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Managing PPROM Without Terminating a Pregnancy

by Grattan Brown, STD, and Stephen Blaha, MD

After the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization, there was confusion and fearmongering about whether pregnant women would receive care when life-threatening complications arose. But even before 1973, women never needed Roe to receive treatment for those complications. They did not need Roe when Roe was the law of the land. They do not need Roe now. The Catholic Church is one of the strongest opponents of abortion, but even in the 1950s, Pope Pius XII taught the basic distinction between abortion and emergency care, relying on ethical principles that go back hundreds of years.

Following that basic distinction, pro-life medical professionals today have been successfully treating these complications, usually with a good outcome for the child as well as the mother. The impact of Roe has not been to enable these good outcomes but to permit a termination of pregnancy when complications could have been managed and a child born.

One well-known kind of complication, the preterm premature rupture of membrane (PPROM), occurs in about 2-4% of all singleton and 7-20% of twin pregnancies. This study of PPROM outcomes showed a child survival rate of about 90% with access to a modern neonatal intensive care unit. No mothers enrolled in the study died. Every case is unique, but these data tell us that termination of pregnancy is not likely to be necessary when a PPROM diagnosis is made. Presenting termination and management to patients as equal options is misleading.

In the following story, Dr. Stephen Blaha tells in his own words how he managed the risks of PPROM to help one of his patients give birth.

I remember a patient who presented with PPROM at about 18 or 19 weeks. At that point, the baby is not viable, so you can't solve the problem by inducing labor and delivery. Even at the point of viability, it is better if the mother continues the pregnancy as long as possible to let the baby develop.

I recognized the mother because she worked in healthcare. She had enough background to recognize the risks and had heard lots of stories, so she was understandably nervous and scared. But she was not an OB/GYN and did not know how we treat complications and manage risk. She had a strong and optimistic demeanor with a supportive family.

Fortunately, I happened to be the doctor on call when she showed up at the hospital with ruptured membranes. In my experience, how a woman is counseled during the very first meeting influences the decisions she makes later on. When a woman and her family are scared about her life and the baby's life, they tend to trust the expert. What they really care about is that you make the right recommendation for them in their situation. And for that, they need to know that you care about them and their child. How we approach and discuss her options will have a significant impact on her decisions. When emotions are high while making a decision, it all can feel overwhelming.

First, I told her and her family that there are risks but that there is a very good chance that their baby will have good long-term outcomes. Then I went over all the different risks. The risks are never 100%, but never 5% either. Most are in the 30-50% range. For each potential complication, I explained how we treat it if it develops.

This family's religious background was Christian. Sometimes patients will really try to push for one thing or another, but this patient and her family did not try to influence me. They were willing to consider whatever advice I offered and thought carefully about it all.

I also told them that, depending on who they talk to, they might hear different recommendations and emphasis on the worst possible outcomes. I knew that in these cases some doctors recommend terminating the pregnancy primarily based on the risks of infection in the mother and long-term complications in the baby. But the risk of infection with PPROM is less than 50% and for a serious infection called sepsis only about 5%. Depending on a variety of different factors most babies will go on to have normal health or just minor health issues.

I was not going to try to sway them in the direction of terminating the pregnancy. In fact, I purposely emphasized the benefits of continuing the pregnancy. I think that is the right thing to do. I knew the progress of her pregnancy could become challenging, but I also knew how to manage it. Most of all, I presume that the family wants the baby. They did not want or need to be frightened into terminating the pregnancy. The mother needed encouragement that she could probably deliver her child, which was true in this case. She needed the assurance that our medical team was not going to let emerging complications jeopardize her health and life.

Some people might think I am not being neutral. I was obligated to, and did, mention that terminating the pregnancy is legally permissible in this situation and why some physicians would recommend it. But I don’t think anyone is truly neutral in this situation. In our profession today, being neutral effectively means presenting termination of pregnancy as an ethical option to avoid a problem that is unlikely to come about and that can be well managed if it does. That is neither neutral nor ethical.

Fortunately, the doctor who came on duty after me had a similar viewpoint. We set up a plan of treatment and were able to discharge the patient. She continued on with the pregnancy, making it to 28 weeks before she delivered and with the baby still doing really well. If it had been a different doctor on call, the baby might not be alive right now, and the family would have to wonder if their child might have made it.

Browse all of the stories here.

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Disclaimer: The views presented in the Rehumanize Blog do not necessarily represent the views of all members, contributors, or donors. We exist to present a forum for discussion within the Consistent Life Ethic, to promote discourse and present an opportunity for peer review and dialogue.

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