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Messages - OBmom

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What's Your Story? Tell us. / Re: Pregnant again after early loss
« on: April 04, 2018 at 09:01 AM »
Aw Jade that sounds super scary.
Do the doctors have any explanation for this? Are there any associated findings?
More important, how are you dealing with this? 3 cm of CL is still pretty good, I wouldn't go on bed rest just yet. Especially since you have a long trip to plan. Do you have company to go? Maybe not driving yourself should be an option.
Thinking of you and hoping for the best possible outcome.

Hi Anish!

(Just to be clear, the "race you there" was a JOKE  :D)

Congrats on your beautiful baby girl, I hope she's doing well with no signs of infection. Just happy and healthy growing. Wishing you the shortest possible NICU stay. If I could offer you one tiny piece of advice: if you want to breastfeed, DO NOT let anyone discourage you. You can pump and save, and your little one will eventually grow stronger and be able to feed for herself. It was a major investment for me, made me feel useful in a situation where it can feel like everyone else can take care of your baby except for the parents.

Best of luck!

Yeah, I guess we're pretty close! My due date is June 3rd, how about you?

Everything is just about the same except contractions are getting painful and boredom levels are skyrocketing.

Erythromicin is the worst, I think I had nausea for at least 2 days after. Next time around ask them for CLARYTHROMICIN , it's the same family of drugs but with less side effects. Plus, administration only 2 times a day as opposed to 3.

Glad to hear your baby princess is back to normal movements, that can be a nasty scare. If you're ever in doubt, go to the ER. Better a thousand times wrong than one-time right. I never heard of less movements after steroid shots, so it may have been just a coincidence.

Keep up the good work! We are on our way to 32 weeks.. race you there? =)

Hey Anish!

Haven't heard from you in a while.
How's everything going?
All calm with the new stitch in?

Hi everyone.

Here's our 2-week update.
I'm now 30 weeks + 1 day and every day closer to 34w is a blessing. Still having contractions (what would be the fun without them, right?) and they're starting to be painful. I was kind of expecting that, once your uterus starts stretching past a certain point, it normally wants to shrink back to the previous setting. They're probably just anticipated Braxton-Hicks though, so I'm pointedly ignoring them :)

Last scan was on Friday, cervix still stable (long live the pessary). My doctors have finally given me permission to get out of the house once a week, yay! Under adult supervision and with minimal walking, but still! Just feeling the fresh air is therapeutical.

Not so great news on baby's growth though - in 2 weeks, we've had a deceleration from centile 60 to centile 30 (if we measured one hundred babies with the same gestational age, this baby would be among the 30 smallest). We're still within the normal range but I worry.. Especially since being on bed-rest usually has the opposite effect - mommy tends to eat more than she's spending, and babies tend to grow on the chubby side. No other signs of trouble though (blood flow is normal in all vessels) so fingers crossed. Maybe this is just his normal growth curve, we'll check again in 2 weeks.

How's everyone else doing? Any news?

What's Your Story? Tell us. / Re: 28 weeks - 2nd Pregnancy
« on: March 26, 2018 at 10:06 AM »
Welcome to the club momma!
Where are you?

I also had a 2015 short cervix pregnancy and am now working on baby no 2 :)
Glad to hear your doctor was on top of things, aspirine to help the baby's growth and progesterone for the cervix.
Though we all hope to avoid recurrence, the normal thing is what happened to you: when it comes back, it's usually at an earlier time than with your first (mine were diagnosed at 28 and now 23 weeks). Still, 3 cm for 28 weeks is over the "normal" limit so yay!

Besides, if your cervix shortens any more you still have the option of placing a pessary - last time I had one placed at 28 weeks with a cervix of only 8mm and only delivered at 34w :) (You guys must think I get some sort of commission on pessary sales, but I honestly don't  ;D)

When's your next appointment / scan?

What's Your Story? Tell us. / Re: New to this
« on: March 26, 2018 at 09:50 AM »
I totally get what you mean, those gushes of fluid also drive me to full-on panic mode.
Only problem is, I'm even more scared of going to the ER because I know they'll probably end up admitting me just to be safe. (To be fair to "them", I did PPROM at 29 weeks last time soooo..). I end up staying at home feeling like a wreck, checking for updates - "is it getting worse?". It normally isn't, and after a couple of hours and drinking another liter of water I settle down. Also happens during the night, which doubles the fun as you wonder whether you should scare the crap out of your husband (who will then rush you to the ER of course).
What's not to like?? =)

Hope week 19 is calmer and lets you look forward to your anatomy scan.

