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Messages - OBmom

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1
Hey ladies.

Just a quick note to put your minds at ease.
Progesterone levels measurement isn't routine before starting treatment. That's because progesterone levels in your blood don't necessarily reflect what's happening locally. Since absorption is so focalized, no significant rises in blood levels are expected.
What CAN happen however is that progesterone increases your respiratory frequency. This is more common in the first trimester, and your head processes this as "a need to breathe more often and more shallow". Basically anything goes to up your metabolism and help get more oxygen for Baby.

Just relax and enjoy the help your cervix is getting! =)

2
Hi Charlotte.

Your assumption is spot-on, it's all in the screen name really :) I'm an OB in a high-risk big MFM center, biggest L&D in Portugal.

Cholestasis does tend to be hereditary, but that doesn't mean you'll get it for sure. Even in normal pregnancy, AST and ALT levels can suffer a slight rise without causing concern. With your family history however I'd keep an eye on things weekly. In pregnant women with cholestasis, we usually tolerate rises up to 3-4 times the normal upper limit (i.e. up to 200-300) - this is a marker of how you're doing, and has no relation to the baby's outcome.

As I said before, progesterone is more likely to trigger cholestasis at late preterm (34-37w), so everything balances on how far along you are. However, the benefits for PTB are so extensive I would recommend keep going at least until 34 weeks. Definitely keep an eye out for any signs and symptoms - abnormal itching that usually affects your palms and the soles of your feet but may spread to your abdomen and chest, especially if it gets worse in the evening. Pregnancy cholestasis is mainly a clinical diagnosis but normally also presents with high levels of bile acids. If you do get diagnosed, most experts believe in induction at around 37 weeks, because of the increased (and unpredictable) risk of fetal demise in utero. --> Please don't freak out about this, nowadays it's EXTREMELY rare because it's easy to recognize and treat. In my recent experience, in 5 years and 80 cases, no baby has ever been compromised, just some short NICU stays <--

Hope this helps. Keep us posted!

3
What's Your Story? Tell us. / Re: Back for round 3
« on: June 16, 2018 at 08:30 PM »
Best of luck!
Wishing you all the best, hope your little one stays for the shortest possible time in the NICU.
Positive everything coming your way.

4
Hi Charlotte.

First of all, congrats on making it past 28 weeks, you've already overcome the hardest part.
Progesterone is one of the mainstays in treating insufficient cervix, so please don't worry about using it in the 2nd or 3rd trimester. I have some scientific literature on how vaginal progesterone is effective and safe in preventing preterm birth. If you want I can send it to you.
Also, the side effects tend to be very limited because it is absorbed locally. You wouldn't expect systemic effects (side effects affecting your whole body) as you would if you were to take it orally. Keep in mind that insomnia and nausea are common when you're pregnant, and they're likely to worsen if you're anxious.
I took progesterone from 23 to 36 weeks, and it helped a lot. Most moms here will tell you that on the days they take progesterone they feel less pelvic pressure and contractions. Just don't push it past 36 weeks because it can affect your liver by then, and maybe trigger pregnancy cholestasis.

Best of luck to you!

5
What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: May 24, 2018 at 01:15 PM »
Hi!! Congrats on the new arrival, so glad to hear you made it to term!
Hope your little one stays for the shortest time in the NICU and you get to bring him home soon.
All the best for your family too.

6
Hello everyone.

I wanted to let you know that last Thursday we got to meet our handsome baby boy. SO HAPPY.
Made it to 37 weeks and 4 days, and then went into spontaneous labor (not preterm haha). Arrived at L&D 3cm dilated and he was born after 3 hours - God bless the epidural.
So this beautiful baby weighed 2,860kg at birth. We stayed for 2 days and have just arrived home.
I'm over the moon and just had to share.
You've all been a rock-solid support in a sea of worry, self-doubt and anxiety. Thank you all for reading, sharing. Thank you for your thoughts and prayers. Thank you for the empathy and the sometimes inappropriate laughs (face it, we've all been there).

Keep hanging in there, every day they cook is another success. And keep posting, I'll keep up with your feeds :)

7
What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: May 15, 2018 at 08:15 PM »
Congrats on 36 weeks! So good to hear you've made it this far! Any weight past 2kg is truly a blessing, makes you feel so much safer..
Have you talked to your doctor about the birth itself? I'd say a programmed c-section is most reasonable, wit your previous C and very low amniotic fluid... No sense in pushing the baby to the limit and end up doing the same thing in emergency context, right?
Keep counting your kicks and before you know it you'll be cuddling your little one in your arms.
Fingers crossed that all goes well, and keep us posted!

8
Preterm Labor: Anything and Everything / Re: Anyone on Nifedipine?
« on: May 13, 2018 at 04:07 PM »
Hi Wren.
Similar story here, second pregnancy with short cervix diagnosed at 23 weeks, put on bed rest and placed a pessary.

I went in at 33 weeks with PTL, they gave me the steroid shots and started me on nifedipine. I stayed on nifedipine every 6h just like you for one week. It made me feel pretty crappy because of headaches and low blood pressure. I stopped after 34 weeks - there's just no credible medical reason to stop contractions after that gestational age. If baby wants to come, and you've done all you can to prepare, then let it come! Better out than in. We usually say:"we might not know why they want to come out, but they do".

