Pregnant After Preemie

Day 4

2008-08-24T11:11:00.001-04:00

The difference between Daria and her sister is uncanny - you can't even say they're related, they look so differently!

Pictures!

2008-08-24T10:56:00.008-04:00

Hello everyone!

I'm very sorry for the delay in getting pictures and details 'out there'. Unfortunately Daria is a pumpkin head - no lie, 36 cm. head circumference! She dislocated my tailbone and gave me a 3rd degree tear so I've been too uncomfortable to sit for too long and I've got some serious edema going on in my feet (can't even wear flip flops) so even standing is painful.

But - she's wonderful. We went home on Thursday, she's officially a 'take home kid' and she's eating magnificently. It's really nice to have a baby that will actually feed at the breast this time. She's only lost weight until discharge - going from 7.14 to 7.6 and has been gaining really well since. I imagine when she gets weighed on Wednesday that she'll be above her birth weight. Even better was that her bilirubin levels were great and we haven't had to do lights or anything out of the ordinary.

It was a little surreal to go through Arianna's baby clothes and realize that much of the clothes she wore for her first 6 months are actually going to be too small for her sister. Otherwise she's a great little lady and we're truely blessed to have her in our lives - I'm so in love with her chubby cheeks!

With big sister Arianna, who is so in love with her 'baby'

Announcing...

2008-08-19T19:01:00.000-04:00

Daria Michelle
Born 8/19/2008 @ 6:03pm
7 lbs, 14 oz.

Pictures to follow!

In the Hospital

2008-08-19T06:04:00.002-04:00

I've been admitted to the hospital with labor. News to follow!

hmm?

2008-08-18T19:46:00.002-04:00

So I'm going on 4 hours of one constant contraction and (TMI) I know I lost my plug (again) this afternoon, so I'm definitely more dilated.

In some way I hope this is it - I'm really tired of being constantly nauseous right now...

I'm going to sit on the ball for a little while and see how everything goes.

Monday Update

2008-08-18T13:11:00.002-04:00

So I went to my OBs office for a 10:15 appointment and we're making some (very slow) progress. I'm 100% effaced, kid is fully engaged (don't know the station) and I'm now 1.5 cm dilated... so 1/2 cm. I'll take it - its better than nothing! I scored a 9 on my bishop scale (which is the 'how good is this person for an induction' rating) and a 9 is good - so if they could/would induce, I'd be golden... but my hospital doesn't do any kind of induction until 39 weeks.

So, encouraged by the appointment, I decided to go walking at the mall. I walked for nearly an hour and stopped to get some sorbet (shhh... don't tell my doc). I've had what feels like one solid contraction since then, not painful but overall tightness that just won't give up - I hope that's a good sign!

I'm really tired now so I'm going to go lay down and take a nap and hope these continue on their own.

Monday...

2008-08-18T08:50:00.002-04:00

Well, we didn't have to go to the hospital last night. I managed to sleep, which was needed. I was up probably every 2 hours or so but was able to 'switch sides' and get back to sleep, which was good.

No regular contractions yet today, just a few big doozies, but I have an appointment with one of the OBs in my office at 10:15 AM today - so I'm hopeful that there has been some progress since Saturday, and if not I hope she's willing to 'help things along'. I'm really frustrated - I wish I hadn't agreed to the terb shot.

Hubby was in a car accident on his way home Friday so we're down to one car this week - thankfully he works close to home. We drove up to my parents home to pick up Arianna and drop her off at daycare - I'm hoping we won't need to go to the hospital today because she was really distraught when we left her this morning. You could tell she really missed us and kept asking to go home.

So I'm just waiting at this point - feeling really nauseous this morning for some reason so I won't be going for a long walk before my appointment. Its supposed to be really hot today so if I haven't progressed enough to go to the hospital I'll probably just go to the mall and walk around for a while...

Another update

2008-08-17T19:43:00.002-04:00

So its about quarter of 8 PM and my contractions are picking up again and they're definitely different from yesterday - I don't get much warning before the peak it happens very suddenly and there's stabbing pain with it so I hope that stabbing pain is in my cervix, meaning its breaking up the scar tissue!

Hubby and I haven't done much of anything today - he still feels yucky and I'm just exhausted so we've been vegging around the house trying to rest (I did manage about 5 hours of sleep all day but the only thing I've managed to eat was 3/4 of a strawberry poppy seed salad from Panera Bread and a yogurt smoothie from Dunkin Donuts). I spent about 30 min. on the birthing ball and we went for a short walk around the neighborhood. I think it took the terb about 12 hours to wear off because the contrax didn't come back regularly until after 4 PM - that stuff works fast, let me tell you! I was having contrax every min. on the strip and then they gave me the terb and it QUICKLY slowed to every 10 min. It was amazing how fast it worked.

After I do this update I'm going to get back on the birth ball for a little while and see if do these psuedo squats will help spread my hips and allow my cervix to break up. We'll probably be back at the ER again tonight but I won't be calling Tina until I get an exam and can be sure I'm progressing some. If the exam at the hospital is uneventful we'll head home and I'll make an appointment to see my OB tomorrow and see if she'll break up my scar tissue for me. The big reason the doc in the ER wouldn't do it fully is that I'm only 36 weeks so not technically full term. The doc that was covering my group was really busy last night (full moon has some truth in it!) so he didn't get to come down to the ER but I know if he could have he would have helped break it up - he told me so when I saw him on Thursday.

So that's it for now. Arianna is being an angel for grandma and grandpa and they're happy to keep her for another night - we'll pick her up in the morning so she can go to daycare and give grandpa a break (who is just newly laid off and has an abundance of free time).

25weeks: My hubby says the same thing. Pregnancy is very morbid, you get very excited about seeing a woman in pain "Ya, Jen is miserable, that's awesome!" LOL!

My frustrating Saturday

2008-08-17T11:47:00.002-04:00

My parents came to the house at 5 and took Arianna to spend the night with them - I knew we'd be going to the hospital at some point that night.

I decided to labor at home until I 'couldn't take it anymore' - a sign that the contractions were strong enough to put me in active labor. I sat on the birthing ball for a while, took a nice bath for a while and DH and I took a nice walk around the neighborhood. After my bath about 8 PM the contractions had slowed to a crawl so I figured we were 'done' for the night. DH had food poisoning from a cookout we'd gone to that day so he was throwing up all over the place and by 9 the contractions had me really tired so I just looked at him and said "let's go to bed as we may be up early". He surprisingly agreed.

I woke up at 10:40 with lots of pain - I was really feeling it now and had a hard time talking through it - surely this was it! I got hubby up and called my doula and started packing the car/getting dressed.

We got to the ER at 11:50 and true 'full moon' fashion it was packed. I got through registration and triage and sat down. Hubby was still not feeling good but I needed to walk around with Tina (my doula) so he stayed with our bags while we walked the halls for about 15 min. They called us back and got me into a room to get the baby monitored and get an exam. Boy do contractions hurt when you have to lay down through them - I don't know why women do that without an epidural! I ended up standing next to the bed for a long time doing the strip because it really hurt to lay on my back. Then the resident/attending came in to give me my exam. Apparantly my doula knew her very well and was excited she would be the one doing my exam because she could 'fast track' me upstairs to L&D if needed.

I was 100% effaced, which was AWESOME, but only 1 cm. dilated (not awesome). So she told me to get up and walk around for two hours and see if that helps any. The scar tissue from the cerclage was going to make dilation pretty impossible - she even tried to break it up for me (ouch!!).

So I diligently followed orders - lots of walking with Tina and lots of contractions - eventually they were right on top of each other with no break in between and it was really frustrating but, if I do say so myself, I did very well despite no pain meds. They were really strong now and Tina said I should get examined because she could tell by the change in contractions that I'm further along.

4 AM I get another exam and there is no freakin' change. Not even a half a centimeter! I couldn't believe it! The the worst news came in.

They have no beds. With contractions showing up on the monitor at every minute or less they couldn't just send me home but they had no where to put me but in the ER on the WORST BEDS IN EXISTANCE and I really couldn't stay laying down - really, back labor sucks when you have to stay on your back.

So they gave me terbutaline and sent me home... after I'd labor hard for more than 24 hours they were giving me drugs to stop all my hard work and sending me home simply because they don't have a bed. WTF?!!

So its noon now, we're finally up and I'm eating something for the first time in 24 hours (I don't get hungry in labor) and incredibly upset about the turn in events. The worst is that I know we'll be back there again tonight playing this dance again... I have to go through those contractions again and hope they have a room for and hope that I get a sympathetic doc who will break up my scar tissue allowing my cervix to open up. All the docs I've seen have said the same thing - once the scar tissue breaks up I'll go from 1 - 6 fairly quickly. I like the sound of that, just wished it would happen sooner than later.

I kinda wish my doctor was on last night - when she took out my cerclage on Friday we talked about the size of the baby and what my cervix looked like and she told me to 'do everything I can' to get this kid out now... so that's what I'm trying to do. Just wish that I didn't have to seemingly fight them on it.

ooh ooh!

2008-08-16T16:53:00.000-04:00

I'm having contractions about 2 - 4 minutes apart. We're going to time for an hour before we make 'the call' but its looking promising!

Wish me luck!

Cerclage Removal!

2008-08-14T22:34:00.002-04:00

I can't believe I made it to the point of actually having it removed... this is surreal to me.

Anyway, in a little under 10 hours I'll be stitch free! Although, theoretically, I could dilate and go into labor immediately, the OB I saw today said in his 30 years he has never seen anyone go into labor the day the stitch is removed, so chances are good I'll be home after a few hours of monitoring.

But... if I'm lucky enough to be the exception I'll have hubby post a quick update here before he jets off to the hospital to meet me.

I can't tell you all enough how wonderful you have all been with your comments and emails - I am very blessed to have such caring people wondering about me.

I can't believe the end is in sight now (hopefully) and hope that my story has been inspiring and helpful to you.

36 weeks!

2008-08-14T13:00:00.003-04:00

It's a funny thing being pregnant again after having a preemie - especially sub 30 weeks. If you're fortunate enough, like me, to make it to (almost) full term you'll experience a strange emotion... the "I never expected to make it this far and now I feel overdue" emotion.

I guess mine is compounded, unfortunately...

Ended up in the ER last night due to lack of movement - which never happens, this kid is VERY active... s/he didn't do well on the NST at first and then they gave me apple juice and pretzels and flipped me all over - then s/he got marginally better, but I still hadn't felt a kick in HOURS... very scary.

Today I had my regularly scheduled NST and still hadn't felt so much as a hiccup... low and behold I get on the NST and s/he decides to hold a dance party. The NST was incredible - beyond perfect wave form. I cried happy tears...

Then I had an U/S. I'm really start to hate these... my AFI is 26 and baby is still in the 97th percentile - now 7 lbs. 12 oz. I'm 36 weeks... it could be off by as much as 10% at this point, which is about a lb. in either direction - so s/he could be as big as 8.5 lbs. or as small as 6.10... still really big for this point.

