18wk prom

Hello all! We have a pt that came in at 18 wks with prom. Dr has her on strict bedrest in trendelenberg most of the time. She leaked for first 3-4 days she was hospitalized, hasn't started

contracting. This pt hasn't leaked any fluid for past 3 days. Dr has ultrasound ordered for AFI. My question is, have any of you had a pt with this early of rom that had a successful pregancy? We are hoping! One of our nurses remembers one that was later gestation, continued to leak though, infant was not viable when born, lungs had not developed with minimal fluid. Thanks

Greyhorse

[imenid37]

A number of years ago, I took care of a pt. in a similar situation who delivered at approx. 26 weeks. The lungs were under-

developed and the baby did not survive after birth. I guess a lot depends on whether or not the baby continues to produce fluid. This is such a waiting game and a heartbreaking situation for the pt. You don't want to dash her hopes or give false optimism.

[Texagain]

We've had lots make it in similar situations. It depends on how the leakage progresses and it sounds like she's doing O.K. now.

I have an x 23.5 weeker myself who started Kindergarten a couple of weeks ago and is doing very well. I was admitted at 18 weeks, but didn't rupture until 23.

I work for a specialty hospital that delivers between 650 and 800 babies a month with many preemies

Best wishes!

[Jolie, BSN]

We cared for a patient who also came in at about 18 weeks with ROM. She remained on bedrest with no s/s of infection for weeks, but continued to leak fluid. She was given amnioinfusions in an effort to maintain an adequate amount of fluid, and also steriods, starting at about 24 weeks. She delivered at about 28 weeks, but the baby's lungs were hypoplastic, and he did not survive long. It was so terribly sad.

My most sincere prayers for your patient and her baby.

[cindylouwho]

I've seen several early ruptures...some that ended ok and others that didn't...I guess it all depends on the reaccumulation of fluid......there was a female physician that ruptured at 18 weeks and delivered a healthy girl...then one mother I remember had 3 early ruptures in 5 years and all three babies died....all hypoplastic lungs.....they determined she had some genetic problem going on there.......poor lady......

[AmberL&D/RN]

We had an 18-19 weeker come in ppromed, MD's sent her home b/c wasn't viable. She came back at 24 weeks, still pregnant, still with FHT's. Gave steriods, antibiotics...all the goodies. She was even allowed bathroom priveledges (until baby turned breech). She stayed with us for a few weeks, started bleeding, partial abruption and evidence of chorio. They sectioned her and baby actually let out a cry at delivery. Last I heard baby was still in NICU but miraculously doing great for a baby that had undergone such stress. I don't know what the end outcome for this baby and family will be but...THERE IS POWER IN PRAYER

Good luck to this woman and her baby.

[fergus51]

I have never seen a rupture that early work out. I sometimes feel like we are experimenting on these poor people.

[SmilingBluEyes]

18 weeks....very very poor prognosis. If that were ME i would not want to see the baby thru the struggles of being born at 23, 24 weeks, IF I COULD EVEN MAKE IT TO THEN.

I feel horrible for this person. Let us know how things go for her.

[Kayde]

I had twins with prom at 20 weeks. I was admitted in a specialty hospital with no labor. I did bedrest with antibiotics and continued to leak. In seven days, labor started and the babies were born and died thirty minutes later.

[Wackyswirly]

That's really sad, Kayde. I hope you are doing OK. I'll be thinking about you.

[OBNurseShelley]

took care of of 16 week pprom twins, stayed in the hospital until she was like 28 weeks, trendelenburg and complete br at first, eventually she had br priveleges, but had twice a day nst's the whole time she was there, babies turned out fine no probs aftera few weeks in the nicu she continues to send us updates and pictures, amazing if you ask me.

[HazeK]

:) occasionally, miracles DO happen!

leaking stops

fluid levels increase

no maternal infection develops

baby becomes viable does well in NICU

family has a miracle baby to take home!

more than 80% have broken hearts

labor starts within 72 hours of PSROM

chorioamnionitis develops

fluid levels remain too low for lungs to develop

amniotic bands cause severe malformations

lack of cushioning by fluid results in a cord 'accident'

does not live til viability

dies from complications in NICU

lives, but is severely damaged, leaving family phsically, financially, emotionaly distraught.

In our facility, we instruct patients on "their odds", so to speak, then let their preferences and decisions direct our plan of care.

Such a hard situation!

Hugs

Haze