I don't have a cerclage. At the beginning of this pregnancy I didn't meet the criteria for preventative cerclage placement (meaning I had only 1 previous PTB, without the characteristic history of cervical insufficiency). If I went for a third pregancy it would be a different story, because I would then have 2 previous threatened PTB at 28 and then 23 weeks - I would probably get a cerclage then around 15-16 weeks, just for prevention. Right now I'm just hoping really hard for a happy healthy baby, 'cause I don't think I want to sign up for all this stress again.

In my case, this time we were already checking for short cervix every 2-3 weeks. I was diagnosed at 23w with an 18mm cervix, and we thought it was risky doing a cerclage because of the higher risk of PPROM after the intervention. So we placed a pessary - it worked wonders the first time around. 

The fact that you don't feel any contractions but the cervix is still shortening is highly suggestive of cervical insufficiency. I totally agree with your OB, the cerclage is still doing it's job and keeping the cervix closed. What the pessary does is slightly different - it gives structural support and changes the angle of the cervical canal, so as to take pressure from the internal opening. So cerclage + pessary + progesterone is definitely a winning combo for you, though it may be a bit too much for everyone else's case.

One more thing -  don't freak out if the pessary increases your discharge. It's called "foreign body reaction" and you may feel tiny drops all day long, and it can be clear fluid, and it can be pretty darn scary. Keep in mind that PPROM at this stage tends to be one big gush of fluid (like "waking up soaked").

Sorry for the long post. I am totally supportive of your new career choice :) Because of my career choice I do have some literature on this, let me know if you need any more info.

Hi Lauren.

So sorry to hear about your development with the cervix shortening. Still, if your stitch is holding up, that's pretty good news.
Also good that you're placing the pessary (I have one too, it's been in for 6 weeks now. Also had one for my first pregnancy, and I am totally convinced it was what held my cervix  - only had 0.8cm then). Any help you can get is good.

I've told other moms on the forum before: where I work, we only admit for in-patient surveillance moms with a cerclage and CL less than 5mm. Everyone else is allowed to stay at home on modified bed rest.

I know it feels like it's a long and hard road ahead, but try and divide up your goals. In 2 weeks time you should be able to check your baby head to bottom in the anatomy scan, and knowing he/she is healthy will go a long way towards lifting your spirits. The fact you caught things early on in this pregnancy gives you the advantage in dealing with the insufficiency - you have options.

How are the contractions by the way?? Do you feel any at all?
And one last thing: are you on magnesium supplements? It's completely unproven but still, most OB doctors here in Portugal recommend them for uterine irritability.

#GoTeamPessary! :)

Hi Sparker.

So sorry to hear about our emergency procedure. It's such a good thing you got a specialist though, that cerclage was the only thing that could have helped in that situation.
Other good news is the fact that you didn't PPROM even with bulging membranes.

I can't even imagine the levels of stress you must be going through. Don't feel like this was something you could have avoided or that it is somehow your fault. Keep your support system close - we all know how hard it is at the end of the day when family and friends leave and we're stuck in a hospital room with a big scary "elephant".

I hope things are stable now. It's just 3 more days till Sunday, trust you will make it to viability. Big babies are always a plus in preterm world :)
Keep holdin' on momma, will be thinking of you.

What's Your Story? Tell us. / Re: Back for round 3
« on: March 20, 2018 at 01:33 PM »
I completely agree with the medical decisions. that were taken in your case. Blood thinners can and should be given and maintained throughout pregnancy to prevent potentially fatal complications for the mother (like a pulmonary embolism). This trumps the risk of bleeding or miscarriage due to SCH.

In fetal growth restriction (FGR) however, aspirine is most effective if started up to 16 weeks (that's when the placenta is forming). As for Lovenox - enoxaparin - it's use in FGR is still in the experimental field. We use it because we know it might help, but the studies are still ongoing.

Making the Best of Bed Rest / Re: Monday Roll Call for March 19, 2018
« on: March 19, 2018 at 08:51 AM »
Hi everyone!

