Thursday, July 26, 2007


When we were first admitted, we were given some mini goals leading to big goals.

Our first mini goal was 26 weeks, which we passed with no problems. Our second goal was 28 weeks, which we passed with huge smiles, our third mini goal was 30 weeks, which we conquered 1 week and 5 days ago. Our major goal was 32 weeks. Monday marks 32 weeks.

When we hit 28 weeks, our big goal was moved to 34 weeks. They wanted Matthew to be as big as possible when he's born.

That goal was set when I still had a healthy amount of fluid. With my AFI (Amniotic Fluid Index) now below 3, my risk of infection is much higher.

Today is a slightly boring day, so I started researching things. This past Tuesday, we were given the option of delivering and declined.

If given the option on Monday, I will take gladly deliver. If it isn't offered, I will inquire to the possibility.

I found a few articles of research regarding delivering a baby at 32 weeks versus 34 weeks when the mother has been ruptured for some time. Nearly all of the articles recommended not waiting for 34 weeks since the risk of infection is so great.

The best and easiest to read article is by the Mayo Clinic:

Why deliver at 32 weeks

"Our findings show us that mothers and babies do just as well when the mothers are induced at 32 weeks rather than later at 34 to 36 weeks, the current standard of care," says Brian Brost, MD, Mayo Clinic high-risk pregnancy specialist and study co-author. "So, why take the risk of infection in keeping the baby in mom longer if there's no difference in how the babies do?"

In cases of prolonged early membrane rupture, obstetricians must do a careful dance to get the unborn baby as close as possible to term, while avoiding the increased risk of infection. Mothers in this situation are at risk for infection of the membranes surrounding the baby, and such infection can prompt premature delivery or infection of the uterus after delivery. Unborn babies are at risk for a host of infections, including one that can lead to cerebral palsy, from bacteria entering the baby's bloodstream via the membrane rupture.

"The idea is to deliver the mother before the baby gets an infection," says Dr Brost. "The dilemma is trying to deliver later so baby can get older but before an infection can set in."

The study found that infections in both mom and baby were significantly lower in mothers experiencing membrane rupture when they opted for induction at 32 weeks pregnancy rather than waiting for spontaneous labor. In addition, hospital stay for the newborn was considerably shorter in cases where the mother was induced.

"After 32 weeks, it's unusual for a baby to have lifelong problems," says Dr Brost. "If the baby is infected due to the membrane rupture between 32 and 34 weeks, however, the long-term outcome can be worse."

The Mayo Clinic researchers indicate their findings show induction at 32 weeks gestation is an option for women with prolonged premature membrane rupture and their obstetricians to consider to decrease potential infection risk. However, Dr Brost adds that it is important that such induction occur at medical center equipped to care for the premature infant. In order to confirm the study's findings and prompt a change in nationwide standard of care for mothers with premature membrane rupture, the Mayo researchers say their results would need to be replicated in a large study with multiple medical centers. Currently the practice at Mayo Clinic, says Dr. Brost, is to talk to women in this situation about the option of induction at 32 versus 34 weeks.

The Mayo Clinic researchers conducted their study by analyzing a prospectively maintained obstetric database for spontaneous membrane rupture between 24 and 31 weeks gestation between January 1992 and December 2003. They found 408 cases. The investigators examined the experiences of women with premature membrane rupture who were induced at 32 weeks. The experiences of these women were compared against women with early membrane rupture who waited for spontaneous labor and those whose induction became mandatory due to other medical

Our goal all along was to have a healthy baby who does not suffer from long term disabilites. While I'll do what the doctor thinks is best, I hate the idea of risking infection if it will not benefit Matthew to stay inside that long.

By Monday he should weigh over 4 pounds and even close to 4 1/2!

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