PPROM and subsequent pregnancies

[whoabethy]

Hi mamas,

DD was born at 35 weeks (PPROM) and was in the NICU for a bit afterward. I'm newly pregnant and Googling everything (how did people obsess before the internet?). Did anyone out there have a full term baby after a PPROM preemie? I'm trying to manage my expectations.

Thanks!

[Ratchet]

do they know why PPROM happened?  Did you have an infection, or was it out of the blue?

[whoabethy]

totally out of the blue. no sign of infection in the placenta, but i had BV a few times during pregnancy. that's my (unconfirmed) theory. MW said it was probably just random. so, not sure...
 

[pigirl]

I had a full term pregnancy after PPROM at 34 weeks, yes!  Like you my water broke out of the blue, no warning signs, and they never figured out why.  For my second (and last) pregnancy I did the progesterone shots (17P) weekly from my 17th week of pregnancy until my 36th, and then I delivered at 40w3d.  Ask about the shots!  There's a basic March of Dimes info page on them here:  http://www.marchofdimes.com/pregnancy/pretermlabor_progesterone.html

Also, this is kind of random, but it turns out my cholesterol was wicked low-- my total was 111 right before I conceived-- and that's been linked to preterm birth as well (http://www.nih.gov/news/pr/oct2007/nhgri-01.htm).  My midwife hadn't heard of it but it makes sense in retrospect-- I was vegan for an eternity, and your body makes progesterone out of cholesterol.  It may be worth testing just for the peace of mind.  (I was really worried about a second preterm birth my whole second pregnancy-- ugh.)  Here's to an easy, full term pregnancy for you.

[whoabethy]

thanks pigirl, that's super helpful information. did you see a perinatalogist for your second baby? it's super hard to choose a practitioner this time. for DD i planned a homebirth, but since she was early and breech i ended up with a c-section. we can't really afford a homebirth this time, but when all is said and done, with health insurance a c-section will probably cost the same. but if i go with a homebirth midwife and then end up getting transferred the cost will be double. grrrr. just trying to work it all out in my head!

[pigirl]

I worked with a midwife practice that I love for both pregnancies.  They're not homebirth midwives-- that route has never been for me-- but they're an awesome midwife practice that delivers at the local hospital.  I couldn't actually deliver with them for my first since he was early; I had to go to the bigger hospital with a NICU and deliver with an OB I'd never met.  But they were comfortable having me as a patient again with my second pregnancy and gave me the 17P shots (and then high fives when I passed the 37 week mark and got moved out of their "high risk" category).  The midwifes are all CNMs and they work in a practice with an OB.  I consulted with the OB directly a few times, and they kept her up to date on my pregnancy throughout.  That worked out great for us.  As a caveat, though, I work in public health research and am a very involved patient-- I raised a lot of questions during my care and they let me direct what sort of interventions I wanted (17P shots, a FFN test around 34 weeks, etc.)  But I guess the bottom line is you probably won't have to see an OB or high-risk person this time around if you don't want to.  Ask around!

[whoabethy]

I am also a super-involved patient - which my last midwife loved. i am an east-coast transplant here in the midwest, so i imagine it's going to a little difficult to find a provider who enjoys how involved i plan to be. :)  I am in grad school right now and my university has full-text access to PubMed. BEST. EVER. thanks for all the info!
 

[pigirl]

HA!  I kept using PubMed to bring my midwife (and my doula, and the labor nurses....) relevant articles.  I'm sure you'll do fine.  Just look into those shots, there's a lot of good evidence behind them.  :)