Q: I lost a baby after a pre-term delivery due to leakage of amniotic fluid at the end of the 28th week. The baby died after 42 days in NICU due to sudden development of sepsis on the 35th day, which was not responsive to medicines. What could be the reason for breach of membrane? I had a normal pregnancy except a slightly higher BP during the first trimester, which was controlled by alphadopa. I also had Profasi shots twice weekly, during the initial stages of pregnancy. Even two days before the breach occured, I had an USG done, which showed no abnormalities. Now I am trying to conceive again. What precautions should we take this time? I have read about stitches during the 14th week to counter possible cervical incompetence. How is this done? Does it require surgery? I have also read that the growing bag is not big enough to hold the baby till the 9th month. Can this be detected at an early stage?

A:There are numerous reasons for premature rupture of membranes. The most important one is infection, which need not necessarily give rise to symptoms in the pregnant lady, before causing leakage. It is difficult for a pre term baby born at 28 weeks to survive, and if he does, he can have delayed milestones etc. Perhaps, God has spared you and the baby of problems that would have occurred later. An incompetent cervix can be diagnosed before pregnancy and also, in early pregnancy. The cervical stitch is a surgical procedure done around 14th week of pregnancy with a success rate of roughly 85-90%. It is important that congenital malformations of the uterus be ruled out, preferably before pregnancy. Sometimes this malformation co-exists with an incompetent cervix. If such a malformation exists, the it may be corrected surgically (depending upon the malformation). If you are suffering from hypertension, you need to be investigated thoroughly before next pregnancy to find out the possible cause, and see that the blood pressure is under control before attempting next pregnancy. I could not figure out the need to give you HCG injections.