WOMENS-HEALTH Messages for June, 1999: PROM at 23 weeks (fairly long)

PROM at 23 weeks (fairly long)

From: A. (anonymous@obgyn.net)
Sat, 19 Jun 1999 10:06:36 -0500 (CDT)

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A friend, who had been struggling with a high-risk pregnancy (extensive abruption of placenta at 14 weeks with heavy bleeding, complete bedrest, etc) called yesterday to tell me her membrane had broken. By LMP, she is now 23 weeks. By U/S, she is 21 weeks.

She lost, she thinks, *all* her fluid, but the baby is alive in there. So she went to her doctor's office and saw her regular doctor's partner (her OB is on vacation for 3 weeks). He told her to come to the hospital for induction, because "we'll just declare the party over" and said she should prepare for the possibility of surgery. She said she didn't want to induce, wanted to give this baby any chance there might be. The Dr. did not (would not?) answer her questions about what she could *try*. Nor did he start her on antibiotics or suggest anything that might assist her in getting this baby to 24 weeks (though, based on LMP, that might be only one week, instead of three).

This is when she called me, because she knows my own current twins pregnancy has had more than its fair share of problems, and did I have *any* suggestions?

I referred her to the same perinatologist group I'm using, because I know the doctors and knew that one in particular, while he couldn't offer her much hope, would *talk* to her and tell her what she can try, and what she can expect next if X happens, if Y happens, if Z happens. She saw him, and he gave her information she can work with. She knows the outlook is very grim. But she's going to *try*. He started her on antibiotics and sent her home to lie in a Trendellenburg position on one of those beds that the foot can be raised - she had already noted that she could accumulate some fluid when her hips were elevated higher than her head. She'll use a bedpan, or her husband (an RN) will cath her (probably straight in-and-out). She's to see the perinatologist again in 2 weeks if she gets that far, but he does expect to see her sooner, unfortunately. If she does get that far, he'll begin beta-methazone shots and have her admitted to the University of Washington Medical Center until she delivers (because of their Level-III NICU).

Now my questions are four (I'm sorry, I know it's too many):

1. Could the U/S GA of 21 weeks be a result of IUGR caused by the abruption, and 23 weeks based on LMP be much closer to her actual gestional age?

2. Can you doctors and midwives think of anything else she can *try* to stave off ascending infection (besides an utter moratorium on vaginal exams of any sort)? Would garlic/echinacea/Vitamin C be of any potential help?

3. Is there anything known to increase output of amniotic fluid?

4. Can a PROM of this variety re-seal itself without infection setting in? I've heard anecdotal evidence that it can happen sometimes.

Please advise.

Thank you for your time,

--angela

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