General Category => What's Your Story? Tell us. => Topic started by: OBmom on February 15, 2018 at 09:22 AM

Title: 24 weeks and facing preterm labor.. again!
Post by: OBmom on February 15, 2018 at 09:22 AM
Hi everybody.
Reading all your stories has been such a comfort. I want to thank you all for sharing your wins, and say I'm so so sorry for those of you who've experienced such tragic loss.
First of all, let me tell you I'm an OB specialist, so I got the technical aspects of this pretty much covered. But when the tables turned and I became the patient, things changed dramatically.

My first pregnancy was absolutely unremarkable up until 24 weeks. Perfect scans, feeling fine. At 24w I started having contractions on occasion. Nothing painful, nothing repetitive. Nothing to worry about, I told myself. I even asked one of my co-workers to check my cervix, just to make sure. And sure enough, at 36mm we were fine. Just fine. 2 weeks passed and I  continued to work, including ER shifts, I only stopped working nights. At 27 weeks, I got my cervix checked again - 27mm. "Not so great, but still okay right?" I decided to take a week off work and go on vacation. When I came back, at 28 weeks, my first shift was ER. One of the doctors on my team insisted I have a cervical ultrasound, just to be absolutely sure.
And my world stopped in its tracks. At 28 weeks my cervix was down to 8mm and I was at High Risk for preterm labor.
Imagine the shock, switching from "doctor-on-the-ER-OB-team" to "lady in room 5" in our Labour Ward.
We decided on placing a pessary (Arabin), medication for the contractions (nifedipine) and started steroids for the baby's lungs. I was admitted to our fetal-maternal medicine ward - my place of work - for three days. After that I begged to be allowed to go home, and they let me. Modified bed rest, of course.
Unfortunately, continued contractions led to my water breaking at 29w and 4 days. Not such a big splash, what we doctors call a "high rupture". But it did mean I had to be admitted again for IV antibiotics to lower the chance of infection. Long story short, I stayed in a hospital bed for the next 5 weeks, getting regular blood check-ups to monitor for infection. Lucky lucky me, the amniotic fluid levels (AFI) stayed almost normal, and baby's scans were fine every time.

--- Let me just say here that one of you suggested reading this article by Katherine Heiny - - and it explains that hospital admission part SO much better that I ever could. Truly cathartic. ---

At 34 weeks we removed the pessary because the risk of being preterm at that point is not as worrysome as the risk of infection. I delivered at 34 weeks and 2 days, a beautiful and healthy baby boy, 2140g. He stayed in the NICU for 2 weeks with no complications, just learning how to eat properly 'cause he was a little lazy.

So anyway.. almost 3 years later, here we are again. Of course we were worried about my obstetric past, so we planned for strict watching out for everything. Spontaneous second pregnancy, normal first trimester scan. Progesterone starting at 14 weeks. Cervical length monitoring starting at 16w. I stopped working at 20 weeks, again because of contractions. Normal morphology and heart scan at 21 weeks. And then, at a routine scan at 23w 5d, a shortened cervix. Again. 18mm.
We've decided on placing a pessary since it worked so well the first time around and cerclage placement this far along can be dangerous. And I've been sent home for modified bed rest. Again.

I'm really scared because this time is even earlier than last time. Being an OB, I have an inflated sense of the consequences of being born this early. I've had "the talk" with concerned parents more times than I can count. Above all, I'm terrified I'll have to be admitted again, not knowing for how long. And of leaving my rock of a husband and my vibrant, cuddly 2,5 year old at home. We're staying at my mom's for extra support and I've taken medication for contractions.
I know I'm doing everything that can possibly be done, and I still worry it might not be enough.

So.. Sorry for the extra-long post. If you're on bed rest like me, and you're bored stiff after 3 days, I hope you might enjoy the read.
Feel free to ask questions, I'll give it my best to answer (with inside knowledge  ;))

Best of luck to all you future moms out there struggling with threatened PTB!
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: reasontohope on February 15, 2018 at 01:25 PM
That was me who posted the Heiny article! Wow, cathartic is definitely the word. I read it shortly after bringing home my 36 week 3 day miracle, born after almost 4 months' bed rest and within 2 days of removing the miracle pessary, and wow, I sobbed.