In essence s/he is measuring 3 weeks ahead - so 39 weeks. Add in the abundant fluid and I'm big... really freaking big and uncomfortable! I can fully appreciate why so many women complain about the end of pregnancy. It used to make me really mad when I'd hear women complain because I had wished to have been able to experience it with Arianna, but now I understand and will never chastise a full term pregnant mom again! Seriously, there isn't anything that doesn't hurt right now. My feet are huge and rolling over in bed brings me to tears... and lack of sleep? I can't even call 'no sleep' lack of sleep, because that implies there is actually SOME sleeping going on.

They won't induce at my office, instead at 40 weeks they'll give me the option of a c-section. He says because my fasting numbers have been so hard to control (now under control with 30 u of insulin) and this kid has been measuring steady at 97th percentile for 3 months, the u/s is probably pretty accurate - this kid is just plain big.

On top of that he said in his 30 years of being an OB he's never seen anyone dilate into labor once the cerclage is removed (which I know is rare, just wishful thinking on my part I guess) and furthermore, since I've been funneled to the stitch for so long (thus creating alot of pressure on the stitch), I will have alot of scar tissue that will make dilation difficult, if not impossible.

Everything about this kids position is perfect for 'natural child birth'- which is what I've paid alot of money to a doula to help me with. I've been preparing myself for this for months and I'm so excited to get the birth I want... but now I'm looking at the very real possibility of a c-section and that is very scary to me. I'm really disappointed. I know in the grand scheme of things having a full term healthy kid is so much more important but I was hoping the actual birthing experience could be close to what I wanted this time. *sigh*

And although I'm only 36 weeks I said a silent prayer - that this weekend I go into labor naturally and have a healthy baby. I'm beyond dreading a c-section. No, I'm not as foolish as some to actually TRY and induce labor but I wouldn't mind it happening on its on at this point. I can only pray...

How exciting!

2008-08-05T16:36:00.004-04:00

Well, today has been an eventful day!

I had a non-stress test (kid was amazing - never seen my tummy move so much when s/he kicks) and my u/s was great - my AFI went down 10 points! WOo HoO!

Baby is measuring in at full term - 37w5d and weighs 6 lbs. 10 oz. I can't believe it! Wow!

Best news of all - we scheduled my cerclage removal. Because I'm already so thinned out I bet the kid is coming when the cerclage is out! Of course, I could go weeks without it too... that would stink!

So next Friday at 9 AM I'll be at the hospital having it removed... and maybe, just maybe, we'll have our new little one too! I can only hope that being 36 weeks and a few days is enough time to avoid the NICU and allow him/her to come home with us - how amazing would that be? A take home kid - WOW!

Maternity Photos

2008-08-02T19:01:00.013-04:00

I had some professional maternity pictures done at 32 weeks and got them back today. Unfortunately I had to fix them... alot. I'm, by no means, a professional photographer but the photos I received today weren't professional quality. My skin color was actually GREEN in the outdoor pictures and the black and white photos were horribly blown out - so much so you still can't see any of the detail in Arianna's dress. I'm pretty disappointed overall, but it is what it is and the only thing I can do is not refer the photographer to anyone else.

At least I have the memories!

34 weeks

2008-08-02T17:47:00.002-04:00

Well, I'm here and miserable! LOL

I swear, I'm going to go insane here in bed but I'm too scared to get up! For the last two days when ever I stand or sit I get massive pressure really low and huge contractions. It used to be that I wouldn't get any when lying down but now I do - I get alot of contractions. At my last ultrasound I had very little cervix left and I really don't see myself lasting the week, but making it to 35 would be wonderful... I just don't see it happening. I'm in alot of pain...

I had such a strange bunch of appointments Friday. I had my first NST which was kinda neat - dozen or so contractions but I felt all of them and they weren't regular so no worry there. I then had an ultrasound to check fluids and my CL. Then saw the OB and finally got my 17P shot.

We're doubling my insulin at night, which I expected.

My fluid is still high but not as dangerous high as it was last time.

The OB (one I don't normally see) tried to tell me there was no cervical funnel... funny, but I saw it on the u/s. She tried to tell me, that's just a pocket of fluid... um, ya, in the funnel of my almost non-existant cervix. I decided I don't like her and am going to try to avoid appointments with her.

So in light of the less than stellar appointment I went to Babies R Us Friday afternoon and purchasing 2 going home layette sets (one boy, one girl) - we'll get to see which one I get to use ;)

Sad...

2008-07-26T21:24:00.002-04:00

I'm bored...
and overwhelmed with everything that needs to be done that I refuse to let myself do (cleaning the house for one).

If I spend too much time out of bed I get cramps and contractions but staying in bed is painful too - laying on my side is really painful to my hips and laying on my back is out of the question at this point.

Today our refrigerator decided to break. Shawn had taken Arianna to the playground and all I wanted was something to drink but I came out to a kitchen slowly drowining in melted ice from my freezer. I wasn't about to leave it there! So I got towels and did alot of bending down and picking up and then had to call a repair guy and spend even more time out of bed.

I feel like crying alot of the time. Everything is just so overwhelming, even when Arianna comes into the room to spend time with me she'll want me to help her up onto the bed (when she's perfectly able to climb up herself, of course) and I'll just cry because I can't get up. She'll want out and I have to scream for hubby and that scares her too. Then there's the eye rolls from hubby when I ask him to do something as simple as get me a drink - does he think I like this??! I hate being so dependent on people!!

I saw my OB yesterday - would you believe they're not going to give me the steroid shots?!!! I don't qualify for them anymore at 34 weeks but I'm obviously in danger of delivering soon and I have gestational diabetes which slows lung maturity. Its pretty doubtful I'll make full term so why not give me the shots?

This makes me cry too.

This pregnancy is really overwhelming right now and I don't have anybody to really talk to about it - so I'll just vent here for all of you to read.

Thanks for the sympathetic 'eyes'!

Still here at 33 weeks!

2008-07-24T11:05:00.003-04:00

Hi everyone,

Sorry for not updating sooner and sorry for worrying people so much that they had to email - I hope to be better in the next few weeks. My only excuse is its really hard to type while laying down.

Things aren't much better than they were 2 weeks ago - I'm still on bedrest at home and my asthma is still really bad.

I'm on enough prednisone to kill a cat right now. Its not really helping so we added 3, yes 3, different inhalers. I'm at the highest advair, flovent and albuterol. All things that aren't great with Long QT Syndrome but I actually haven't been having any weird symptoms with all this medicine so I must really need it!

The prednisone, unfortunately, has raised my blood sugars so I'm considered a gestational diabetic and have to test my blood sugar 5 times a day and follow a special diet - do you know how hard that is to do when your on bed rest? Sigh...

My cervix has shortened a lot in the last 2 weeks also - its at 1.7 now and the OB I saw on Tuesday said they may take out my cerclage on Friday to avoid ripping through my cervix. I think this is jumping the gun - I'm not having contractions and as far as I know I'm not dilating (didn't get a manual exam this week) so why take it out? If I have shortened more I may ask for hospital bedrest because its obvious that bedrest at home isn't working too well... I'll also be asking for steroid shots regardless of tomorrows appointment. Since I've got gestational diabetes lung maturity is slowed even more and I'm at risk of delivering soon so I'd hope they'd be open to giving the baby a little boost with one round of steroids.

On the bright side this kid is still huge - 97th percentile and 5.5 lbs. already at only 32 weeks! Part of me is happy that I won't see full term because natural delivery will be really hard with a 9 lb. kid. I'll need recovery from bedrest and adding recovery from a c-section (because the kid is so big) will be awful.

So that's my update - not great, but I'm still here and baby is still baking away (oh ya, and not breech anymore! ya!)

31 weeks

2008-07-11T14:41:00.002-04:00

Well, here I am at 31 weeks - this is great!

Good news: Had another negative FFN this week and my 5th to last 17P shot - I'm positive I'll see 33 weeks now - wow! My cervix is still funneled, still 2.5 and still finger tip dilated, but no change so that's good.

Bad news: My asthma is OUT OF CONTROL. The last time my asthma was this bad I was hospitalized for 3 days.

I finally saw OB medicine yesterday which was none too soon. She is very concerned about my horrible peak flow readings (as am I) and doubly concerned that my breathing gets even worse when I'm laying down (and particularly on my right side). I have to spend the majority of my day laying down so this is a real problem. When doing a quick exam she heard some extra heart sounds that may or may not be related to where I am in my pregnancy (blood volume is at its highest right now), so she ordered an echo cardiogram for next Friday to check for pregnancy associated cardiomyopathy.

CAN I CATCH A BREAK PLEASE?! SERIOUSLY!!

I'm on 2 weeks of prednisone and albuterol via nebulizer around the clock (despite my not to be taking it with my Long QT Syndrome) until things get better but I'm not very hopeful. I haven't slept well in 3 days now because I'm gasping and coughing. This is terrifying. I never expected it to get this bad. She's trying to get some answers from my cardiologist regarding which steroidal inhaler I can use because the pulmicort I've been on for a 12 years isn't even touching it now. The problem is that most of the steroidals that I should be using have a component to them that is bad for folks with Long QT Syndrome.

As she put it, I have the ultimate protection, my defibrillator so I need to get my breathing under control and if that means using stuff that is contra-indicated, then so be it. I'm reasonably well protected and its more important for me and baby that I nip this in the bud.

She'll check back in on me on Monday to see if the prednisone is helping - if not I'll be looking at some hospital time and IV steroids. G R E A T!

This is the pits!

But on the bright side, pregnancy is going well so I'll look at the positives for now...

Jinx!

2008-07-07T09:38:00.003-04:00

I wrote my last post about an hour before I left the office for the weekend.

We were getting our house exterminated for carpenter ants and I was getting home about 30 minutes earlier than my husband and the exterminator so I could make sure everything was all set to pack up and wrangle the cats into carriers - hubby knew I wasn't doing any of the actual work, just getting everything lined up for him to do it. Well, I get home and the exterminator was there early and already putting the chemicals on the outside of the house! He arrived early so he could start his vacation early - so I had to run in and wrangle the cats and do EVERYTHING before hubby and my mom arrived to help. It was alot of work and I was stupid for doing it...

We got out of the house with the cats on time and I drove hubby back to his office so he could leave his car at the house when he was in NC... so I've got the cats in the back of the car for the next 4 hours and 3 adults crammed into my corolla (oh ya, with a carseat taking up a seat...). I dropped off hubby and was already having lots of contractions. Thankfully I had an appointment for my 17P shot so my mom and I drove there. She was coming with me so that she could stay in the cats while the car was running with the AC on. I had 3 hours between taking him back to work and picking him up to the airport and OF COURSE I would spend that at the office... I got my shot and an exam.

I'm 1/2 - 1 cm. dilated and contracting. I'm on bedrest at home now and had to go to the hospital Thursday night for an ultrasound and meds to stop any contractions ( I had 3-4 dozen of very painful contractions over the course of 4 hours). I got there about 6 PM after picking up Arianna at daycare, dropping off the cats at the house and driving up to my parents (only to turn around and go back to the hospital) I was super worried 'this was it' when I got to the hospital
but thankfully my u/s was the same as earlier in the week and the contractions had stopped by the time I got on the monitors...

The the doctor came in and gave me some 'perspective'. She yelled at me for 10 minutes...

