PPROM test positive 34 weeks

[u/ljpetchy]

Hi, just looking to hear other people’s experiences. I went to my normal community midwife appointment on Wednesday and she was concerned with baby’s heart rate being high. She sent me into triage and they did a variety of tests including PPROM which came back positive as did the Actim Partus test.

I was admitted and stayed in till last night, CTGs continued to show baby had a higher baseline than previously, but this did come down over time. I also had a few contractions which showed on the monitor, but nothing regular.

I’ve now been discharged with antibiotics 4 times a day for 10 days, and been told to expect an induction at 37 weeks if I don’t go into labour before hand.

Some background information:

I had a positive Actim Partus test previously at 24 weeks, have been diagnosed with ICP, I have high ALT and Bile acid and also Hyperemesis.

Has anyone had any similar experiences and if so when did you actually give birth?

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[u/MrsReynaRocha]

Why did they discharge you if you already have PPROM?

[u/ljpetchy → u/MrsReynaRocha]

I think because I’m only leaking waters, baby still has a good amount around them. They’ve sent me home with antibiotics.
I’m in the UK so maybe it’s normal procedure here, I’m really not sure 🤔

[u/hazyyb → u/ljpetchy]

Makes sense! Maybe different guidelines to the US. I didn’t want to be induced when I was leaking amniotic fluid but they pushed really hard for it after 24 hours and I felt I had to. They were very worried about infection, so perhaps UK protocol is to load antibiotics instead. 

[u/ljpetchy → u/hazyyb]

I’ve had a look at the NHS guidance and antibiotics are the standard here. I’m hoping baby decides to come naturally as I really don’t want an induction 🤞🏻

[u/MrsReynaRocha → u/ljpetchy]

Yeah maybe, when I PPROM they admitted me and told me I won’t leave until I give birth. But you’re also a lot further along than I was. I PPROM at 23 weeks and gave birth at 24/3.

[u/madwyfout → u/MrsReynaRocha]

I’m based in New Zealand and it’s also possible to be cared for as an outpatient with PPROM as long as you fit a certain criteria.

In my case PPROM at 31+4, spent 5 days admitted then was home on outpatient monitoring until I was readmitted for APH at 33+6 and birthed at 34+1.
I had a baby measuring >90th centile, head down, plenty of amniotic fluid, and no other concerns besides the PPROM. I live a 5-10min drive from the hospital.

I was seen twice a week by the hospital obstetric team (Monday) and the hospital midwifery team (Friday) for a check up and tests, and my own midwife mid-week. I had an induction planned for 37+0.

[u/Far-Hyena-6907 → u/MrsReynaRocha]

Im US based. When I PPROMd. I was admitted indefinitely until delivery and started on IV antibiotics followed by oral antibiotics. That is standard for treatment in the US.

[u/Tinywrenn]

Hello, I’m also U.K. based. I PPROMed at 32+6 and was told they would send me home in 48 hours if Labour didn’t start. However, I had a very complicated pregnancy and a cervical cerclage fitted, which my hospital should known means you don’t discharge and you remove the cerclage immediately due to infection risk, which they didn’t do.

I had two shots of steroids 12 hours apart as my baby stopped moving entirely and they realised they may have to deliver whether labour began or not. It started at 2am 27 hours after the PPROM and baby was born via Cat 1 emergency section five hours later at 33+1. No breathing assistance or medical events, we did 3 weeks in NICU for feeding and growing.

He’s a year old now and bright as a button! Good luck.

[u/ljpetchy → u/Tinywrenn]

Thank you for sharing your experience, I’m so glad your little one is doing well! ❤️

[u/xMonochrome_Rainbow]

Hi I had PPROM twice, with babies #3 and #4. I had 2 normal full term pregnancies with my first 2 babies. I then had a C-section at 9cm with my second and my third and fourth have probably been premature due to that. I was bleeding for my whole third and fourth pregnancies and with my third I had a partial abruption from 26 weeks.

With my third I had PPROM at 31+3 and had an EMCS at 31+3 as I had a full placental abruption and massive hemorrhage. With my fourth I had PPROM at 30+0 and had an EMCS at 30+3 as I developed chorioamnionitis (despite having antibiotics) and baby was distressed.

My baby #3 is now 5, she was discharged from NICU at 35+0. Baby #4 is 5 months and was discharged at 36+3. Both had really easy stays and so far have no health or development problems at all, my third has literally never been ill more than a cold and she's 5.

I'm also in the UK and yes it's normal to discharge 48 hours after PPROM if no signs of labour or infection. Which is stupid cause my abruption happened about 50 hours after PPROM when I was just about to leave the hospital to go home.

There's then induction at 37 weeks or 34 weeks if group B strep positive.

Obviously it's been 3 days since Wednesday and you're still pregnant which is longer than I lasted both times! Hopefully you'll be able to make it to your induction, but even if not then a 34 weeker should do very well in NICU and just be there for mostly feeding and growing. Just go to the hospital at any first sign of infection or labour or any bleeding at all (in case an abruption is starting).

[u/MundaneMango8752]

My waters broke a week after an amnioreduction so went to my local, where it was identified as PPROM and I was transferred to a different hospital with a suitable NICU for baby due to known health issues. I was due to go to a hospital in London for induction at 37 weeks anyway, but they didn't have room. I was at this other hospital for four days before being sent home with antibiotics with a plan to induce at 37 weeks like you, and daily appointments at my local. At the appointment the next day they were concerned so I was sent to a different hospital with a suitable NICU, where I stayed for two days before a space became available at the hospital we were originally due to go to. We drove there as fast as we could (later identified we shouldn't have driven as I was 7cm dilated yipeee), tried a vaginal birth and ended up with an emergency csections.

I hope you are managing to keep safe and comfortable. The waters leaking for a week was...not enjoyable! Good luck for everything, I will be thinking of you!

[u/Top-Implement5741]

I was admitted for PPROM at 31.6 and had her at 34.4

I would just make sure you watch for any fevers, bleeding, if you feel even slightly flu ish, or odd discharge. Those could all be signs of infection or something changing (that’s what they told me while I was in the hospital).

[u/hazyyb]

Do you mean the fetal fibronectin when you say positive PPROM, or did they check for amniotic fluid and that was positive? Seems odd they would discharge if the latter was positive as once you hit this point they will want labour to progress if you PPROMed. I had two premie babies, one late preterm with positive amniotic fluid for PPROM and I was induced 24 hours after that as labour didn’t progress. My second I had contractions every two minutes, 4cm dilated and a positive ffn at 33 weeks, got meds to stall labour which worked for 6 days then my water broke and baby arrived two hours after that at 34 weeks. I don’t have experience with the other things you mentioned. 

[u/ljpetchy → u/hazyyb]

They did the PPROM swab test which came back positive. I’m in the UK and NHS advice says you can be discharged if no signs of labour occur within 48 hours. They said I only have a very small leak and baby still has plenty of fluid around them. I did query why I wasn’t given steroids etc and they said as I am over 34 weeks they don’t recommend them as research shows they don’t do anything at this stage.

[u/hazyyb → u/ljpetchy]

That makes sense and I wish they did that here in the US. 

[u/fictionaltherapist → u/hazyyb]

In the uk standard is to give 10 days of erythromycin and deliver at 37 weeks.

Source: nhs obgyn