Still cookin', 29 weeks + 1 day today :)
No real news this week, but we do have an ultrasound on Friday. Hoping for a stable cervix and a healthy baby with normal amniotic fluid.Had a bit of trouble with contractions yesterday, but it calmed down durig the night so.. part of the package.
How about the rest of the mamas? Anything good to share?

What's Your Story? Tell us. / Re: Back for round 3
« on: March 17, 2018 at 05:21 AM »
Hey English Rose.

Sorry to hear about your dog, such sad news :( It must be hard dealing with that on top of your complicated pregnancy.

I was glad to hear about your baby normal anatomy scan though! I hear your concerns on her growth. I am part of the team that runs the fetal growth restriction program in my center, so I literally have any info you might need on this. Placenta settled on the septum is likely to get less blood flow, and that can limit the baby's development in terms of weight. But the most important thing is not how much she's measuring, but if she's maintaining her regular growth curve. Meaning, she may be a small baby as long as she's consistently small (no "drop in growth centile"). It's a shame the drugs that could potentially help blood flow to your placenta (like enoxaparin and aspirine) are also blood thinners - you're not a candidate because of the SCH, they might restart your bleeds..

Things to go over with your doctor:
- growth scans every two weeks - no point in doing then with less time in between, baby's growth doesn't happen overnight.
- try and have always the same US tech / doctor perform the scans - this improves accuracy and you won't have so much fluctuation from scan to scan.
- ask about your uterine blood flow - they can do Doppler scans of the uterine arteries and see if there's any added risk of fetal growth impairment.
- I don't know if your current weight gain is on target, but consider supplements - high protein / high calories shakes, yogurts, etc.. We have some in powder-form to mix in with your regular food. This is just meant to boost your little girl's uptake. We only recommend this if we start suspecting she won't have the possibility of reaching term.

Anyways, you have a perfect little girl, good cervical length and no new bleeds. There's always something to be grateful for. :) Keep up the good work momma!

Hey again.

Yeah, I'm an OB specialist in a big high-risk MFM center in Lisbon, Portugal. To be honest it's been all kinds of interesting finding out the different perspectives and approaches to preterm birth worldwide. Love the forum!
Also on my background are two rounds of dealing with threatened PT labor and one PT birth at 34 weeks. Currently at 28 weeks with a cervix of 18mm, with a pessary in place.  My full story is on the forum in another post, feel free to check it out.

To answer your question on funneling, it's not straightforward. You can have funneling with a really long cervix (good prognosis as long as the length holds, with cerclage or pessary). Bottom line, cervical length determines prognosis for the most part. Funneling is a dynamic event that shows predisposition for a softening of the cervix (the internal orifice of the uterus is more open, a sort of "pre-dilation" if that makes sense). So it is a warning sign, but in most cases we can hold it back if we detect it on US.

Hope this helps =)

Hey Sparker.

How are you holding up? Short cervix at the anatomy scan can be a pretty scary thing to deal with, especially if you haven't gotten the chance to discuss your options with an MFM specialist.

13mm is pretty short for this stage. Since it's your first pregnancy, you might be a case of insufficient cervix (IC). Or maybe you've had some previous cervical surgery? LEEP or conization?
Still, it doesn't mean you can't hold things off for quite a long time.

I'd say your options definitely should include:
- Bed rest (not mummy-style no-moving, just restricted everyday activity: 3-5 min showers, no chores, bed or couch and no pressure on the pelvis). Stay off your feet as much as you can.
- Cerclage or pessary - this choice will most likely be influenced by your Clinic / MFM specialist. A 13mm cervix, especially with funneling, might prove tricky to perform a cerclage on - there just might not be enough cervix to place the stitch in securely. Ask if your doctor works with pessaries - they're rubber rings you place around the cervix for support and to keep the cervix from opening. You can order them online even if they don't have any at your practice.
- Progesterone - depending on where you are, PRG can be administered weekly as an intramuscular shot or vaginally everyday. But you should definitely be on it.

Steroid shots for helping develop the little one's lungs will probably on the table once you reach viability. Make sure you ask what that limit is precisely in your hospital, because 23 or 24 weeks can make a big difference.

Will be thinking of you and sending positive vibes your way!

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