I guess I needed to hear it - as I vented to her about everything I have to do at home with my 2 year old she counter-acted with "You have a husband and family and friends to help, you have more important things to do right now and that is stay in bed... allow other people to do everything, you do nothing but lay in bed"

I stayed with my parents and they put Arianna in a diaper all weekend... it was really hard to 'allow that' considering how hard we've worked on potty training (successfully!) for more than a month.

This is going to be really hard so expect to read lots of venting here!

30 Weeks!!

2008-07-03T10:30:00.002-04:00

I can't believe I'm in the 30's now! This is AWESOME!

This week I had another OB appointment and u/s. My cervix is still funneled and a little bit shorter at 2.4 cm and it looks like the 'Y' shape I was worried about - meaning its starting to dilate too. Not enough to be worried about, yet. I have another appointment next week and will ask for a dilation check to be sure.

I'm having ALOT of trouble with my asthma lately - to the point where I'm taking my inhaler frequently throughout the day. I'm actually really worried about it. The hospital I will deliver at doesn't do anything BUT OB related stuff. The hospital next to it can handle my Long QT Syndrome (which limits the meds I can take for my asthma) and asthma but hasn't done anything OB related in 50 years... I'm supposed to see OB medicine which is the branch between the two hospitals but at yesterday's appointment they were running so far behind that they had me reschedule my appointment, so I have no OB medicine doc right now.

Add to that the fact that I'm 'moving in' with my parents this weekend because my husband is going to NC for the weekend - and that moves me more than an hour from the hospitals! So, if I have trouble, and I probably will, I think I'll make the trek up to Brigham and Women's hospital in Boston which has a great cardiology deparmtent and OB department and can handle my asthma with my 2 high risk factors. This will create a problem with getting records to my doctors but I don't really care - the 'tangled web' of hospitals down here is a bit too much to deal with right now and I don't want to have to wait for hours at one of the hospitals down here while OB medicine figures out what they're doing...

My ffn is still valid for another week (its predicts 10 to 14 days out), so I'm still pregnant for at least another week! woo hoo!

Next weekend I'm getting professional maternity pictures done and will post them for everyone to see!

Have a great 4th of July!!

Good News!

2008-06-27T13:06:00.002-04:00

I had another ultrasound and FFN test today. Baby is still huge but fluid level is very normal. Cervical length is holding strong at 2.6 cm, so I can rest easy for the weekend! My FFN test came back negative - this means I'll see the 30s... I can't believe it! I'll be able to say "I'm 3x weeks pregnant"... unbelievable!

So much for that...

2008-06-25T09:59:00.004-04:00

So today I'm my most pregnant - this was my first milestone and I'm very happy.

Now the bad news:

Yesterday I had an ultrasound (my first in 4 weeks) to check the baby's size and my cervical length. My doctor is concerned because I'm HUGE... when I say huge, I mean really big - as in full term big. As it turns out this kid is in the 90th percentile and I have an 'overabundance of amniotic fluid' - both of which put pressure on my cervix... which is now funneling and short at 2.5 cm - a loss of nearly a cm in a month. I've had an increase in discharge that I chalked up to advancing pregnancy but now realize its my cervix thinning...g.r.e.a.t.

I failed my 1 hour like I thought I would and have to take the 3 hour this weekend. A big kid and overabundance of amnio fluid are signs of gestational diabetes - so I bet I have it. My father has Type II so its not like I don't have risk factors for it.

Arianna was born at this point in my pregnancy and weighed 2 lbs. 15 oz... this kid, at the same gestation, is weighing in at 3 lbs. 9 oz! I'm paying $1000 for a doula and watch, I'll end up with a c-section because the kid is too big... oh ya, and breech... fun times.

On the bright side my OB and I agreed that the reason Arianna was born early was cervical incompetance so getting the cerclage was the single best thing I've done this pregnancy. The 17P shots are a close second because they've been shown to strengthen weak cervix. We also agreed that even if I pass the 3 hour on Saturday I should plan on following a low carb diet because this kid is just WAY too big and if it continues I'll be looking at a 9 lb baby. I won't lie to you that if I go full term I'm VERY scared of delivery. I hired a doula to do it 'all natural' and I'm scared that the size of the baby will make that very hard.

I have another ultrasound on Friday to check the cervical funnel - if it shortens more I'm on bedrest. It would be very hard to do bedrest at home with the amount of work required around the house and potty training a 2-year old and it sounds odd to request it but I'll be asking for hospital bedrest. Although I haven't been having any contractions a funnel/short cervix brings it on and I'd rather be in the hospital if that happens so it can be stopped immediately.

I just need 6 more weeks to feel comfortable... I can do that in the hospital; I know I can, I know I can...

I've made it this far - that's a reason to celebrate but I want my 'take home kid' and I don't care if I have to hang from my toenails to get it!

28 weeks...

2008-06-23T10:17:00.001-04:00

Yesterday I was 28/3 - the day I went into labor with Arianna so I'm a little teary eyed yesterday and today. At 5 o'clock I was driving to the ER with DH thinking they'd just give me some meds and send me home. The nice nurse in the ER had me give a UA sample and get changed and no sooner did I get back to the bed the resident checked me and told me I was 'paper thin' effaced at 100% and 4 cm. I wasn't going to leave the hospital and she would be born very soon. For some strange reason I was more excited than not and when the resident tried to calm me down I stupidly said "I was born really early and I'm fine... she'll be fine too". I've learned so much since that day.

I was wheeled up to L&D and they immediately gave me the first steroid shot and it seems that the exam the resident gave me really sent me into full labor - the pain was UNBEARABLE! Within an hour I had an epidural and the onslaught of Social workers/NICU staff/Nurses/OB Medicine and OB staff would infiltrate my room throwing all sorts of info at us but I was too scared to really listen.

She was born at 6:43 AM on 28/5 - so if I can make it to 28/5 and still be pregnant I've reached my first goal - to make it past where she was born.

I have a growth u/s and meeting with my doc tomorrow afternoon - I am very optimistic everything will be fine but still have my fingers crossed, just in case.

Third Trimester!!

2008-06-13T16:12:00.002-04:00

I did it - I made it to the 3rd trimester. Only 12 days until I can say I'm my most pregnant. I can't believe how time has FLOWN! Wow!

I was just sending an email to my husband today saying how I'm glad we'll have all our debts (minus my 2006 Toyota) paid off next month so we can actually have some money to buy baby things because we haven't purchased ANYTHING yet. I feel bad in a way. At this point in my first pregnancy we had finished the nursery and had lots of baby things. This baby is already second best and s/he isn't even here yet!

Oh well - its more important that we pay off our debts so I can stay home with minimal stress when the baby arrives.

I had my 1 hour gestational diabetes test this morning - I hate that test, its so pointless. I'm sure I'll fail it again like I did with Arianna and I'm really not looking forward to doing the 3 hour. I didn't get to do the 3 hour with her because she was born the day I was scheduled to take it - oh well! I was good and watched my diet closely for 3 days prior to the test so I hope it makes a difference. I only failed my 1 hour by a few points last time but had a huge carb loaded breakfast before hand. This time I enjoyed a yogurt and water so I hope it makes the difference!

I had my 17P shot and they're getting so much more tolerable now - maybe its because I'm more vocal about how they should administer the shots or just that I'm used to them, but either way its good. Only 8 more shots! WOo HoO!

I have an appointment on Tuesday and then we make a plan for the rest of the pregnancy. Since I'm in the 3rd trimester I'm out of the 'incompetant cervix' danger zone and if my cervical length is favorable we can pretty much rest assured it won't be the reason I deliver early if I do.

On the bright side I haven't had any contractions (that I feel anyway) in 2 weeks - how odd considering how the weeks previously had gone. I'm not complaining, its the best news I could report. I'm so optimistic right now. As long as Tuesday's appointment goes well my anxiety level will drop through the floor because I'm doing really well now! Who'd-a-thunk it? :)

WOW!

2008-06-06T14:31:00.003-04:00

I know I've been here before but I still can't believe it - next week I'm in the third trimester! WOW! I'm so happy to have made it this far without bedrest or intervention!

26 Weeks!

2008-06-06T11:39:00.002-04:00

It's been a milestone week!

I'm now under 100 days and I have had more 17P shots than I have left (10 shots so far, only 9 left now). Things are going really well (knock on wood). I haven't had ANY contractions in over a week and although my hips still ache all the time, I can deal with that if I'm not having contractions. Maybe we've 'turned a corner' and things will be nice and quiet from now on?

I have my 1-hour glucose test next Friday. I failed this by 5 points in my first pregnancy and was scheduled for my 3-hour the day Arianna was born. It was a big source of stress for me and I really want to avoid that this time so I'm going to be really diligent about watching what I eat next week so I don't consume too many carbs or whatever and hope for the best! My OB is concerned that I'll fail it again - I'm measuring 3 weeks ahead already so she wouldn't be surprised if I had gestational diabetes. I sure hope I don't though - I don't want the added stress!

It's been weird the last 2 weeks for me. I have no appetite - I haven't been hungry and nothing sounds good. I don't know if I've got a cold or not but my asthma has been pretty out of control - which is very rare for me. I had alot of trouble with my asthma early in my first pregnancy but it was gone by the second trimester. This time it didn't peak until the end of the second trimester! Due to being pregnant and due to my heart condition I'm very limited in what I can take and that's scary to me. I really hope doubling up on my steroids will help soon because being pregnant makes you out of breathe anyway!

I'm going to do something I said I would never do this weekend - I'm putting on a bathing suit and going to a public beach! Put out the beached whale signs! I have no clue how I'm going to shave my legs and bikini area, I can barely see my feet! But it's going to be 95 degrees this weekend and my husband is in NJ for a 'guys weekend' and I'm sure not going to be chasing after a toddler when its THAT hot outside all by myself- I've recruited my mom and hope the two of us can wrangle a two year old who loves the water!

Another mini-milestone

2008-06-05T14:43:00.001-04:00

I'm under 100 days left - woo hoo! Double digits!

That requires cake and ice cream doesn't it?

NICU Levels

2008-06-05T13:00:00.001-04:00

I thought this was very interesting... in case anyone is looking for a chart on how the AAP (American Academy of Pediatrics) grades their NICUs:

Consistancy...

2008-05-30T10:19:00.002-04:00

I can't tell you how upset and relieved I am right now.

I went to see my regular OB yesterday, the one who really knows me, and she did an exam and I had an ultrasound. Not only is my cervical length the same it was on Tuesday (3.3 cm) but I'm not soft and certainly NOT dilated. She can't explain why the resident told me I was... but that's why she's my doctor and the resident isn't.

I went to the hospital for reassurance on the increased amount of pressure/pain in my hips and instead left thinking I was going to have another 28 weeker. I have Symphysis Pubis Dysfunction which basically means my hips feel like they're on fire all the time - most likely my hips are out of alignment due to some injuries I suffered while skydiving (bad landings on my butt, nearly breaking my tail bone etc.) - so for the remainder of my pregnancy I will have severe hip pain and it will mostly likely get worse. How fair is this? How fair is it that I'm already neurotic about every twinge and have to deal with this? It's not fair but lots of people deal with stuff that isn't 'fair' in life and I just have to suck it up. At least I have a name for it now and know that I'm not really crazy - this really is painful and there isn't much they can do.

