What is PPROM?

WHAT IS PPROM?
Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM). PROM occurs in about 8 to 10 percent of all pregnancies. PPROM (before 37 weeks) accounts for one fourth to one third of all preterm births (The Children’s Hospital of Philadelphia, 2018). Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. Once the sac breaks, an increased risk for infection can occur for baby and mother. Chances the baby will be born early are very high (University of Rochester Medical Center, 2019).
SYMPTOMS
Symptoms can occur a bit differently in each pregnancy. They can include:
    •  A sudden gush of fluid from your vagina
    •  Feeling like you are peeing, but it is not urine (color/odor)
    •  Leaking of fluid from your vagina
    •  A feeling of wetness in your vagina or underwear
    •  Above symptoms followed by low amniotic fluid levels
WHAT CAUSES PPROM?
Before term, PPROM is often due to an infection in the uterus. Other factors that are linked to PPROM:
•  Low socioeconomic conditions (as women in lower socioeconomic conditions are less likely to receive proper prenatal care)
•  Having an infection in your reproductive system such as BV, UTIs 
•  Subchorionic haematoma (SCH)
•  Sexually transmitted infections, such as chlamydia and gonorrhea
•  Previous preterm birth
•  Vaginal bleeding
•  Cigarette smoking during pregnancy
•  Unknown causes
WHAT SHOULD I DO IF I THINK I HAVE PPROM?
Call your healthcare provider immediately and go to the hospital. If you can, take a sample of the fluid gush, if it continues, for testing. Require your physician to test you (and if possible the sample). Some physicians may not be familiar with PPROM, so it is important to firmly insist on a test of the leaking fluids. 
•  An examination of the cervix (may show fluid leaking from the cervical opening)
•  Testing of the pH (acid or alkaline) of the fluid
•  Looking at the dried fluid under a microscope (may show a characteristic fern-like pattern)
•  Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess how much fluid is around the baby.
DANGERS OF PPROM
A significant risk of PPROM is that the baby is very likely to be born within a few days of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis, which can be very dangerous for mother and baby. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum (after delivery) infection (The Children’s Hospital of Philadelphia, 2018).
PPROM OUTLOOK: WHAT SHOULD I DO?
It is important to understand that thousands of babies have survived PPROM, even as early as 12 weeks. These babies have lived to be completely healthy and normal. In some cases, the amniotic sac resealed. Babies have still developed their lungs and organs by finding pockets of amniotic fluid though there appears to be no measurable fluid. This is possible because fetal urine contributes to amniotic fluid levels. Since every PPROM case is unique, no doctor can say for certainty that your child will live or die, or be healthy or unhealthy.

REASONS WORTH FIGHTING FOR
There are many medical advances to assist your baby. Antibiotics are effective treatments to reduce infection risks to mother and baby and prolong pregnancy. Amoxicillin is safe for baby and also prolonged pregnancy in over 46% of trial cases (Seelbach-Goebel, 2013). Without antibiotics, there is a very high chance of infection and labor within 7 days of PPROM. 

The baby will develop quickly! Each day and week is a milestone which drastically increases survival.  By 28 weeks, doctors can give steroids to help the baby's lungs catch up in development. Amazingly, babies have survived birth as early as 21 weeks. Your goal is to stay pregnant as long as possible. An extended hospital stay is necessary after PPROM to monitor baby's heart and both your risks of infection.
HOW DO I FIGHT FOR MY BABY?
The best advice for fighting for your baby is:
•   Remain calm
•   Don't think of the bad things that can happen, think positive thoughts only.
•   Join PPROM support groups. This will help you find strength.
•   Drink lots of water daily. Some sources say your body weight in ounces!
•   Go on COMPLETE BED REST. Only get up to go the bathroom! Know the risks of laying on bed rest and learn safe exercises to prevent blood clots
•   Occupy you mind! This is possibly one of the most important. Find bed rest activities that keep you positive..
•   Set small goals, then bigger goals. Celebrate making 24 hours, then each week, then important milestones in baby's development.
•   Start planning ahead.
•   Write a journal to ditch your anxiety and blues.
•   Talk to your baby and rub your belly. This will help both of you!
•   Be positive, be positive, be positive!
References
Seelbach-Goebel B. (2013). Antibiotic Therapy for Premature Rupture of Membranes and Preterm Labor and Effect on Fetal Outcome. Geburtshilfe und Frauenheilkunde, 73(12), 1218–1227. doi:10.1055/s-0033-1360195 Source.
The Children’s Hospital of Philadelphia. (2018). Premature Rupture of Membranes (PROM)/Preterm Premature Rupture of Membranes (PPROM). Source
University of Rochester Medical Center. (2019). Health Encyclopedia: Preterm Premature Rupture of Membranes (PPROM). Source.

Valour foundation

PPROM & BV Awareness

The Valour Foundation was created to bring awareness to about PPROM and its connection with BV. It offers support and hope to parents dealing with PPROM, because every baby matters, every trimester.
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