I knew all along that having twins meant that we were at a higher risk of pregnancy complications. I had read about everything from Intrauterine Growth Restriction (IUGR) to preterm labor to an increased chance of preeclampsia. These were all things that I was on the lookout for, but of course the pregnancy complication that we ended up with was something that I didn't really know anything about.
Judging by the reactions of my family and friends when they heard that my "water broke," I would wager that very few people know anything about pPROM unless it has personally affected their lives. Preterm Premature Rupture Of Membranes (commonly referred to as pPROM) is a serious pregnancy complication that is the rupturing of the amniotic sac before 37 weeks and before contractions (or labor) begins. The most critical part of that definition in my case is the "before 37 weeks" part. Although, the before labor begins portion of the definition is the only reason why I am writing this post from an OB Special Care Room instead of a Labor and Delivery Recovery Room.
In most cases, labor will spontaneously begin within 72 hours after your "water breaks." However, in cases where the amniotic sac ruptures at a very early gestation (like me for example) the body sometimes resists going into labor. This small chance is what we are pinning all of our hopes on right now. You can do an internet search for pPROM and find women who lasted up to 10 weeks after "rupturing" before going into labor. Unfortunately, these miraculous cases are the exception. Even in an ideal situation, most women will either get an infection or go into labor within 2 weeks.
The list of risks and negative consequences of pPROM includes uterine infection, the baby catching an infection, placental abruption, a prolapsed umbilical cord, and either preterm delivery, stillbirth, or miscarriage depending on the gestational age and health of the baby. So, once things go bad after pPROM, it generally means the end of pregnancy since all of the complications will lead to an immediate delivery.
Why does pPROM happen? The most common reason is that an infection weakens the membrane causing it to rupture. I don't have any signs of infection though and my doctor thinks that there was a weak spot in the membrane that didn't develop right. Multiple pregnancies are sometimes cited as being at a higher risk for pPROM, but many, many singleton pregnancies are affected as well.
My doctors and nurses are constantly reminding me that there is nothing that I did to cause this to happen and it is something that I have to repeat to myself often. Chances are that I will never know what caused Baby A's amniotic sac to rupture and it is hard not knowing what went wrong. I'd been having an uncomplicated, easy twin pregnancy up until that point in time and I was always very careful about following "the rules" and not overdoing it. But...here we are.
**Update on our current condition**
Rather than publishing two separate posts in a day, I will just tack on a quick update for now. There has been no real change in our condition over the last several days. I am in the hospital on bed rest and antibiotics. All we can do is take this one day at a time. They are monitoring me and the babies for signs of infection and contractions. I am still leaking amniotic fluid once or twice a day which is the most unsettling thing, but they tell me that I should expect that to continue. Our hopes and prayers are that we will be luckier than most who suffer from pPROM and that we will be able to maintain the pregnancy for several weeks. Our big goal is to make it to 28 weeks, but that would be just over four weeks after rupturing which is a really long time. In reality, every single day matters and I try to focus on the little goals such as staying pregnant and healthy for today. This is our 6th day in the hospital and I am so grateful for each one of those days. While the odds are still against us...every single day that they can grow and mature inside me, increases their chance of survival substantially. I am torn between being hopeful and complete despair over the statistics. My babies are moving more than I've ever felt them move before. It's almost as if they are comforting me by reminding me that they are still in there and strong.