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Messages - OBmom

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61
Hi!

My first pregnancy I had a short cervix (8mm) diagnosed at 28 weeks. We placed a pessary and managed to hold off the birth until 34 weeks, which was great.
Since you already have the cerclage, the effect should be pretty much the same.
Have you been having any symptons at all? Cramping, contractions, discharge? If so don't hesitate and go to the ER, make sure it has perinatal support / NICU.
Any chance you can stay off your feet these days? With that progressive shortening, it's not likely the cervix will elongate again. So the whole point is going to be holding on for as long as possible. Where I work (biggest MFM center in Lisbon Portugal) we'd stop measuring cervical length - we know it's really short, and the more we mess around in there the more we stimulate contractions.

I'm now 26+4 and also on bedrest for short cervix, so we'll be keeping each other company.

Hoping for all the best! Next big milestone is 28 weeks. Keep in mind that this week, for every day baby stays in utero we gain 2% survival without long-term complications (sequelae).  :)

62
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.

63
Making the Best of Bed Rest / Re: Keeping entertained!
« on: February 23, 2018 at 06:05 AM »
Also, recent update, online card games!
I started this week, and I'm having a ball just trying to remember the rules I learned as a child (my Grandma taught me all sorts).
Plus, it gives a small amount of joy to all the retired German friends who get to kick my a**  ;D ;D ;D

64
What's Your Story? Tell us. / Re: New to this
« on: February 23, 2018 at 06:03 AM »
Hi!

Just wanted to break some good news to you. 35mm is a great cervical length for 2nd trimester! Hopefully this cheers you up!
Being do far away for your support system must be really hard though..
Hope the bleeding stops soon.
Keep us posted!

65
Making the Best of Bed Rest / Re: Keeping entertained!
« on: February 20, 2018 at 02:18 PM »
Unreasonable addiction to Candy Crush here.
Not proud  ;D

66
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..

67
What's Your Story? Tell us. / Re: 18 weeks with a preventative cerclage
« on: February 17, 2018 at 06:46 AM »
Happy 19w missK!

I know it's scary. But trust me, 25mm with a stitch in place is right around perfect  ;)
With a cerclage, in my place of work (big MFM centre in Lisbon) we don't admit patients to the ward unless they're down to 5mm or PPROM.

Have faith and try (try!) to take it easy.

68
What's Your Story? Tell us. / Re: Back for round 3
« on: February 17, 2018 at 06:42 AM »
Hooray for false alarms!  ;D

I can't imagine how exhausted you must be. Just the stress of dealing with the bleeding and the possible outcomes day in and day out is enough to send anyone off their rockers.

Great news about all those clots passing, eh? More room for your little one inside!
Speaking of room, make sure your bowel is working properly (i.e. daily) and without needing too much effort. Try a mild laxative if it helps to get along. No need for the extra pelvic pressure.

Even through the Ultrasound probe we can get a feel for the cervix - "soft" in your case probably feels like "mushy". It's just a warning sign but pretty much what you'd expect in your case. You can check for cervical length before 16 weeks but the predictive value isn't great. Also, the more we probe around in there, the more we stimulate ctxs.

Have you started progesterone yet?
I would definitely discuss placing a pessary. Cerclage not so much, not with previous history of PPROM and uterine structure anomaly. Also, a little bit of cervical opening is good for draining. We don't want those clots staying inside and causing inflammation..

Anything to look forward to this week? Sending lots of patience and good vibes your way!

69
I agree 100% with English Rose on this one.
At the end of the day, there are no rewards for "fastest-coming-back-to-work-again" pregnant moms.
Just take your time and take care of yourself and your baby, that's the best investment possible.
Best wishes!

70
What's Your Story? Tell us. / Re: Back for round 3
« on: February 15, 2018 at 07:42 AM »
Hey English Rose.

Just wandering if there are any updates?
The " I suck at pregnancy" thing really stuck with me, I've had that feeling too. Please don't beat yourself up, this is NOT your fault or anything you could change. Nobody wants this baby to be okay and have a chance more than you. Therefore, you're this baby's best shot.

Bed rest sucks, and it's even more frustrating if we're not that sure it is even helping. But we keep on doing whatever we can right? Just hang in there, and keep hoping for the best!

71
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 - https://www.theguardian.com/lifeandstyle/2017/oct/24/88-days-trapped-in-bed-to-save-a-pregnancy-bed-rest - 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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