So, not only am I not helping my neurotic/paranoid high risk pregnancy thoughts, but the hospital didn't help either. My doctor was really nice about all of this and simply said "I'll see you next week but you're doing really good, there isn't anything happening right now out of the ordinary"... she, thankfully didn't say "try to not worry" because I think she knows that's impossible.

Thanks again for the kind thoughts everyone - they seem to do the trick because, once again, it was a false alarm :)

25 weeks

2008-05-29T09:54:00.000-04:00

I narrowly averted getting admitted to L&D last night. My hips were absolutely killing me - walking hurt, sitting hurt and I was getting contractions. I took 10 mg. of nifedipine but after an hour nothing seemed to help my hip pain so I went to the ER.

My cervix is 'soft' and finger tip dilated... and I'm officially freaking out. I had a negative on my fFN test. I have an appointment with my doctor at 11:15 today. Tuesday I had an ultrasound and was 3.3 cm which was a loss of 1/2 cm. in one week. Things are happening fast now and the doctor covering for mine said he was very worried about me tearing through my cerclage. The resident I saw at first talked about steroid shots....

I just started crying - how did I go from 3 cm and everything great to them talking about steroid and admitting me?!

Bedrest is a given, I started that as soon as I got home and I'm fortunate that my work will allow me to work from home.

I'm getting scared now - I'm only 25 weeks. Even the resident didn't express confidence I'd last another 10. Although no contractions showed up on the strip it wasn't all quiet so they think I'm 'irritable'... and I didn't feel any of it.

ugh - Please keep me in your good thoughts today. I hope to update this afternoon!

Percentiles of Sonographic Cervical Length

2008-05-28T11:39:00.002-04:00

Please click the picture to see the bigger version

Ya... I'm below the 10th percentile right now. I'm very glad I have a cerclage!

Great new come-back

2008-05-27T14:40:00.003-04:00

This story comes from a new-preemie mom and I thought she created a great story!

So a mom at the playground approaches me to ask how old my 29 week preemie is.

"3 weeks?" she guesses.

"No, 3 months." I reply.

I sit and wait for the normal look of confusion that comes over people's faces when I tell them my preemie's age. It is quite humorous. I think they wonder if I have forgotten my own baby's age.

The look appears and then I go into the whole explaination of his age, birth weight, NICU stay, blah, blah blah.

Then she looks at me through her Dolce sunglasses and asks me what has to be the most retarded question I have ever heard.

"So when do you celebrate his birthday?"

"On the day he was born."

"Even though he was early?"

"Yes, most people celebrate their birthday according to the day they were born." I am really irritated at this point by now.

"Oh, I suppose that makes sense."

Oh my God, is this conversation really happening?

Then she procedes to go on and on about her baby was a larger weight when he was born than my baby is now.

I just wanted to look at her and say " Congratulations! I guess you get the loose cooch award for the day!"

Ok, I can't stop laughing - I wish I could have used that one of the multi-tude of times comments were made about Arianna's size...

I just can't respond...

2008-05-23T14:30:00.003-04:00

I belong to a message board for women due at the same time as me - September. Earlier this week, unfortunately, a mom gave birth to a little girl at 24 weeks. I can't imagine being in her shoes and my heart really goes out to her, she will have a long/hard road in the NICU and beyond.

I can't respond to the messages of support - I feel badly about not being able to reach out to her but the majority of the other posts are "my cousins friends sisters finance's brother's wife had a little girl at 23 weeks last year - she's 12 months now and TOTALLY PERFECT! No problems at all!" (really, at a year old you can say that?) or "My sister and I were born at 29 weeks 30 years ago and we're totally fine now" (Can you really compare 29 weeks to 24 weeks?), and the most hurtful "Preemie's do so well now - they just need time to grow outside for a while and she'll be just fine!"... ya, that's what my daughter NEEDED... she needed to be outside of me in order to grow.

So how do I respond with "I'm very sorry you are in this position - your NICU rollercoaster will be very hard and you can expect lots of ups and downs. You'll have a big learning curve but don't underestimate how well your daughter can do or even if she falls in with the normal course of a 24 weeker and has trouble for a while. I wish you the best and feel free to email me if you want to talk"... I did and immediately got pelted with all sorts of messages from others saying I was being too negative blah blah blah.

It's amazing how prematurity wears such rose colored glasses to the general public... well, no its not really amazing in a good way.

Seeing pictures of her little girl - with a preemie diaper up to her armpits despite an umbilical line - make me so sad for all preemies. Who's life needs to start being poked, prodded and having a tube shoved down your throat? I cried seeing her pictures. I'm so very scared of putting another baby through that but its practically out of my control and thats even more scary.

24 weeks

2008-05-22T09:54:00.003-04:00

Today marks 'viability'. I'm trying to not celebrate making this point because it was never my goal. My goal is to make it further than I did with my first pregnancy and we're still 4 weeks 6 days from that. But at least I know that bean baby could arrive now and we may bring a baby home.

I'm doing well - no repeats of last week (knock on wood) and I'm still as active as I have been. I'm measuring big and carrying pretty high so I'm out of breath alot and even now, just sitting here, I'm out of breath and its really annoying. I hope its just the position bean baby is in today.

Otherwise everything is progressing just fine and I get to complain about normal pregnancy stuff... so I'll start that here for levity.

* Whose stupid idea were maternity jeans? Seriously - the stretchy band is either too low causing your pants to FALL OFF when you bend over or the band is high causing the top of the jean material to totally dig into your stomach making you look 'fat' when you sit down! I'm sick and tired of them but its all I have minus one dress and one black skirt - so I'll be investing in some skirts and summer dresses tomorrow because they're much more comfortable and cute than jeans/pants.

* I didn't have a foot swelling problem with #1 but boy oh boy do I have it now! I haven't been able to wear sneakers for a good month now and I need a pedicure! My heels are nasty. To save money I usually do it myself but its SO hard to bend down to do it now and there is no way I'm letting hubby near my feet (he's a little 'rough'). Spend the money on a pedicure or pay off the car before kid comes so I can stay home in the fall? Hmm... I think I'll invest in lotion and wear socks to bed.

* Bloody noses - I'm really sick and tired of waking up with one EVERY DAY, not to mention that my nose is ALWAYS stuffed up. I've been using a nasonex nasal spray for months now but its not really being very affective anymore. At this point in pregnancy #1 my nose wasn't bothering me at all - what's up?

* Weight gain. I've stopped looking at the scale because I know it ain't pretty. I tell the nurse every week "I'm closing my eyes, tell me if there's a problem, otherwise I don't want to know". I did this with Arianna too and by the time she was born I was up 30 lbs. I probably am this time too :(

I guess I'll just have to suffer through it - and its worth it if I get to term.

Meeting with my doula this weekend and I'm very excited! I hope everyone has a great long weekend!

Thank you!

2008-05-20T11:01:00.003-04:00

Thank you so much for your good thoughts - they must have worked!

I'm very glad my doctor is conservative. I had my ultrasound yesterday - baby is great, and big! S/he is already 1.5 lbs. I can't believe that! She checked my cervix by abdominal ultrasound and didn't tell me the results - said she wanted to do a vaginal ultrasound instead. That had me worried but I didn't have to be. She later told me she wanted to do the vaginal ultrasound because she didn't believe that my cervix could be 'that good' on an abdominal ultrasound.

My cervix is measuring 3.8 - I have a 'wonder cervix!'. That's a fabulous measurement and I'm so happy!

Yesterday afternoon my OB called me after getting the preliminary report from the ultrasound I had earlier in the day. Since my cervical length is 3.8 she doesn't want to see me before my next appointment in 2 weeks - which I'm ok with. I have an ultrasound to check length again next week.

I've been getting lots of cluster contractions which are almost never painful but concerning because I get LOTS of them - Thursday, Friday and Saturday I had lots but nothing since then and my cervical length is still really good - awesome in fact. Its a mystery. Last Friday this was my contraction counts:

10:21
10:32
1:01
1:16
1:25
1:28
1:30
1:34... and nothing for the rest of the day.

Saturday DH and I went up to NH for a convention and I had dozens on the way there. Then Sunday the 3 of us went to the zoo and walked around ALOT, I had not one contraction the entire time!

I talked to her about going on nifedipine around-the-clock and she doesn't think its necessary. I agree. At this point my cervix isn't being affected by the contractions and it may just be what my body does when pregnant now. Lots of women have many BH like contractions and go on to have full term pregnancies.

She gave the option of long term nifedipine (procardia) up to me. I don't think I want to take any medication if it's not necessary right now. We're going to continue to closely monitor everything and watch out for pre-term labor problems but right now I don't think I'll take the nifedipine long term. I can still take one if I get alot of contractions in a short period of time but that's it.

I'm surprisingly OK with all of this - but more importantly I'm ECSTATIC at how well my cervix is holding up despite the contractions. I am crediting the 17P shots and early cerclage with how well this is all going.

This weekend I have my first meeting with my new doula and I've drafted up a birth plan - how odd to be thinking of normal pregnancy stuff now. I remember at this point in my pregnancy with Arianna I was all about researching breastfeeding... so much for that. I tried for 6 long months to get Arianna to breastfeed and had to give up and ya know what - she was just fine with me pumping for 13 months! So I'm not stressing about that stuff now - now I just want to make it to 'take home' gestation.

Yesterday I called my mom to update her on my appointments and she told me "your brother was born at 34 weeks and was only in the hospital for 2 weeks!". I kinda snapped at her - "No, this one is coming home with me!"... I felt kinda bad but I don't think she understands how scared I am of leaving the hospital without my baby. I pray every day to reach 8/8/08 - 35 weeks and a great shot of going home with me.

Prayers today please

2008-05-19T09:38:00.001-04:00

So this morning I had my bi-weekly appointment and was told two things:

1. I'm measuring pretty big (which I knew because I'm HUGE right now) - 26 weeks, when I'm only 23 - good if I have a preemie.

2. She thinks my cervix has done some serious shortening based on a manual exam so I have an 'emergency ultrasound' at 11 o'clock today. I'm still closed and the cerclage is still tight, so that's good news. I'm only in the office for about an hour and then off to the appontment. I really wish there were more ultrasound tech's so I could have gotten the ultrasound at my 8 AM appointment! So I'm really nervous now but can only pray for the best. I had felt I'd 'dropped' on Saturday, I was suddenly carrying really low and my mind was RACING with bad thoughts but I really didn't want to pay ANOTHER $100 ER copay and wait there for hours, so I just laid in bed all afternoon/evening. Despite contracting all day thursdya, friday and saturday...Sunday everything was good - not one contractions! Wierd!

So I'll ask you to all keep me in your good thoughts today and I hope to update when my appointment is over.

Physical Assessment guidelines to establish risk

2008-05-17T22:13:00.002-04:00

Hi everyone,

I came across a study on pre-term labor that you will probably find really interesting and encouraging:

http://www.emedicine.com/med/topic3245.htm

Physical assessment guidelines to establish risk

The obstetrician should review previous preterm deliveries, including autopsy reports and medical records, if appropriate and available. Social stressors (including housing and food availability), social support in the family, financial stability, domestic violence, drug abuse involving the patient or her family, and death or serious illness in a close family member should be assessed.

