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Messages - OBmom

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Hey Lauren.

Such great news making it to 23 weeks with a stable cervix!
From a personal point of view - as you know, this is my second pregnancy with a pessary. It does increase your discharge which can be watery and fluid. It's scary, and even with my experience, it can be hard to tell between discharge and AF. Everyday I have to put on my warrior face and say to myself (and him) "This is not it". As long as a light panty liner catches it, you're on the safe side. If it goes through panty liners or soaks underwear / pants / sheets then definitely go in for a check-up.

From a professional point of view - it's hard for me to give a recommendation without knowing the exact measurement. But if your doctors are that confident you're unlikely to go into labor in the next 2 weeks, then that's a really good sign. Even more so if you're completely without symptoms.
This is such a personal decision. Steroids are definitely your best shot at helping the baby's lungs (respiratory problems being the no.1 complication with micro preemies). However, they can have quite an impact on brain circulation - some neonatologists are starting to raise the concern for intracranial bleeds associated with steroids. So yes, we have to nail the right time to go ahead. I faced this dilemma at 23w + 5d with an 18mm cervix. They placed the pessary and asked if we wanted to go ahead with steroids. We declined, but only because: 1) I felt no symptoms of PTL, 2) I thought I could judge if things changed and 3) I live pretty close to the MFM centre.
EnglishRose is also right when she says you can have multiple courses of steroids. In high-risk women we sometimes do one cycle at 24 weeks (the just-in-case scenario) and then a rescue-cycle if they go into PTL and more than 4 weeks have passed.

The best advice I can offer is talk this through with your doctor. Do you trust her? What is her concern exactly, are your membranes bulging past the stitch? If you can deal with the anxiety, how about reevaluating at 25 weeks as they suggested? Of course, this is only valid in stable clinical conditions - modified bed rest, feeling no pelvic pressure, no bleeding, etc..

Fingers crossed so hard for you and your baby! Let us know how you decide, I'm sure there are other moms out there dealing with the same issues.

Preterm Labor: Anything and Everything / Re: Makena Injections ????
« on: April 18, 2018 at 12:53 PM »
Hey Keriann.

Progesterone shots are actually really common in the world of preterm labor and cervical insufficiency. And those problems have a scary rate of complications such as miscarriage and stillbirth. Which we are trying to avoid.
Maybe you can share a bit more of your story? Like what pregnancy is this (first, second..), prior problems, how far along you are..?
You'll find plenty of moms on Makena shots in here, and apart from some migraines, I think most people tolerate them well.
Don't panic just yet :)

Hey Congrats!
Such a long and brave journey, you deserve every happiness with your new arrival.
Best wishes for your family - enjoy every moment :)

What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: April 17, 2018 at 05:39 AM »
Hi Marguerite.

I was happy to hear you're latest results are stable. Love the "we get another week" mentality. I think sometimes people on the outside just can't grasp how important that is to us. We're ACTIVELY waiting :)

Another thought that popped into my head after rereading your story - are you still on nifedipine? Long-term use of hypertension drugs can lower the blood flow to the placenta - and that might be contributing to your lower-end AF levels and growth impairment.  If the contractions have eased up a bit, I would ask your doctor if you can stop for a while and check how things go. I don't know, whatever we can do to try and make things balance, right?

How many weeks now? Fingers crossed for you!

Making the Best of Bed Rest / Re: Monday Roll Call for April 16, 2018
« on: April 17, 2018 at 05:26 AM »
Hi ladies.

Calm night here in Lisbon. Contractions eased up, so the Nifedipine must be working :)
Thanks for all the positive thoughts.

@EnglishRose glad you got checked out too. I lived in constant fear of going to L&D because they might keep me, so I know what you're going through. But you're right, in the end we can't be too careful. When will you know about the cerclage? Also, how's things at home with your doggo?

@jmomma Keep it up, sounds like what you're doing is working! Hope everything is well on your scan on Friday.

Making the Best of Bed Rest / Re: Monday Roll Call for April 16, 2018
« on: April 16, 2018 at 02:14 PM »
Back from L&D guys.
NST confirmed regular contractions, so I started nifedipine for those. Also went ahead with the first dose of steroid shots for the baby's lungs.
Had a quick scan, CL is at 18mm but with some serious funneling. Guess the little one's head is really pressing up against the cervix now..
Will be going back tomorrow to finish lung maturation shot.
Hoping for a calm night. 33 weeks is preemie heaven I know, but all the NICU time we can save is precious.

NOT TODAY my friend :P

Making the Best of Bed Rest / Re: Monday Roll Call for April 16, 2018
« on: April 16, 2018 at 08:32 AM »
Just one mantra: "Not today my friend, not today!"  ;D

Except since Friday when the baby turned I've been having this pelvic pressure. Yesterday had a couple hours of lower abdomen pain that passed with rest and a liter of water. And today.. I'm having contractions that are close together.
I think I'm gonna go for another ER trip. It's a hard decision just because it makes everyone on the family jump into panic mode!

So my mantra might be about to be blown away :) Wish us luck :)

Hey everyone.
I have some great news, seems to be a happy week all around :)

First of all, 32 weeks and 5 days, which means 12 weeks since we got the first scare (contractions at 20 weeks, yes).
But still counting and still cooking!

