions spontaneously started. He had some initial breathing problems despite me getting the steroids after my waters went, and we were in scbu for about 3.5 weeks in all. I had a debrief with the consultant afterwards, and she basically said that they had no idea why DS1 was premature.

With DS2, I was consultant led because of DS1 being premature, but all tests came back normal, including a transvaginal cervix scan as part of the 20 week scan. My waters did break again before labour - although hindwaters that time so less dramatically - but we'd (just) hit the 37 week mark by then, so got induced the next day, and DS2 was born at 37+2 weeks.

Thanks Shadow. Sounds pretty similar to me (although my contractions started only a couple of hours after waters went, so PPROM at 33+6 and birth at 34+0). DD didn't have breathing support but she didn't breathe for about 3-4 mins after birth, and we were also in SCBU for 3.5 weeks.

When you say "all tests came back normal", what tests - just the routine ones or anything special? (apart from the transv cervix scan which I will definitely ask for). Good that you got to 37+2 next time.

The consultant has signed me off so I think I am no longer consultant led... which just makes me a bit worried that they are being too relaxed about the whole thing!

minipie - I had the routine tests and scans that everyone gets plus a gtt due to my weight, plus the transvaginal cervix scan , plus a Doppler scan to check blood flow to the placenta.

I think I got the Doppler scan with DS2 because a Doppler scan with DS1 showed potential problems with the blood flow to DS1's placenta. But the consultant said that that had nothing to do with DS1 being premature as poor blood flow to the placenta doesn't cause spontaneous preterm labour (although it can lead to the doctors deciding to deliver the baby early if it's affecting the baby badly).

And yes, I was very happy to get past 37 weeks!

What to do when your waters break before 37 weeks of pregnancy support group and campaign

We are group of mums who have experience this in pregnancy, we also run a closed group called Little Heartbeats PPROM support

watersbrokepregnancy.blogspot.co.uk

Congratulation Minipie :)

I had PPROM at 28+6 weeks, babies born at 29.

At the time they didn't find any infections and my cervix was closed. I was pregnant with twins so that was seen as the 'cause', although the average gestation with twins (apparently) is still 35wks.

Second time round. I am 13+ weeks now. I am under the care of St Thomas in London and this may be specific to them. At my 12wk scan I got seen by the research midwife and picked out for the INSIGHT study, which looks in to biomarkers that predict prem labour. I saw the clinical fellow (Natasha Hezelgrave) and she said that yes likely that twins was the main cause and that if we do nothing, 80% chance that everything will go just fine. So I would imagine similar nrs would apply to your case.

I am now being monitored every 2 weeks, where they measure the cervix length and whether there is fetal fibronectin present. The combination of those 2 can predict with 99% certainty whether you will be giving birth in the next 2 weeks. (One wonders why this test is not routinely done for ladies at increased risk for prem labour, but hey ho).

If the measurements say that something is up, then they'll start 'doing things'. I haven't asked about progesterone treatment, but that was one of my questions for my next appt!

Hope that helps a little.

Oh and minipie they did test me for all sorts of infections at my 12 wk scan too, because these are often the cause for PPROM. I did say that they tested me for that straight after my waters broke but she said that this tested for a lot more and that the tests straight after PPROM don't always pick up all infections.

Thanks dildals. glad you are being looked after - I am not having any of those tests, I did wonder about asking to be referred to the St Thomas's clinic (they do way more tests than anywhere else I think) but never followed through. Interesting about the wider infection test. Very very best of luck.

I am now 35+3 and so far so good...

thanks neversleep!

That baby is practically cooked! :-)

update: Well I had PPROM again, at 36+6, again labour followed on very fast and DD2 was born a few hours later. No idea of the cause. I'd been tested for infections at 30 weeks (after a false alarm for waters leaking) and all clear.

I guess this is just what my body does?

Anyway DD2 was very nearly term and a decent weight, 6lb 13, we avoided NICU and were home after 2 days. So not quite the 39/40 weeks I ideally wanted but not bad...

Best of luck to those still cooking.