The integrity of the cervix and the extent of any prior injury to the cervix may be assessed by speculum and digital examination. The presence of asymptomatic bacteriuria, STD, and symptomatic BV may be investigated.

In some patients, formal cervical length assessment may be of use in risk assessment.

Cervical length during prenatal care, particularly at 24-28 weeks' gestation, has been demonstrated to be the most sensitive prenatal predictor of preterm birth between both high- and low-risk women. In a mixed high- and low-risk population of singleton pregnancies, transvaginal ultrasound-measured cervical length at 24 weeks was highly correlated with the risk of spontaneous preterm delivery before 35 weeks. The relative risk of preterm delivery among women with a cervix 25 mm or shorter at 24 weeks was 6.2. Furthermore, at 28 weeks, a short cervix (=25 mm) was associated with a 9.6 relative risk of preterm delivery. Cervical length 25 mm or shorter at 28 weeks had a 49% sensitivity for prediction of preterm delivery at less than 35 weeks, a value markedly greater than that of cervical funneling.

Among high-risk women with a history of one or more spontaneous preterm births (excluding those with multiple gestation, uterine anomalies, and prior cervical surgeries), 20% of patients demonstrated a cervical length shorter than 25 mm by transvaginal ultrasonography at 22-25 weeks. Among these patients with a short cervix and one previous preterm birth, 37.5% delivered at less than 35 weeks. In contrast, patients with a cervical length longer than 25 mm had a preterm rate (<35 wk) of only 10.6%. Cervical length has similarly been demonstrated as the optimal predictor of preterm delivery in low-risk women. In an assessment of low-risk women, short cervical length at 24-28 weeks was detected in 8.5% of women.7 These patients demonstrated a relative risk of 6.9 for preterm delivery at less than 35 weeks. As compared with fetal fibronectin or Bishop score, cervical length demonstrated the greatest sensitivity (39%), with a specificity of 92.5% and a negative predictive value of 98%.
Whereas cervical length assessment by digital exam is a semisubjective measurement, a recent study has demonstrated the value of an objective cervico-portio length measurement using Cerivlenz, an intravaginal measuring device.8 These manually obtained cervical length measurements appear to be reproducible, accurate, and predictive of a short cervical length by transvaginal ultrasonography. Therefore, Cerivlenz may represent a low-cost, objective screening tool to identify at-risk patients for preterm delivery.

In addition to the 24-28 week assessment, evidence shows the value of early midtrimester cervical length measurement. Studies of Owen et al from the Maternal Fetal Medicine Units Network demonstrate the value of cervical length measurements between 16 weeks and 23 weeks and 6 days. Serial transvaginal ultrasonographic cervical length measurements in a high-risk population demonstrated that a cervix shorter than 25 mm resulted in a relative risk of 4.5 for spontaneous preterm birth at less than 35 weeks, with a 69% sensitivity, 80% specificity, 55% positive predictive value, and 88% negative predictive value. As the NIH Maternal Fetal Medicine Units Network is initiating a study of progesterone treatment for patients with a short cervix in the early midtrimester, a program of routine cervical length screening may soon be justified.

Among patients with a short cervix, education should be provided concerning the signs and symptoms of preterm labor, especially as the pregnancy approaches potential viability. Prenatal visits/contacts may be scheduled at more frequent intervals to increase patient interaction with the care provider, especially between 20 and 34 weeks' gestation, which may decrease the rate of extreme preterm birth.

22 Weeks!

2008-05-12T09:57:00.003-04:00

Another week down and it was pretty uneventful, thank goodness. I didn't have any repeats of the 'Tuesday night contraction-fest' and got my 17P shot.

I have to vent about these shots - I don't know if its the nurse giving it to me or what but they really hurt. I have several black and blue marks on my butt and it takes 4 or 5 days for the HUGE welt to go away after I get the shot. The injection site is really itchy for a few days and it hurts to sit down. I'm getting really tired of it and I still have a long way to go! I don't know what to do to make it better because everyone else I talk to who gets these shots says they aren't that bad... what the heck is my problem then??!

Otherwise things are going well. Last night baby decided to hang out using my uterus as a hammock and it was really really uncomfortable - I ended up going to bed early because laying down on my side was the only thing that made me slightly comfortable. Not only that but s/he was still hanging out that way at 3 AM when I got up to use the bathroom! Luckily by the time I got up s/he had shifted a bit and it wasn't so bad. By the time I got to work bean baby was 'head up' and an hour later 'head down'... s/he must love moving around so much! I don't remember Arianna moving around like this at all!

I don't have another appointment until next Monday and I hope everything is still going well then! I'm coming up on 'viability' and that's super scary for me - baby is only a little over a pound right now! I'm not going to worry about that too much though - we're going to go much farther than last time. I dream of a take-home baby all the time, so it must be a sign! :-)

21 weeks

2008-05-07T12:47:00.003-04:00

I'm getting big... and I'm letting myself enjoy it this time! I hope to post photos soon!

Last night was Tuesday and was the first, in the previous 3, that didn't end with me in the ER with contractions - it was such a nice change. Last Thursday I saw my OB and got my 17P injection and convinced her to give me procardia to help with the contractions so I didn't waste my time in the ER until 4 AM again. She agreed! I did end up taking one on Saturday when I got 6 contractions in about 10 minutes, but I haven't had anything since, which has been wonderful.

I saw my OB again on Monday where she did a cervical check and we talked for a bit. My cervix is SUPER HIGH (she actually had a really hard time reaching it) and long and closed which is the best news I could have heard. She told me she understands why I'm nervous and nothing besides getting through the next 2 months will help but she said she thinks its in my best interest to see her every 2 weeks instead of every week because she feels its too much stress for me. She wants me to keep my feet up when I'm home and continue to drink lots of fluids. Baby is very active now and I get kicked so much more than I did with Arianna - I bet this one will be the one that keeps me awake at night. Everything is going really well despite the contractions and I just need to focus on the positives.

I still can't believe that in one month the baby could be born alive - not that I want that but still, its scary close. We have nothing done in preparation. Last weekend we got some used furniture from my coworker to replace all the furniture Arianna will be losing to the baby but its all stacked up in the room that will be the baby's room which still has a ton of crap in it that needs to be moved out. I doubt we'll get it done before the baby arrives, even if its full term. H/She will sleep in a bassinet in our room until 15 lbs. anyway, so they won't need a bedroom for a while. I'll just need a big basket for clothes for now.

I hope everyone is enjoying the sunshine out there - today is a beautiful day as was yesterday. I love spring/summer in New England!

20 Weeks!!!!!!!!!

2008-04-25T13:37:00.003-04:00

I can't believe this time has come! I'm half way today - when did that happen?! When did 5 months go by?! Seriously...

I've had a rough week with lots of contractions that mess with my head but the 17P shots must be working wonders on my cervix because the contractions don't seem to yet be causing problems - I'm so thankful for that.

I have another appointment on Wednesday and can only hope that my cervix is still behaving. I'm still debating to push for Procardia to help with the contractions but since they aren't doing anything at this point, I'm ok with waiting it out.

We signed the contract for our birth doula today and sent her a check for her deposit. I'm optomistic that we'll make it to full term and have a normal delivery but I also know that at any moment it can change - so we have a doula lined up, for now so that my labor and delivery experience will be better than my first pregnancy. I really felt like a caged animal being poked at and it was really scary and I think it made me ask for the epidural super early and as a result I was tied to a bed with way too much time to obsess about what was happening - it was the worst experience and I hope we don't have to repeat it.

Did you know?

Numerous clinical studies have found that a doula’s presence at birth

tends to result in shorter labors with fewer complications
reduces negative feelings about one’s childbirth experience
reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
reduces the mother’s request for pain medication and/or epidurals

These are all good things in my mind so we're going to try one and see. We met with Tina, our doula, about 3 weeks ago and felt very comfortable with her. She also runs some of the child birth education classes that are given at the hospital we'll deliver, and that made us even more comfortable with the decision.

We've even decided on names now that we're half way: Christopher Michael for a boy and Madelyn for a girl (undecided middle name right now).

Next step is cleaning out the bed room that will serve as his/her bedroom - that's a huge task in and of itself!

19 weeks

2008-04-23T20:22:00.002-04:00

I'm nearly at the half way point... Friday marks 20 weeks and its not very fun.

I enjoyed 2 hours of near constant contractions last night - since they didn't hurt, I didn't bother calling my doctor (since I knew I'd waste a trip to the ER anyway) and just drank lots of water and put my feet up. Eventually they stopped. Today started out fine but I was still getting crampy about once an hour or so. I left work after 1 PM to go to the office to get an U/S and see one of the doctors. Everything looks good on U/S - 3.8 cm which is great. If these contractions keep it up I'll be requesting procardia soon as eventually these will thin my cervix and I don't want to wait for that to start happening before we do something.

So ya, my stress level is through the roof right now - but what's new?

#1...

2008-04-16T10:27:00.002-04:00

I'm sure this won't be the first time, but it was a shame it had to happen at only 18 weeks 3 days.

I ended up at the Emergency Room on Monday night about 8 PM. After I got home from work my round ligament pain (which has been REALLY bad) was worse than usual. After dinner I decided to lie down for a while.

After laying down for a few minutes the same round ligament pain was occuring, but I wasn't moving - which made me think it wasn't round ligament pain. I haven't felt the baby move much because I have an anterior placenta so even movements confuse me - I didn't get many with my first pregnancy because of the same reason so even, what could be, normal movements confuse me. So I decided to call my doctors office. The OB on call quickly called me back and I was very frank about my situation telling her I didn't think it was something serious and wanted to know what I should do.

She told me to play it safe and come in to the ER to get checked out.

I know, at 18 weeks there is nothing they can or will do and that scares me. We were all sitting in Arianna's room when I took the call and after I hung up the phone I just started bawling - something I haven't done in a long time. Arianna was so confused - she kept yelling 'mama! mama!' and trying to get close to me. I couldn't help but look at her and think of how lucky we are to have her - I picked her up and gave her a big hug when she said 'all done crying?'... and I laughed and said 'yes, all done crying'. She's so precious.

I then tried to call my parents - I wanted someone to come by and stay with her while we left. It was close to her bed time so it would be easy for someone to stay at the house - I was pretty confident we wouldn't be at the ER long. Well... no answer at my parents house, no answer on moms cell, no answer on dads cell, no answer on my brothers cell - but his girlfriend answered so I asked her if she could come down to the house and watch her while I went to the hospital. She was a wreck, even more so than me I think! She ended up calling the VFW post where my brother tends bar and my dad was with him and told them of the situation - my dad was more than just a little rude with her and I felt bad, she was only trying to help.

So a little after 7:30 my parents showed up at my house and took Arianna home with them and Shawn and I drove down to Providence to the ER.

We were very lucky there were only two other parties waiting - both women were obviously very full term and then there was me, who just looks fat rather than pregnant. I got in very quickly and the on call doctor and my nurse were very nice. She gave me a quick exam and said my cerclage looked wonderful and I was still long and closed (music to my ears!) and then we struggled to find bean baby on the doppler - we found him/her after a few tense minutes. I must have a tilted uterus - I didn't know it would STILL be so hard to pick him/her up at this stage but the nurse wasn't surprised.

