The Potential risks of PPROM To Your Baby’s Arms, Legs and Nervous System: A Doctor’s Perspective

I am writing this article, both as a doctor and as a PPROM dad. I know all to well what many of you are going through. Whilst I have been a doctor for ten years, I knew as little about PPROM as most of you do when it happened during my wife’s pregnancy. However, my job as an orthopaedic surgeon about to complete his training has given me a much greater knowledge about the potential effects of PPROM on your baby’s musculoskeletal system and nervous system. I’ve seen a lot of people who have been told to terminate their pregnancy on the basis of risks such as limb contractures, club foot and cerebral palsy. This is something which shocked me. Whilst termination is a very personal choice for all mums, I think everyone should be aware of what these conditions mean and the quality of life you can expect your

baby to have should they be affected by these conditions. There is not good research out there regarding how common these conditions are, but from what I’ve seen in the group, many children who have gone through PPROM are born without any of these conditions and have no problems with their arms or legs whatsoever.

Me and my wife have been members of the group since her membranes ruptured at 14 weeks back in October 2018. We never had any fluid from the time of rupture until our little miracle baby was born at 31+2 weeks. It was a tough journey, both before and after the birth, but after 97 days in hospital our son came home and is now doing well. Like many of you, we were told there was no chance of our baby surviving and that we should terminate.

Club foot is the most common limb deformity seen at birth and is seen in many otherwise normal pregnancies. It is more common with less fluid because the foot is squished. It can be treated with a course of casting, a small operation under local anaesthetic and splinting until the baby is 5. Often children will end up with a slightly different looking foot, but will have no long-term problems with the foot after treatment. The treatment is quite labour-intensive and involves lots of trips back and forth to the hospital for cast changes, but is well tolerated by babies and leads to a very good functional result in most children. Occasionally, the deformity can recur and require more major surgery when the child is a bit older.

Fig 1: A baby with clubfoot of both feet

Fig 2: Casting for clubfoot

Cerebral Palsy is a very broad term for children who sustain brain damage in the first two years of life. It can vary from children with only one leg or arm affected to children with both legs, half their body or their whole body effected. It leaves them with stiff, weak arms and legs which often need physio and/or surgery at multiple stages of growth. However, the vast majority of children with CP live happy and fulfilled lives. Many can walk, get jobs and go on to live an independent existence. Even ones who are more disabled can enjoy their lives.

Limb contractures are when a baby’s joints don’t move as much as they should and are often unable to fully straighten. They are often treated with physio alone and settle down. Sometimes they need surgery, but are also treatable. Our son was born with quite severe contractions of his elbows, wrists, hips, knees and ankles/feet. His elbows were so bent it was very difficult for the medical team to find veins to insert medications into. A large amount of the stiffness in his joints settled in the first few weeks with very little help. Gentle stretching exercises have helped improve his range of movement even further. Now, at 8 months corrected age he can almost fully straighten all his joints and the medical team are helpful this won’t be a problem for him in later life. Most of his contractures corrected with time alone, and he didn’t require much physio at all for this.

Dislocated hips, which are also mentioned in the group many times are often treated with a special harness which has a 90% success rate of getting the hip back in. If this doesn’t work, surgery is required which is also often successful. Our son’s right hip was completely dislocated when he was born. The doctors tried to treat this with a harness which unfortunately didn’t work in our case. When he was almost four months old he had an operation involving a cut in the groin to put his hip back in. Following this he needed three months in a plaster cast, 6 weeks wearing a splint night and day and a further four weeks of wearing a splint just at night. Whilst it is early days and his hip is still quite stiff, everything appears to be going well. If this procedure doesn’t work further surgery can involve cutting and redirecting the thigh bone or the pelvis. Even if the hip can never be put back in it doesn’t stop children from walking!

Fig 3: A baby wearing a Pavlik harness for shallow/dislocated hips

Fig 4: A baby with a hip spica (plaster cast) for dislocated hip

In summary, children are amazing, and can cope with a lot of problems which is adults think would be impossible to deal with. Keep yourselves armed with the facts, and it makes everything much more manageable. None of the musculoskeletal or neurological conditions associated with PPROM are untreatable. Some don’t lead to any long-term effects whilst others do. What is important is knowing enough about these conditions to be able to make informed decisions. If anyone has any questions, please do not hesitate to contact me in the Little Heartbeats Facebook group or on twitter.

Matt Walker PPROM Dad and Orthopaedic Surgical Registrar

MattJWalker1987