Sharing so that others may find this story since I feel so alone and anxious now.
Two and a half weeks ago I woke up in the middle of the night to some pink fluid leaking. I was just past 16 weeks with di/di twins and on my last business trip for the year. I leaked a little bit more a few days later and brought it up at my OB appt at the end of the week. I've never had spotting before but he reassured me that spotting is normal and twin pregnancies can be different than my previous singleton pregnancies. However, Baby A had low amniotic fluid. It measured at 1.2cm MVP (maximal vertical pocket). I was referred to the MFM at the nearby hospital, but they were booked for over a week out.
I had one more light leak the next week and then on Friday (the day after a Costco run with heavy lifting) I woke up to a very large gush of pink fluid. I called the OB when they opened and they got me in that afternoon. Both babies had heartbeats, but Baby A now had no measurable fluid. Not hard to put 2+2 together to get 4, but it was truly confirmed when they swabbed me and the fluid tested positive in the 'fern' test under a microscope.
We were informed that they would try to bump us up at the MFM to Monday but in the meantime, all I could do was go home and watch for any contractions which would mean I was miscarrying. No need for bedrest, just keep activity light. The OB said he'd had one patient that had ruptured early and got to term so there was hope, just not much.
I cried the whole way home. Had a terrible weekend where I put myself on bedrest and researched the crap out of it. I discovered it was called PPROM and the low/no amniotic fluid was Oligohydramnios. I was at a higher risk of infection and thus preterm delivery or fetal loss in the womb that would later deliver as a stillborn with the hopefully still living twin. Also amniotic fluid is used to develop the lungs, so without any, you have a baby that can't breathe. So even without infection, things were not looking good for Twin A.
I got into the MFM yesterday. They spent a looooong time trying to get all measurements and checks on the ultrasound for both babies. It was clear that baby A was scrunched up with no fluid, while baby B had a full sac and lots of movement. Kidneys and stomach were full and working which means that baby A will keep making amniotic fluid even though it will keep leaking. The MFM walked us through all the known indicators for PPROM (like incompetent cervix, amniocentesis, placenta failures) and we had none, so we fall into the unexplained bucket. This means that there is nothing we can do to fix it now or prevent in future pregnancies. He walked us through the scenario of infection and loss, then delayed birth but no lung development and then added that because baby was essentially saran wrapped, there could be muscle problems and 'contractions' like clubfoot that could be corrected with therapy, but those were less serious.
In my research, there are not many studies out there for PPROM before 20 or even 17 weeks so I had trouble even trying to gauge my odds to hitting 24 weeks.
24 weeks is the magic number for viability. If you deliver before 20 weeks, it is classified as a miscarriage, their organs are not developed enough. After 20 weeks it is a stillbirth and they typically die because their lungs are not developed enough. Some hospitals may try to save down to 22 weeks depending on weight of the baby, but not most.
In our situation with one twin ruptured: first, we have to try to hit 24 weeks first at home with hope and luck and increased appts for monitoring. I'm also supposed to check my temp every day for signs of a fever thus infection. Once we hit 24 weeks, I can choose to be submitted to the hospital for monitoring, antibiotics, and steroid shots to help speed development up. Because Baby A has little/no fluid, there's a chance the cord could get compressed cutting off their oxygen and necessitating an emergency C-section. However, if that happens at an early week, that means we are also dooming Baby B to the same NICU stay and odds even though they would have kept going just fine. The earlier they come, obviously the worse the chances are that they both come home. By 28 weeks, things start to look up statistically, then 30, and 32 and finally, at 34 weeks the risks become too great for infection and they'll be induced. So at some point we may have to make the call if we want two early babies with a low survival rate, or a healthy baby and a stillborn.
Things I have read that reassure me: typically 1/3 PPROM babies go into labor in 72 hours, then 1/3 in 2 weeks, the last 1/3 have a longer 'latency' period. This data is probably based on all PROM that happens before 37 weeks though. By the time I got to the MFM, I was past the 2 week mark. Typically earlier ruptures mean a longer latency period in the span of weeks vs days.
After 20 weeks, amniotic fluid is mostly generated by baby urine. Before then it is pulled in from osmosis, so it is very important to stay super hydrated at all times. The more you drink, the more the baby will be able to pull into the sac and generate with urine. I'm currently trying to drink a gallon of water/gatorade/bodyarmor a day.
Also, sometimes people seal back up. There's a little evidence for vitamin C and collagen playing a role in membrane strength.
There isn't much evidence for or against bedrest in this situation. Generally the UK doesn't like to use bedrest, but the US does in this situation. Pelvic rest however is standard because you don't want to introduce anything to the vagina and risk infection.
It makes sense to me that not moving around would give the amniotic fluid more of a chance to build up instead of leaking with your movement. Every time I've leaked, it has been due to higher physical movement the day before. Sometimes the baby can plug the hole with their body and have fluid for a little while. Possibly they'll even be able to have it by their face and use it for 'practice breathing'. I got to see baby A actually do practice breathing with a tiny 1cm pocket at the MFM which gives me hope.
I hope that I'll be able to provide a positive update in a few weeks, but at least this crazy long post may help another poor mom understand what early PPROM means.