Then they did a test to see if I had a urinary tract infection (which was negative) and sent us home. I was hoping the UA came back showing an infection so that it was easily explained but instead I got - everything is normal, its just round ligament pain, get a maternity belt.

I don't feel bad about going in but I have found I'm much more anxious now. I stayed home from work on Tuesday and felt really good so I'm hoping that my ultrasound on the 21st shows that my cervix is still behaving (fingers crossed)!

I did something really stupid tonight...

2008-04-10T23:22:00.003-04:00

I went to a website for women with incompetent cervix and looked at the pictures of the babies that died due to mom's IC - many of them from 17 - 24 weeks.

I'll stop bawling eventually... really.

Its so horrible that this has to happen. Its so horrible that anyone has to deal with that. I'll be saying an extra prayer for them tonight and kissing my angel baby (now a toddler!) before I go to bed.

Sigh of...

2008-04-10T20:53:00.002-04:00

...relief.

Had my 18 week ultrasound today - Bean baby is doing awesome! Currently weighs in at 8 oz and is developing fine.

Best news was my cervical length - 3.6! :) This is still great, they don't worry until you're under 3.0. The only thought still crossing my mind is that this is slightly shorter than when I was pregnant with Arianna - at 20 weeks I was 4.0 with her, but the discrepancy can be for a number of reasons including new ultrasound equipment (I had the same tech this time as with Arianna so I don't want to say it could have been the tech... even though it could have been).

So I can exhale for another 2 weeks... phew.

Rant...

2008-04-09T09:47:00.003-04:00

Ok, you get to listen to me rant for a little while - hope you don't mind!

I'm in pain, every freakin' day. They call it normal 'round ligament pain' but I call it torture! Sitting hurts, standing hurts, bending over hurts, getting up from the floor hurts. But mentally it hurts too because I'm in the danger zone now - 18 weeks and every single ache and pain sends my mind racing! Is this a contraction? Is the fullness I'm feeling because I'm funneled to the cerclage?

I knew that this pregnancy wouldn't be 'fun' but I was really hoping to keep my exposure a little bit more. I feel like crying. Monday I was sitting on the floor reading books to Arianna (her favorite thing!) and when we were done I tried getting up and my left hip sort of locked up on me and I couldn't get up. It was so painful, for only a few seconds, that I was too scared to move. I screamed and then just started crying - not because it hurt after the initial pain but because I was so scared. I hate being scared that I could lose this pregnancy at any moment - I have no reason to really be worried, so far everything is fine! I'm doing this to myself!

We have our 'big ultrasound' tomorrow. Will finding out the sex help me bond better with my baby? I really want to be surprised on delivery day but will knowing help me have a more 'normal' pregnancy? I'm starting to feel kicks now (despite my anterior placenta) and its very reassuring but I question even those movements - the baby rolls over, is that minute amount of pressure a contraction?

I don't know what will help my anxiety. Therapy? Drugs? No, I won't be taking any medication to help this. I've been through much worse in my life and didn't need medication - I can get through this without causing potential harm to my baby. But maybe its time for therapy again...

Tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks of gestation: a randomized controlled pilot study

2008-04-07T15:53:00.002-04:00

Link to article

OBJECTIVE: The purpose of this study was to determine whether intravenous magnesium sulfate (MgSO(4)) followed by oral nifidepine tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks' gestation reduces neonatal hospital stay.

STUDY DESIGN: Fifty-four women between 32 0/7 and 34 6/7 weeks with preterm labor were randomized to receive either MgSO(4) and oral nifidepine (n = 24) or no tocolysis (n = 30). All women received betamethasone and prophylactic antibiotics. The primary outcome was total neonatal hospital stay. Data were analyzed using Chi-square and Mann Whitney U test.

RESULTS: The 2 groups had similar mean cervical dilation and gestational age at enrollment. There were no statistically significant differences in total neonatal hospital stay (5.8 +/- 7.2 days; median of 3 days in the no tocolysis vs. 7.5 +/- 8.6 days; median of 3 days in the tocolysis group), rate of preterm delivery (57% vs. 75%) or need for oxygen supplementation (7% vs. 21%, p < 0.23). The neonatal complications were similar in each group.

CONCLUSION: Tocolysis after 32 weeks gestation does not reduce neonatal hospital stay.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I am very disheartened to read this. I wouldn't be surprised to learn that some women have not been offered tocolysis because 'it won't do any good anyway'.

Very sad.

17 weeks

2008-04-07T08:36:00.004-04:00

I went away on a retreat with some friends this weekend, but before I left I went to my doctors office to get my first 17P injection. I had to see a doctor, which surprised me because I thought all my appointments were supposed to be with the same doctor to avoid mis communication etc. It was Dr. Brodsky who was the admitting doctor the day I went into labor with Arianna - she's not my favorite because of her rather crass bedside manner but she was pleasant and the appointment went well because I got to hear the bean baby on doppler for the first time!! It was a great sound!

The appointment was super quick and then I had to wait around for almost 45 minutes for my shot. I only went to this appointment for the shot so I was really annoyed that I was there for more than an hour - really annoyed because one of my friends was waiting for me to get home so we could drive to our retreat. I'll have to ask at my appointment this week if I really need to see a doctor and then wait around for an available nurse to give me the injection. I was really hoping to avoid weekly appointments this pregnancy!

I'm not going to lie - the shot hurt! My butt was sore all weekend! But if it works I'm not going to complain! I have another shot this week on the other side so now both butt cheeks can be sore, ya!

This week we have our structural ultrasound when they could tell us the gender - but we're not going to find out this time, we'll let it be a surprise. The most important part of this appointment is that I will find out what my current cervical length is - I haven't had a trans-vaginal ultrasound to check its length since before my cerclage was placed; my doctor has just been doing manual exams so I'm anxious to hear that NOTHING has changed. I had no change in my cervical length until after 20 weeks with Arianna (my last ultrasound was at 20 weeks) and I'm hoping for the same here. I'll be talking to my doctor about starting Vitamin C this week to help ward off pPROM which has a high occurrence when cervical funneling is present (as is typical from this point on in IC patients with and without a cerclage)

I'm starting to get more anxious as the time goes by because I feel so much more sore in my hips than I remember being with Arianna. On top of that I'm getting HORRIBLE leg cramps at night
and feel so old! I'm praying really hard for good news this week and would appreciate any good thoughts from my readers!

Week 16

2008-03-31T10:00:00.003-04:00

I'm officially 4 months along! Wow - time is really flying.

I had an appointment last Monday - the day after we came back from our cruise. My cerclage looks good but we still can't find the baby on doppler. Some of this may be because of my anterior placenta but most likely it is due to low fluid around the baby! I was really bad about staying hydrated while we were on vacation and the day we flew back we were delayed 5 hours and I don't think I drank more than 24 oz. of fluid ALL day - really bad!

So I got yelled at... justifyably so. I have to be better about drinking fluids - I knew this and just because I was on vacation doesn't mean I can stop being pregnant for a week. Since that appointment I've been really good so I hope it made a difference!

I have my 'big ultrasound' on 4/10 - we could find out the sex then, but we're going to be surprised on delivery day! They'll also check my cervical length then (and hope for LONG). I have my next high risk appointment for 4/11. I also start my 17P shots on Friday - not looking forward to getting stuck with a needle every week but if it works, I won't complain!

I'm starting to get uncomfortable standing too long or laying on my back - I'm sure I'm in for even more fun as time goes by...

Week 13

2008-03-07T14:03:00.003-05:00

I made it to the second trimester. Now if I can just get into the 3rd trimester (after 28 weeks) I'll be super happy!

Last night we took Arianna to a toddler gymnastics class. It involved parental participation. When I arrived I asked the perky young girl at the desk what was expected of parents and she glanced at me and all she could say was "well everyone needs exercise, you'll be doing everything the kids do!". I was taken aback a bit. I'll admit I hate this stage of pregnancy; where you don't look pregnant, just fat. (I guess it didn't help that all I was wearing was a bulky sweatshirt huh?) So I spun around to my hubby and said loudly "Well, since I'M PREGNANT and can't lift more than 20 lbs. you'll have to help her". I was a bit upset about the comment. I ended up doing much more than I should have and paid for it dearly when I got home - my hips were VERY sore.

Today I went to run some errands at lunch. I wanted to get some last minute things for our upcoming cruise vacation. I walked around two stores and stopped to get some lunch. My hips are STILL hurting me. I want to take it easy this weekend but we have so much to do! Arianna's birthday party is tomorrow and we have to pack for leaving for our cruise next weekend. I don't see how I'm going to be able to 'take it easy'.

On the plus side I had my post-op appointment yesterday and it went well. They still can't pick up Bean baby on the doppler so I got another quick ultrasound. This time Bean was sleeping quietly.

My biggest complaint with my OB group is that with my pregnancy with Arianna I was 'watched' for problems. There are 12 doctors and twice as many secretaries in this group and they all had different ideas on what to watch for. I was told I would have weekly ultrasounds until 24 weeks by one doctor and then the next would say everything was fine. I didn't get the treatment I hoped for and was hurt by it when Arianna came so early. I decided to stay with this group because they have admitting privileges at the hospital and are one of the few high risk groups and I had hopes that things would be better if I started to demand more.

Well as it turns out, now that I have a cerclage I'm high risk (duh!). So I'm in their high risk protocol now. I got a call from a nice lady earlier this week. She is the high risk secretary - yes, there is one dedicated to gals like me. She told me that from here on out I would see the same doctor every two weeks and would only deal with her for scheduling. My prayers have been answered! I'm very happy to FINALLY be getting the treatment I want.

Anyway, I decided to pick the doctor that put in my cerclage as the one that will follow me - we have a good rapport and I like her. I see her again in 3 weeks and then every 2 weeks after that until delivery (hopefully about 38 weeks). She said she does a mix of manual exam of the cervix (with her hand) and trans-vaginal ultrasounds to measure the length. I'm not exactly thrilled at the thought of having something poking at my cervix and cerclage too often but I trust she knows what she's doing. My next ultrasound is at 18 weeks but I see Dr. Cavanaugh at 16 weeks. We'll discuss starting 17P shots then also.

I have a new concern. I was doing some research into the drugs used to stop pre-term labor and found that I supposedly can't take them with the heart condition I have (Long QT Syndrome) . This obviously isn't great news but I also understand that managing pre-term labor with underlying conditions is all about managing risk - is it more risky to give drugs to stop pre-term labor to mom or more risk to baby due to early arrival. My cardiologist is fine with all the drugs used to stop pre-term labor but I know OB-Gyn's can get a little weary about that. This group is well aware of my heart condition so its not news to them but I am going to talk about my concern with these medications at my next appointment. I'm worried they're going to send me to Maternal Fetal Medicine - which is a separate group I saw last time. It turns out my heart condition was not at all a concern during my pregnancy and I went to WAY too many useless appointments (they wanted to see me weekly!). I really don't want to go back to weekly appointments with them in addition to the appointments I'll have with my high risk OB... so I've got my fingers crossed.