Reading your story made me think again about my pessary...I'm really hopeful for you because for both of us, the pessary seemed to hold our pregnancies in place. I went down as low as 4 mm in cervical length and had a positive fFN, but stayed pregnant until the pessary was removed. This also mirrors what my MFM practice (well-respected research practice connected to a med school) told me they are finding, that the pessary really seems to work for a certain subset of patients (as always though, hard to tell exactly who). Because it worked for me this time, they are optimistic that if we have a second child it will work again if needed. They won't place it automatically though, they will just monitor for cervical length and give me progesterone shots.

I hope you are doing ok! Bed rest is such a mind trip. Sending you all the best! <3
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: Freshview on February 16, 2018 at 12:23 AM
Hi, thanks for sharing your stories.
OBmom - I can so relate. I’m a registered midwife and laboured at 24 weeks (anatomy scan at 20 weeks shows 4cm cvx trans abdo) and was 70% effaced and 4cm dilated on admission with moderate ctxs. For 2 days I was looked after by my colleagues and consultants. I received excellent care, but it ended in the birth and death of my son - in my workplace amongst my colleagues. Needless to say I haven’t gone back to work.
We won’t know if it was cervical incompetence or labour for some other reason, but my MFM has said she’d do a cerclage next pregnancy, in large part to support my mental health. She hasn’t mentioned a pessary. Are both of you in the UK? I’m wondering if it’s just a European intervention. I’m in Canada.
I’m keeping my fingers crossed for you and a nice, long pregnancy. 
Thank you.
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: OBmom on February 17, 2018 at 09:18 AM
Hi Freshview. Thanks for sharing your story. I can't imagine how hard that must have been. That 3cm dilation really is so hard to reverse.. My heart goes out to you and I hope you're healing.

I'm in a big MFM center in Lisbon. We're huge fans of pessaries for cases like mine. Probably yours also. We usually go for cerclage in classical insufficient cervix cases ( 2 previews losses with decreasing gestational age). In your case we'd probably do a cervical length check (vaginal) at around 15w and place a stitch if you were below 25mm. Otherwise we'd check at 2 week intervals and go for a pessary placement if the cervix got to 20mm or less.

FYI, I wrote to Dr. Arabin herself during my first pregnancy. Even if your practice isn't big on pessaries you can order one online, they deliver international. They're pretty easy to put in.

Hope this helps..
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: EnglishRose23 on February 17, 2018 at 12:30 PM
OBmom: Since you were kind enough to give me some advice, a few non-medical words of wisdom I can offer you.

You will make it past the super-scary micro-preemie stage soon, but since you're a dr you've probably had to warn parents about survival odds and severe disabilities at this stage: try to connect with some people who have had success stories. I fund raise for the March of Dimes, and the keynote speaker at our walk last year was a former 24 weeker. He was a honor-roll high school student and athlete, about to graduate and go to college on a full scholarship. His parents talked about his complications as an infant, and how long and grueling his NICU stay was, and all of that is true for any parent of a micro-preemie. They suffer extensively, but there is a beautiful ending to many of these stories, with happy healthy children growing up.

It's great that you are able to stay at your moms for the extra support. I think things like that can really make a difference in the outcome. I hear you on being terrified of being admitted again. As awful as bedrest at home is it is so much worse in the hospital. My second time round as an inpatient I had definitely learned a few things, and one of those if you don't need to follow every bit of medical advice since a lot of it is "hospital policy" designed to make sure they don't get sued over something that had minimal risk to begin with.  I was able to get the rules bent on a few things that made my stay more comfortable, clothes from home, dark tape covering all the flashing lights in the room to give me an outside chance at sleep, food during threatened labor (this was a big one, since I was threatening pretty much every other day I was missing a lot of meals, finally stood my ground and demanded to speak to the head anesthesiologist, and after a long discussion on the risks and benefits I earned back meal privileges, apparently this was a first for their hospital), and lastly not being shy on requesting visitors, having people come and go with news of the outside world is so important, no reason why your husband and child can't spend most of the day in that room with you. I even got visits from my three dogs (had to be wheeled down to the parking lot for it, but it always made my day). So instead of worrying about that hospital stay, start planning now for how you can make it more bearable.