And second.. I woke up feeling weird, and with a sore pelvis, which isn't usual. I did my best to ignore it, but of course, paranoia sets in and I thought he felt like he was moving less. So I got my mom to drive me to "my" ER (L&D at my usual place of work).
I asked the team there to do an US check and they had nothing but good things to say! Big news is - baby's turned head-down, and that's probably what I felt earlier. Normal amniotic fluid too.

So all in all, I'm having a wonderful Friday 13th :)
I have my next growth scan in a week, but I feel more at ease knowing he is no longer breech. Far less risk of complications if I PPROM, and no need for an emergency C-section. Will keep you posted.

Preterm Labor: Anything and Everything / Re: Pelvic pressure?
« on: April 13, 2018 at 12:19 PM »
That's great news!!

Keep it up momma! It's a long long road and we all know how hard it can get, but you're more than halfway there and getting better every day!

Hi Amanda.

First of all, great news the fact that you've been stable for these past weeks. That alone is reason enough to celebrate.
I'm all in favor of moving more, but moving with caution. All the studies available at this point say strict bedrest is harmful for the moms with no benefit for the baby. They also say when you're in preterm labor, staying still is not going to help. But of course, as most moms here can tell you, we tend to feel better and have less contractions when we rest.
All in all, I would say IF you feel well, start moving around the house - preparing breakfast (NOT a meal for 10 members of the family), 5 minute showers (NOT scrubbing the toilets), short walks (this one is personal but I don't think you should be driving - if you have a painful contraction you can step on the brakes or swerve, and someone else can end up in danger).

As for cervical checks, here's the deal: yes, transvaginal ultrasound is more reliable than abdominal measurements. BUT, when you have great lengths such as yourself (anything over 25mm really), it doesn't really matter how you measure it. (As opposed to really short cervix like 8-10 mm, in those cases you can't see that well with abdominal, and should ask for vaginal probe). I agree with your OBGYN in "not poking around in there", as a matter of fact, that's what I chose for my own evaluations. As a general approach, we do bi-weekly checks until 34 weeks or 6 weeks stable. I can understand them wanting t stop the checks (even tough it gives you some reassurance, fact is you've been stable and each check means getting out of the house, driving, waiting rooms, etc..)

I would ask if they're planning on a growth scan around 28 weeks - that would be a great time to take another look at cervical length.

If things change for any reason or you have ANY symptoms of preterm labor, make sure you head to L&D - no living soul will refuse to do a cervical length check if you're feeling pressure or contractions.

There! Sorry for the long post! :)

What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: April 10, 2018 at 02:10 PM »
It's fine, really :)
Me being here IS actually a stroke of luck.. for me! It's incredibly stressful dealing with this alone.
Talking to everyone here keeps me sane and focused :)

What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: April 09, 2018 at 02:44 PM »
Hi Marguerite,

Hope all is well with you.
As I've mentioned in previous posts, fetal growth is kind of my line of work. I help run the clinic for Fetal Growth Restriction (FGR) at my MFM center. Just a couple of things you should take into consideration:
1) Growth scans are generally only repeated every 2 weeks, that's the smallest interval in which we can see a difference
2) It's best if you can arrange for the same person to scan you every time - that reduces differences between measurements
3) Most experts in this field agree there's no need to deliver just because you've reached the 10th centile, especially before term!! We keep monitoring the baby using Doppler ultrasound - measuring the resistance in fetal and maternal blood vessels. We don't usually deliver unless there are signs of fetal distress.

Let me know if you need extra info on management of FGR. It's always best to meet your doctors already understanding what they're going to talk to you about.
Best of luck to you!

What's Your Story? Tell us. / Re: 2.2cm- bed rest?
« on: April 09, 2018 at 07:03 AM »
Hi Star32.

It all depends on you gestational age and the reason for bedrest.
As an OB, I'd be more concerned about your placenta previa than about 22mm cervix.
Most jobs, even desk jobs, aren't advisable after 20 weeks because of what they involve - getting up early, getting a shower/dressed, the commute to work, long hours without hydration, bathroom breaks on the other end of the hallway etc..
With previa it's always a good ideia do avoid ANY contractions, painful or not, since you don't know what might trigger a bleed.

Hope this helps and good luck :)

Preterm Labor: Anything and Everything / Re: Pelvic pressure?
« on: April 06, 2018 at 05:52 PM »
Hi EnglishRose.

I totally agree with Angela, this should be checked out. And this IS medical advice :)
Your CL may be fine and you could still have clinically significant funneling. OR you could have an undiagnosed and TREATABLE ITU (you wouln't believe how often this happens).
You don't have to go directly to your MFM - is there anywhere closer you could be seen? They'll transfer you if they don't have the resources, right?
Meanwhile, try and stay off your feet. I know you have a little one to take care of and it's hard. Keep your spirits high, you've been through so much already!

Hello mommas!

31+5 today and still cookin'! :)
Had a scan yesterday, CL is holding up (19mm) but we're starting to see funneling. It's expected, but I've been having more frequent contractions and it gets scary - there's still the chance of PPROM.
Anyway, super happy about the 32 week-mark on Sunday, that's when the neurological prognosis really starts looking up.
Doctor says we can lift some of the restrictions then - I'll get to go along when someone goes to pick my little boy up from school! (as long as I'm not driving, eheh).

@Gethaline where are you? Please tell me you're seeing an MFM specialist at a 3rd-level center - it is extremely likely your babies will need some NICU support. And specialized ultrasounds of course. With MC-BA twins, you need to check very often for growth issues and in utero transfusions - short cervix will probably not be your biggest concern.

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