I doubt you'll hear anymore from me this week. We leave next Friday for a week in the Caribbean (Jealous yet? I know I am! hehe). I hope its a relaxing, uneventful vacation and that the only news I come back with is how gorgeous my tan is!

We're on lockdown!

2008-03-05T12:22:00.002-05:00

My cerclage surgery was last Friday, everything went well in that aspect. I don't have any cramping and only a little bleeding. The spinal was really surreal - I'm watching them lifting my legs into the stirrups and no feeling A THING - it was wierd.

The worst part of the day, and why I'm very lucky to have had the cerclage at all, is that I got my daughters stomach flu that morning. As of 9 PM I'd vomitted 10 times. 5 of which was from the drive to the hospital until I was in the operating room. 1 of which was in the middle of surgery! I notified my doctor of the virus I had and she wanted to go ahead with it as I wasn't running a fever or anything - this TOTALLY surprised me. They gave me nearly 20 mg. of Zofran through my IV and I was still vomitting. Of course, I wasn't allowed to eat anything because of the surgery so it was mostly dry heaving. Try doing that on your back... it sucked big time. They gave me an u/s as soon as the surgery was done and it was a little sad to see the baby had moved to the very other side of my uterus from my cervix - it must have 'needed' to move from all the 'work' they were doing down there. I hope s/he is ok now!

I lingered around the house all weekend (doctors orders) trying to recoup after all the vomitting but it was not easy. It's hard for me to not have control - so it was hard to see the table a mess, my daughter still in PJs and dishes in the sink. If I get put on bedrest there is going to be ALOT of tension between hubby and I when it comes to the house work...

I have my post-op appointment tomorrow and hopefully everything looks good. I didn't get ANY antibiotics (IV or take home) and I'm worried about infection. I'm on pelvic rest for the remainder of the pregnancy now (no sex, poor hubby!) and have to refrain from picking up anything over 20 lbs. Arianna weighs in at 22 and is a very needy kid, so this won't be easy - she already screams at daycare when I won't pick her up immediately... and its hard on me, I want to pick her up!

So the new bean baby is on lockdown - ordered not to come out for AT least another 24 weeks!

NT Scan

2008-02-26T13:38:00.003-05:00

I had my NT scan yesterday and I must say - it was the best ultrasound I've ever had! My doctors office scans stink. I've actually gone to appointments for cervical checks where they don't even show me the baby. This u/s was done at the hospital and it was incredible - she showed me everything and took me on a baby tour. This one moves around so much more than any scan I had with Arianna. Bad news is that I have an anterior placenta so I won't feel any movement until much later, but I doubt I'll have problems with previa as its high - but everything looks marvelous so I'm very happy about that. I left with two sets of pictures and its amazing how clear they are - this one has the same nose as Arianna (which is very different than mine or my husbands - its actually cute). I was there for about 20 minutes and left with 2 sets of 4 pictures - one for hubby and I (no fighting! haha). I was so happy I had it done.

I'll have pictures to post soon - I just have to find a reliable scanner!

Next up - 3 days until my cerclage! I'm nervous with anticipation!

Week 11

2008-02-22T10:26:00.002-05:00

Week 11 is already here - where has the time gone?! Things are better, overall with my morning sickness but still not perfect. I find that most of the time I eat stuff, thinking I want it, only to find it tastes horrible and then I feel sick. Not fun. But I'll take that over all day nausea!

I find the hormones are totally wrecking with my patience. Last night we went to dinner (cause the thought of cooking was gross to me) at a local restaurant and ordered Arianna's macaroni and cheese immediately. Of course, she finished her food before ours arrived and wanted to get down and run around. Um... no. So she whined and cried which of course set me off cause I can't stand the thought of other people staring at us wondering why we took such an unruly child to dinner. So we spent dinner hurriedly trying to eat our food and keep her entertained. It didn't work and we ended up leaving before we were done. I was so made at her for being such a brat! Why? Its perfectly normal for her age to have acted like that. It seems the new baby is already zapping my patience!

The next week is my last week of freedom - things will definitely change after my cerclage. I'll be doing my own sort of modified bed rest and will be relying on family/friends to help me more. I think things will still be hectic until after we come back from vacation but then its 'feet up' for me!

Dehydration

2008-02-21T13:34:00.003-05:00

This pregnancy is very different from my first in a variety of ways. First was the morning sickness (aka all day sickness) - I didn't get it with Arianna at all. I had/have it very bad with this one but its getting much better - instead of all day nausea nothing tastes good.

Second has been my lack of 'thinking about it'. With Arianna I thought about being pregnant every day - looking up all sorts of baby/parenting information and obsessing over my pregnancy. This time I generally don't think about it much at all - I'm actually hoping I can start 'bonding with this pregnancy' a bit more after the cerclage surgery.

Thirdly its my dehydration. I'm naturally NOT a thirsty person - never have been. I probably live the majority of my life in a mildly dehydrated state. Last weekend I don't think I drank much at all - we were busy, out and about so I didn't take the time I needed to drink many decaf fluids.

Monday morning I came into work and my lips were dry/cracked. My legs were itchy from being dry and my hands were cracking. Hmm... I should probably drink something. So I brought in a pitcher and some decaf iced tea sweetened with sugar - the only thing I can drink unlimited amounts of. I'm not kidding when I tell you I drank 2.5 Liters of tea at work and only used the bathroom 3 times.

HOLY DEHYDRATED BATMAN!

It's now Thursday and I've been drinking about 3 liters a day and not really using the bathroom all that much - its obvious my body really needs all this fluid. But its horrible that its sugary iced tea! So today I went to the store and got some decaf iced tea sweetened with splenda which my OB told me is a much better alternative, so as soon as the original container of iced tea mix is gone I'll switch to the no sugar kind.

Being dehydrated can trigger pre-term labor and it makes me wonder if that's what happened with Arianna. The day I went into labor I was working the cat show at the convention center and on my feet all day. I can't really recall drinking anything that day. I met my mom for lunch and drank 2 big glasses of seltzer water that day but in the bathroom I had lost my plug (not knowing that was what it was). I was in active labor 5 hours later.

Well... you can rest assured I won't make the same mistake this time - I'm drinking tons of fluids and staying hydrated. Just finished my 2 liter pitcher and its only 1:45 PM!

Pre-op appointment

2008-02-21T13:20:00.002-05:00

Yesterday I met with the OB who will be placing my cerclage next Friday. She is one of the few in my OB practice whom I have not met yet. She was a bit abrasive to start but we got to talking and things softened. I did have to chuckle when she said:

"Your cervical length on ultrasound is 4.0 right now, that's good. But I take it you still want the cerclage? Have you been pregnant before?"

I know she's busy - they're all busy running from patient to patient (I waited in the waiting room for 45 minutes!)... but I'm there for cerclage placement, the LEAST you can do is read my chart and my history - it won't take long, promise!

I have a LEEP and 2 cone biopsies in 1998, followed by a 28 week gestation delivery in 2006 - these are MORE than reason enough for a cerclage. Then she commented, "Well, 28 weeks is good!". Um, ya, I guess. Compared to 24 weeks, 28 weeks is good. But compared to full term, 28 is bad! I'm not looking for 'good', I'm looking for full term.

She did a quick ultrasound, which was a welcomed surprise! I got to see my little bean baby bouncing around and s/he was waving! I was so happy - but no sooner did I see that, it was over. She then did a manual exam of my cervix and had to comment there "well, you certainly don't feel like you have a 4 cm cervix - you don't have much cervix up front but there seems to be a lot in back. I think the cerclage is a good idea". Duh.

The better part? She said I can go swimming when I'm on vacation! She said she didn't want me doing cannon balls into the pool or something but if I wanted to go wading into the ocean with Arianna or leisurely swim, I have permission. No sex until after baby though - sorry hubby!

The only thing that concerned me was that I won't be getting antibiotics to take after surgery. I'll get them in my IV during surgery, but nothing afterwards. Infection is a major cause of early cerclage failure and means end of the pregnancy - which is obviously scary... but then I started asking other women with cerclages and found many of them DON'T get antibiotics after cerclage placement so that made me feel less panicky.

So now I'm just biding my time until next Friday's surgery. I'm nervous but excited to get it over with.

Next Monday is my NT ultrasound which I'm very much looking forward to - any chance to see my little bean baby again make me happy!

10 weeks today!

2008-02-15T08:37:00.002-05:00

I can't believe how fast time is FLYING! I'm 10 weeks today and so excited - my baby looks like a baby now and not some Martian blob! woo hoo!

And, to make it even better - my all day nausea is GONE! I'm able to eat whatever I want and not feel bad. I don't think I've even gobbled TUMS in a week! It's so nice to feel more normal. I still get queasy but not nearly as bad as it was the 4 weeks prior - this is so wonderful!

I'm in my maternity pants full time now. I'm still wearing regular shirts for the time being. I went shopping last weekend to get clothes for our upcoming cruise and managed to find two pairs of shorts and 4 shirts. I still have to find a bathing suit - even though I know I won't be able to go swimming I want one for getting some sun on deck!

This coming week I have my next OB appointment and pre-op appointment. No ultrasound this time but thats ok - the following week I have my sequential screening (history of spina bifida in my family recently) and it involves a very detailed ultrasound to check for trisomy disorders and SB. Then I have my cerclage on the 29th. I'm very happy I'm getting it as early as possible. I can't find the exact studies but I've heard from other IC patients that getting your preventive cerclage earlier means your cervix is even better protected - 12 weeks is the minimum many will get it at and I'm getting it at 12 weeks exactly. I just pray everything goes well!

Week 9

2008-02-08T10:06:00.000-05:00

I made it to week 9 and I'm not having a good time. Earlier this week I think hubby and I got food poisoning - it was like morning sickness times 10. I ended up leaving work at noon to come home and crash into bed until 3. And then we were BOTH in bed at 7:30 that night. The only thing I could eat was a baked potato and I got so sick afterwards - it was horrible. Now I'm just back to my normal all day nausea and I can't wait for it to go away!

I had my first appointment with the OBs in my group on Monday. I dislike this particular OB that I saw - she was the one that admitted me when Arianna was born and her attitude turned me off then and now. She came into the room and said "So do you have any questions for me?"... um... a TON! And I told her so. She said (this is great) "Well, we'll watch you extra closely this time....". I cut her off right there. Why did I have a preconception appointment to discuss a cerclage when, at my first appointment, they'd ignore that?! I told her "No! That's what we did last time and we 'watched closely' as I had a 28 weeker!"... and she actually said "well, what do you want us to do?".

Oh geez.

So anyway, I have my cerclage scheduled for 12 weeks exactly on February 29th, a Friday. I can still go on my cruise scheduled for 2 weeks after that. So I have a pre-op and regular OB appointment on the 20th to start. I haven't met the doctor that will do my cerclage so I'm happy to have this appointment. On the 25th I have my nuchal translucency ultrasound and blood test and then cerclage on the 29th. I'm a little upset that my surgery isn't until 3 PM. I don't think I can eat ALL DAY because of it... yuck.

Otherwise things are going as well as can be expected and I just hope all this morning sickness is over by 11 weeks. With my first 11 weeks was the point where I felt normal again... so fingers crossed! Just two more weeks!

