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Hi ladies!

Great news! Just in from the press (American Journal of Obstetrics and Gynecology):
" Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with
a short cervix: a meta-analysis of individual patient data"
Authors: Roberto Romero, MD, DMedSci; Agustin Conde-Agudelo, MD, MPH, PhD; Eduardo Da Fonseca, MD; John M. O’Brien, MD; Elcin Cetingoz, MD; George W. Creasy, MD; Sonia S. Hassan, MD; Kypros H. Nicolaides, MD

This is a great article: evidence-based, which means hard facts, no "expert opinions". Plus, the authors are super-stars of obstetrics, multi-published, OB royalty =)

I can't upload the file because of size restrictions, but PM me and I'll send it to anyone interested.

Basically, their findings are:
- vaginal progesterone reduces the odds of preterm birth if you have a short cervix (under 25mm after 14 weeks)
- it also reduces poor neonatal outcomes (NICU admission, neonatal health problems, etc..)
- no increase in maternal complications
- no increase in neurodevelopmental problems at 2 years of age.

So look out for options! This is a great support if you want to discuss progesterone administration with your doctors.

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!

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