What Are You Wearing to PPROM?

When you hear the word prom, your mind immediately goes to dresses, dancing, and corsages—those awkward high school days when who your prom date was felt as important as who was running for president. And while we would love to relive what we wore and who we wore it with, the PPROM we are here to discuss is premature preterm rupture of membranes (a.k.a. breaking your water before you’re in labor and way before your due date!).

Before we delve into the details of PPROM, let’s take a step back. From the moment of implantation, your plus one spends his or her days and nights swimming in a pool. This pool is in your uterus and is called the amniotic sac. When your water breaks, be it at six months or nine months, it signifies that the amniotic sac has opened and your amniotic fluid (a.k.a. water) is leaking. When this happens at or around your due date, it’s game on. Pack your bags; let’s go have a baby!

And while there is excitement (#babyontheway), there is generally no cause for concern. However, when your water breaks before you have reached the full-term mark (37 weeks), we put on a full-court press to stop things from moving any further. And depending just how early in pregnancy you are, we may pull out all the stops to stop labor from progressing. Preterm delivery can be dangerous: think lung problems, brain problems, GI problems, and beyond. That’s why we will do our very best to stop it.

Because of the what-ifs and the what-cans that often follow premature babies, women with PPROM can anticipate a lot of attention. You, your uterus, and your fetus will take center stage on the labor floor, which will become your new home until the baby is born. And depending on how things go (Do you develop an infection? Does your baby appear to be in distress? Have you reached a safe gestational age for delivery?), the curtain may not fall for several weeks. In short, our goal is to keep you pregnant for as long as we safely can. When it comes to fetal development, days matter. Although the neonatal intensive care units (NICUs) have come a long way, there is no better home for a developing baby than in your womb.

Why your uterus decides to go to PPROM earlier than it should is often unknown. While most cases occur because of an underlying infection, in many cases, we aren’t sure what set the system into motion. However, given that infection is the no. 1 culprit, we will routinely start antibiotics to treat a potential infection and to hold off what might come next (a.k.a. full-blown labor). We will also keep a close eye on your temperature, your white blood cell count, and your baby’s heart rate to make sure that an infection is not arising or, if already present, getting worse. Additionally, if the PPROM occurred at less than about 34 to 36 weeks, your OB/GYN will administer a dose of steroids to help your baby’s lungs reach maturity.

Many of us have had many water-breaking false alarms during pregnancy. The kind when you realize, “Oops, I just peed on myself.” And while it can be hard to distinguish amniotic fluid from urine (for the non-OB/GYNs amongst us), when symptoms like cramping, pressure, and bleeding are present, it is usually the former.

However, the only way to know is to go (we purposely made that rhyme so it sticks in your head!). Going to your OB’s office or the labor floor is the only reliable way to know exactly what that liquid is. And while no one wants to be the boy (or girl) who cried wolf, it is always better to be safe than sorry.

The good news is that most of us won’t show up for the prom early. In fact, only about 3% of all pregnancies in the US are complicated by PPROM. However, women with a previous PPROM are at increased risk for another PPROM. To avoid an encore performance in your next pregnancy, your care might be transferred to a high-risk OB. Such individuals are specifically trained to take care of women with previous pregnancy complications. Furthermore, they may suggest taking weekly progesterone injections, starting at 16 weeks of pregnancy and twice-monthly cervical length checks to reduce the chance of the preterm delivery happening again.

Additionally, if fertility treatments are being used in the future, we strongly recommend that your doctor employ all and any techniques to reduce the risk of multiple gestations. After all, if your uterus had a hard time making it to the end with one, why stress the system with two?

The good news is that while your courtship (a.k.a. pregnancy) may be cut short, the “prom” usually ends on a high note. With early attention, immediate treatment, and a team approach (OB, pediatricians, nurses, and support staff), most babies born following PPROM will do great. And not unlike the prom that they will attend nearly 17 years down the road, while their time in the NICU will be beyond stressful for us as parents and family members, most “kings” and “queens” leave the PPROM none the wiser.

Welcome to parenthood!