Good luck to you!
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: Flynnsprinkles on February 20, 2018 at 12:50 PM
Thank you for sharing your story. It's always harder when you are not just a patient but a medical professional. I'm a peds NP with a neonatal background now working in primary care. I see the other side of the OB/MFM side. While our MFM Dr kept saying 28 weeks is a success I kept reminding him of the hurdles babies face. This was at 22w with about 4-6mm of cervix left. Fortunately his wife is a pediatrician and he said I sounded just like her so off to surgery I went to get my cerclage. Now at 35 weeks I know I have made it this far because of this intervention.

You're being proactive as much as you can but of course that can't fend off all the worry. I focused all my energy on visualizing my cervix holding. If anything it kept me positive minded. And my 2.5 year old has been such a trooper. They are more resilient than we give them credit for. I just keep talking to her about baby and all we'll get to do when she's born. Hang in there!
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: OBmom on February 26, 2018 at 11:01 AM
Hey ladies.

Just sharing some great news that have got me smiling   :)
I am now at 26 weeks +1day, and still having some 4-6 painfull contractions everyday.
I did have another scan though, and my cervix is holding stable at 18mm (#LoveThePessary) YAY! Baby has turned to sitting position (breech) but that's really for the best since when they're head-down they put so much more pressure on the cervical canal. Anyway, only 2 more weeks till the 28-week-hurdle and then I think I'll breathe easier.
Funny how the first time around 28 weeks seemed impossibly tiny, and now it's a goal we're aiming for  ;D ;D

DH still being his lovable supporting self, but 4 weeks of living with his mother-in-law takes a toll. And my 2-year-old has started kissing my belly "for his brother".. Adorable!

Today I had my glucose tolerance test, I don't know how anyone tolerates that thing! Ugh! I kept thinking "do this now and do do it right or they'll make you do it again!" ;D Only good part was the excuse to get out of the house. Still feeling the nausea though. And if all this lying around gives me gestational diabetes well.. tough! I guess none of us are going jogging anytime soon right?  ;D ;D ;D

Feeling good today mommas! Hope you all have a great day.
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: MissKBoss on February 26, 2018 at 06:53 PM
Yay for being stable and almost at 28 weeks.  must be such a relief. Praying you continue to hold strong and get bubs to full term  God is great.
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: Anish on March 07, 2018 at 11:46 AM
There you go OBMum. Glad to have a dr with us😊😊 We will make it to good viability💪 This far the Lord has been good and faithful. This group eases alot of anxiety and uncertainity.. #hope for better. Cant wait to hear more wins for you😊
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: OBmom on March 10, 2018 at 07:11 AM
Hey guys.

Had another ultrasound yesterday, at this point no news is good news. CL is still stable with the pessary, and baby boy is doing just fine. EFW (estimated fetal weight) is just over 1,1kg which is fantastic. NICU specialists say that 1 kg is a big milestone survival-wise. Still breech though, which causes mixed feelings. On one hand, not so much pressure on the cervix. On the other hand, if I do go into labor, delivering breech can be trickier for moms and beanies.. We'll just have to see.
Next goal is 32 weeks and 1,5 kg and I'm really starting to believe we're going to make it there.

I'll be 28 weeks tomorrow (BIG YAY) and I'm kind of hoping to ease up on the "strict" part of bedrest.
Any ideas of what to do for celebration?
Title: Re: 24 weeks and facing preterm labor.. again!
Post by: EnglishRose23 on March 10, 2018 at 11:40 AM
What great news! A stable cervical length at this point is a big reason to celebrate, and it sounds like your baby boy is growing well. For what it's worth my drs were way off on EFW, mine were both born 10oz bigger than the estimates so it's possible you'll pass the 1.5kg mark this week. At 28 wks 6 days my sons birth weight was 3lbs 3oz, just shy of the 1.5kg mark.

I think it's good news that baby is breech, less pressure on that cervix could be making all the difference, and when you get close to term and start moving around more baby is more likely to flip than while you are stuck in bed all day. I think most pregnant moms get to worry about the how-is-baby-getting-out part more than we do; concerns about breech birth or c-sections are for moms with normal pregnancies, here that is just a minor concern since all our focus is on how-to-keep-baby-in!

If the weather is nice where you are, celebrate slightly relaxed rules on bedrest by getting outside and laying in a deck chair. Sunshine is so healing after a long stay in bed.