Tuesday, 19 October 2010

Consultant appointment; causes of pPROM and stillbirth and the future

I finally had my consultant appointment yesterday. This appointment seems to have many names, follow up appointment, 6 week appointment, counselling appointment... but essentially it was to discuss my pregnancy with Orson, where I am now physically and emotionally and then the future.

After the appointment I was of course sad. However I was surprised how well I coped during the actual appointment. Normally you are supposed to have the appointment 6 weeks after your loss. In my case it has been over 3 months. But I was calm during the appointment and even found myself laughing at times. Had I had it 6 weeks after Orson died I think I would have been in tears for most of the time.

I had lots of questions for my Consultant, she said she would put everything we discussed in writing to me but here are her answers as best I remember.

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Why did my waters break (pPROM) at 21 weeks?

Obviously the Consultant does not know for sure but in her opinion I had pPROM because of the heavy bleeding I had in the first trimester. I bled at 6, 7 and 8 weeks and was diagnosed with a large area of haemorrhage / haematoma. She thinks that is why my waters broke. Possibly also the Step b that was found in vaginal swabs also played a role.

Why did I go into labour at 31 weeks?

The Consultant was almost certain that the infection I was diagnosed with during labour actually made me go into labour. She does not know what the infection was, possibly Strep b or some other anaerobic infection. I got it simply because my membranes had been ruptured for so long.

My blood cultures came back with a Staph infection however the Consultant thought that may have been contamination from when they took the blood and that it is far more likely that I had a different infection that just wasn't identified or the Strep b that was.

Why did Orson die in labour?

We did not have a post mortem so cannot be certain but the Consultant thinks that Orson had the same infection that I had. She believes this was the cause of his death.

The tests run on the placenta, for example genetic testing were all okay.

Would it have made a difference if I had realised I was in labour sooner (I could have been at the hospital an hour earlier)?

No. The Consultant thinks that if I had been at the hospital an hour earlier they may have been able to do an emergency c section (Orson had a weak heartbeat on an ultrasound scan 10 -15 minutes before a second scan showed there was no heartbeat). Had they been able to resuscitate Orson and assuming his lungs were sufficiently developed she thinks he would have died aged one or two days old from the infection that I had.

Was the risk of stillbirth much lower than the risk of delivery bearing in mind I had so much blood loss etc. the week Orson died?

Yes. If I had been a few more weeks along then I would have had a scheduled delivery. However at 30 - 31 weeks bearing in mind how little amniotic fluid I had after 21 weeks Orson's lungs may not have been sufficiently developed and he needed the extra weeks. He may not have survived even if he didn't have the infection. In most cases where preterm labour occurs at this stage they would have had time to deliver. We were just very unlucky.

What are the chances that pPROM will happen again?

Assuming my pPROM was caused by the bleeding then 1:50. If I get past the first trimester (1:4 chance of miscarriage) then the Consultant thinks it is likely I will get to take a baby home but that it is likely to be premature or early.

When can I try to conceive again?

Anytime. After a couple months physically I would have been ready. However the Consultant stated that women who get pregnant within a year after stillbirth find it emotionally much harder to cope with the pregnancy than those who leave it longer.

What treatment is there for a future pregnancy?

After an early scan I would see the Consultant at around 12 weeks. I would be tested for infection and after these results were known they would decide on treatment. Possibly if I had Strep b still they may give low dose penecilin from around 18 weeks. However this may have other effects and cause other infections.

From 16 weeks I would have vaginal ultrasound scans to check my cervix was okay. I think she might have said every two weeks for a few weeks.

From about 28 weeks I would have growth scans every 4 weeks.

What about the flowing treatments:

In my case this is unlikely to be of benefit. The Consultant does not think I have a weak cervix and a stitch may introduce infection.

- progesterone?

This is used for women who have had preterm labour. The treatment is going out of favour and is being used less now. However according to the Consultant I do not fit into this category as I showed the opposite tendency - I didn't go into labour for 10 weeks after pPROM.

- vitamins?

Taking multivitamins for pregnant women will not do any harm. The Consultant said when I pressed her on this that she would recommend it and to ensure they include vitamin d and folic acid.


  1. It's good to hear that you are healing (and able to find some laughter again) after such a devestating loss. I hope that when you try again everything goes well and that you can enjoy your pregnancy (as much as possible). I will be following your journey and praying that you get everything you dreamed!

  2. i read many emails from the PROM list about hemorrhaging (correct spelling?). I had a polyp that kept bleeding on my first trim and my new OB speculates that could have affected my rupture. You asked good questions for yourself and you seem to have control of your research.

  3. Thank you so much for documenting this - it's always good to have more information.

    I wish you a normal and boring pregnancy next time :)