9
Ugh definitely!
Any viral infection can make you less hydrated than normal, and we all know where that leads.
So besides feeling yucky, we also get the "pleasure" of dealing with the pregnancy consequences of our sickness.

I feel you - I spent half the night up vomiting with a stupid stomach bug. And today of course, more contractions. Not a bad thing at this stage, except I feel like I've been run over by a truck  :(

10
What's Your Story? Tell us. / Re: 23 weeks and counting...
« on: May 11, 2018 at 12:52 PM »
Hi lady!

Welcome to the forum, though as you say, it's not always for the best reasons.
Thanks for sharing your story, my heart goes out to you for your previous losses. It's an incredibly difficult pain to bear, and we can only be glad you have picked yourself up and are trying again.

Also good to hear you work in a hospital. Do you feel you trust the team? I ask because sometimes the grief can be so associated with the place that changing scenery can do you good. The most important thing being that you're seeing an MFM specialist and being treated in a center with 3rd level NICU of course.

As an OB, I have to say I agree with your doctors - a cerclage in these circumstances is risky, your SC hematoma being the most concerning factor. However, I have never heard of SCH being a contra-indication for vaginal or injectable progesterone for your short cervix - maybe you can ask your team? Also, another option would be to place a pessary - it's a rubber ring that goes in your vaginal (around the cervix) but with no stitch, so there's less risk of membrane rupture. The idea is to provide structural support to the short cervix. Not all the MFM center use this, but we do and are big fans.

As for your contractions, modified bed rest and an infinite amount of patience are your best allies at the moment. Don't forget to keep very well hydrated - keep a bottle or some other way of measuring your intake. Some doctors also believe in magnesium supplements.

Best of luck to you and your baby! We'll be waiting around to celebrate you next big marker - 24 weeks and viability is almost around the corner!

11
Hi Tyler,

So sorry for the terrible situation you and your wife are experiencing right now.
Making it to viability is the number one priority, you just hang in there. The forum is an immense pool of support for most of us, so feel free to express your worries and fears, or simply lash out. We hear you.
Sometimes with Trendelenburg and the right medication we can stop the membranes from bulging for long enough to place a cerclage. Anything that buys time is an option to consider.
I know early transfer might seem like a great idea, but keep in mind that any moves and jolts might aggravate the situation.
Best of luck to your family.

12
Hi everyone!

Made it to 36 weeks on Sunday.
Big news today, had my equivalent to ditch the stitch day  :D :D :D Pessary came out! Cervix is soft but not dilated.
I spend the rest of my day doing NORMAL stuff, and my superstar mom took me out for lunch by the beach, which was absolutely amazing.

Of course, every contraction now feels like the end of the world. I've been feeling so much pressure and stabbing down here I would have sworn he would be out by now :)

Thanks for all your kind thoughts and positive messages, you guys don't know how much you've helped throughout this LONG journey.
Keep taking every day as it comes, a small victory on its own. Will keep you posted!

13
What's Your Story? Tell us. / Re: Pregnant again after early loss
« on: April 30, 2018 at 08:12 AM »
Congrats on making it to this ever-important week! I've been rooting for you  :D
And you're exactly right, every day is an achievement on it's own now!

Hoping for good news on your next scan, keep us posted!

14
Hey ladies!

Sorry I've been off the radar but things have started to heat up :)
34 weeks and 6 days today, HOORAY!
Last growth scan was a week ago, everything is absolutely fine with our baby boy. Estimated fetal weight was 2,2 kg (yoo-hoo!). I basically have NO functional cervix left, only the pessary holding things steady-ish. And the cervix has such funneling that you can actually see the amniotic sac suspended between the cervical lips :)

Which goes a long way in explaining why I've been having regular bouts of contractions. I went to L&D last week with PTL, they managed to stop it with nifedipine and hydration. Got the steroid shots in, which is always a welcome safety net. Two days ago I had a minor bleed so I had to go in again to get checked. They actually admitted me to L&D but after 10h of observation there was no progression so they let me come home again. It's like "catch and release", me being the fish, HAHA.

Yesterday I had 2 hours of painful contractions every 8-10 mins but then everything calmed down again.. Weird thing is, it normally starts to go crazy after 6 pm. Anyone else experience this time-zone thing?

I don't know why but I get the feeling we're getting pretty close  ;D Every contraction I get, I keep waiting to PPROM. Oh well, I guess I'm ready as I'll ever be after almost 12 weeks of waiting for the little guy!

Hope you all are doing well, I try to keep up with everyone's journey.

15
Hi littlemissamanda.

So sorry to hear about your rough experience, sometimes it's difficult for healthcare professionals to relate to how we feel -  not only the anxiety, but the exposure and the discomfort.. Glad to hear your cramping passed with rest and there has been no bleeding.

I was going to answer your post but then I read @jmomma's reply - BRAVA! :) I couldn't agree more, and subscribe every word.

24 week mark is excellent, and from this day on every day counts! Everything seems to be ok, so go ahead, take a deep breath and start enjoying your pregnancy! :)

Only thing I'd insist on is doing a growth check - 28w, 32w, whatever they feel confortable. But waiting until 36 weeks can be a bit late for detecting growth problems. I'm all for measuring the belly, but recent Brittish studies have shown that clinical evaluation only detects 30-40% of small-for-gestational-age babies, vs 80-90% with ultrasound. Just saying :)

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