Thank you for all the wonderful emails! I read them all but haven't had a chance to reply. My morning sickness includes bad headaches that are light sensitive and I don't like to stare at a computer screen any longer than absolutely necessary - which is hard seeing as I'm a computer programmer - but you WILL get a reply, just give me a few days to feel better!

Week 8

2008-02-04T09:42:00.000-05:00

Hello everyone!

Between stresses at home and my 'all day' sickness I haven't been very good about updating this week - I'm sorry. I hope to get better about it as I start to feel better!

I had my first ultrasound last Friday - it went well. I got to see the (one) little bean that is making me so sick! Bean's heart rate was 165, which was on track with development at 8 weeks 0 days.

Today I have my appointment with my high risk OB. We'll talk about my cerclage placement and 17p shots. I really hope I don't erupt into a volcano of tears like my preconception appointment!

Here's the ultrasound picture - It scanned very badly because the scanner here at work is junk:

Week 7

2008-01-25T10:55:00.000-05:00

Well...it's been quite a week! I don't know how I managed to make it to work every day. I most certainly didn't cook every day. I didn't have this type of 'all-day-sickness' when I was pregnant with Arianna and I really wasn't prepared.

Today I actually woke up without feeling sick - which was so nice. But I'm drinking lots of sprite zero to help calm my tummy. I also find I have to eat constantly or I get ill. I wish I could ALWAYS pick healthy things to eat, but I don't. It's just before lunch today and so far I've had: Scrambled egg, cheese on a croissant, small pudding cup, granola bar, pear. Lunch will probably be a sm. subway veggie sub with cheese and extra vinegar - I lived on this when pregnant with Arianna and haven't really touched it since. Why does being pregnant make me crave vegetables? I guess it could be worse...

Next Friday is my ultrasound! ahh!!! I'm excited to see the little bean that's been making me SO sick!

I'm still here...

2008-01-23T13:38:00.000-05:00

I'm still here, I promise. I'm just so sick with 'all day sickness'. I can't hardly concentrate on anything right now. I hope it only lasts a few weeks and if I'm feeling up to it I'll post more here but right now I just want to curl under a rock and sleep the next 5 weeks away!

Week 6

2008-01-18T08:47:00.000-05:00

Today I'm half way through my first trimester! ya!!

It's starting to feel more real now. I'm having trouble sleeping as I'm up to the use the bathroom at least once a night. I had my first craving yesterday and boy did it feel great to get it too!

It was a waldorf chicken salad sandwich from a deli near my office. Its chicken with lots of mayo, cranberries, cheddar cheese, lettuce on a wheat wrap. Ahhh... heaven in a sandwich! Today I'm craving a Panera Bread Orchard Harvest salad and can't wait for lunch time!

I also had my first bout with nausea this morning. I was holding Arianna while getting everything ready for work and a wave hit me. I had to put her down and of course, as usual, she screamed and wanted to be picked up again but there was no way I was bending over! Daddy came to the rescue and picked her up though! It's sure going to be tough when I get my cerclage and can't pick her up at all. I hope she doesn't start to favor others just because I can't pick her up.

As I wrote in this post, I've been getting pretty emotional. Yesterday involved breaking down and crying after seeing the NICU Arianna stayed at. I'm determined to all I can in my power to avoid going there again!

Tonight I'm headed to Target to get some maternity jeans and hopefully some regular sweaters - its cold out!

Body fat link to pre-eclampsia

2008-01-17T15:49:00.000-05:00

Link to article

Chemicals in fat tissue may trigger pre-eclampsia in some pregnant women, a study suggests.

Researchers in the United States studied over 1,000 pregnant women. About 6% went on to develop pre-eclampsia.

The condition causes a woman's blood pressure to rise sharply, putting both mother and baby at risk.

The researchers found a direct link between the women's weight before they became pregnant and their risks of developing pre-eclampsia.

Higher risk

For instance, women who were obese before they were pregnant were three times more likely to develop pre-eclampsia compared to those of normal weight.

Women who were overweight were twice as likely to suffer problems. Those who were underweight were half as likely to experience difficulties compared to those of normal weight.

Action on Pre-Eclampsia

In fact, the risks increased steadily depending on how much body fat the women had before they were pregnant.

The researchers, who are based at the Magee Women's Research Institute in Pittsburgh, said this suggested that body fat played a role in determining who was at risk.

While further studies are needed, they suggested that chemicals produced by fat tissue may be responsible.

Speaking at the American Society for Nutritional Sciences annual meeting in Washington, they said the findings could lead to new treatments to protect against the condition.

However, they said the findings also highlighted the importance for women of being normal weight when they become pregnant.

Researchers at the University of Glasgow were recently awarded has almost £129,000 by the British Heart Foundation to carry out work in this area.

They will compare blood plasma from women who have had pre-eclampsia with healthy women.

They believe that in some women plasma can stimulate fat cells and cause them to release excessive amounts of fatty acids and other toxic products triggering pre-eclampsia.

Mike Rich, chief executive of Action on Pre-Eclampsia, said women planning to become pregnant can take action to reduce their risks of developing the condition.

"The Magee research confirms what we have known about increased BMI being linked to a greater risk of pre-eclampsia.

"However, it goes further and shows that even small increases in BMI can be significant.

"There is a clear health message. We would advise all women, pregnant and considering becoming pregnant to eat a sensible and healthy diet in order to help reduce the risk of pregnancy complications such as pre-eclampsia.

"Women should also ensure that they attend all of their antenatal appointments for blood pressure monitoring and urine testing."

Pregnancy disorder link to cancer

2008-01-17T15:38:00.000-05:00

Link to article

Women with a history of the pregnancy disorder pre-eclampsia are at greater risk of cancer, research suggests.

The chance of developing breast cancer is "significantly" increased, the study shows.

Research by the Hadassah-Hebrew University in Jerusalem also indicates a greater risk of stomach, ovary, lung and larynx cancer.

A report in the BMJ also suggests environmental and genetic factors may influence pre-eclampsia and cancer.

The study, which found a link to specific cancers, looked at 37,000 women delivering babies in three large hospitals in Jerusalem between 1964 and 1976.

They compared the risk of cancer in those who had experienced pre-eclampsia, with those who had not.

They also looked at the link between social class and other factors including ethnic origin, religion and diabetes on pre-eclampsia - a life-threatening condition which affects about 5-8% of all pregnancies.

It is characterised by a sharp rise in blood pressure and the presence of protein in the urine and occurs in the last three months of pregnancy.

The study revealed that nearly 2,300 women developed cancer for the first time, including 978 (42.6%) of the breast.

'Significant' risk

Pre-eclampsia was recorded in 1,070 women from the study and of these, 40 or 3.7% developed breast cancer.

This compares to 938 or 2.6% of women who got breast cancer among the 36,000 women who did not have pre-eclampsia.

The research team in Israel concluded the risk of breast cancer was "significantly" increased for pre-eclamptic women.

Only a third of the Jerusalem study group originated in Europe - the others were from the Middle East, north Africa, other Western countries and the Americas.

It is believed that in general breast cancer rates are higher among Western women.

The Israeli study also found the risk of cancers of the stomach, ovary, lung and larynx were increased.

The women were followed-up for an average of 29 years.

Genetic link

The study also discovered that West Asian women were more likely to have pre-eclampsia as were those from a lower social class and those with gestational diabetes - the type which occurs during pregnancy.

Dr Simon Vincent of Cancer Research UK said the results of the study were interesting.

"There are likely to be many factors to do with our environment and our health that might increase our risk of developing cancer," he said.

"We already know of some of these factors thanks to research projects, like this one, that look at large numbers of people over a long period of time.

"There are several very large studies, following women over several years, which are currently running in the UK and elsewhere.

"It will be interesting to see if these researchers see the same effects of pre-eclampsia as this study has demonstrated in Israel."

Some, but not all, previous studies have shown a protective effect of pre-eclampsia on breast cancer, although such research has been carried out mainly in northern Europe and North American populations.

The research team suggests there may be a genetic link to both pre-eclampsia and cancer.

They also claim that diet, insulin resistance, smoking or patterns of infection may affect the development of both cancer and pre-eclampsia and their effects may differ between populations.

Birth weight pre-eclampsia 'link'

2008-01-17T15:35:00.000-05:00

Link to article

Women who were underweight when they were born are at greater risk of severe pre-eclampsia in pregnancy, a Swedish study involving 6,000 women suggests.

The risk is particularly pronounced if their mothers had pre-eclampsia when pregnant with them, researchers say.

Pre-eclampsia is a common condition which causes high blood pressure and can put the mother's life at risk.

UK experts said doctors should use the findings, reported in BJOG, to identify women who need more careful monitoring.

The researchers looked at more than 6,000 women under the age of 30 years who had been unusually small when they were born and who had given birth themselves.

Women who were underweight when born had a "markedly increased" risk for severe pre-eclampsia during their pregnancy, they said.

If their mothers had also had pre-eclampsia, the risk was doubled.

The research supports previous work suggesting that pre-eclampsia may run in families.

Low birth weight is also believed to be related to other conditions associated with high blood pressure, such as heart disease.

Prevention

Spotting pre-eclampsia early on can be difficult, despite routine monitoring of blood pressure, and knowing who might be more at risk would be useful.

Dr Karin Zetterstrom, study leader and gynaecologist and obstetrician at Orebro University Hospital in Sweden, said pre-eclampsia could be dangerous to a mother and baby in many ways.

"Those who are born underweight also have high risk of heart disease and the severe form of pre-eclampsia might be part of that pathway.

"It might be of value to ask a woman if she was born underweight or if her mother had pre-eclampsia because we know she is at high risk that her pre-eclampsia will turn out to be the severe form."

Professor Andrew Shennan, professor of Obstetrics and Gynaecology at King's College London and spokesperson for the baby charity Tommy's, agreed with the researchers recommendations for identifying and monitoring those at increased risk.

He said finding women at risk of the severe form of the condition was key.

"One of the really important things is distinguishing between early (commonly severe) and late onset pre-eclampsia because early onset is where the problems lie.

"But paradoxically we don't see people very often at that crucial time and that's the time we need increased surveillance."

"This is quite new stuff and a lot of obstetricians may not even be thinking about it," he added.

Professor Phil Steer, BJOG editor-in-chief, said: "What this research demonstrates is the need for careful and detailed history taking when a woman is first seen in pregnancy.

"If we know that the likelihood of a woman developing severe pre-eclampsia is high, increased surveillance during pregnancy and early appropriate management will help to safeguard the health of both mother and baby."

Preeclampsia genetic basis

2008-01-17T15:33:00.000-05:00

Link to article

A gene associated with susceptibility to preeclampsia is identified in the May issue of Nature Genetics, explaining why this condition runs in families. Preeclampsia is a common and serious complication of pregnancy, involving elevated blood pressure and impaired kidney function.

Cees Oudejans and colleagues found that the majority of individuals with preeclampsia had received variants of a particular gene from their mother, and suggest that this variant functions less well than most other forms of the gene.

Intriguingly, only the maternal copy of this gene is expressed in the placenta during the critical stage in which it invades the lining of the uterus, explaining why the process is so sensitive to loss of this gene's function.

The loss of appropriate function of this gene in the placenta is suggested as a cause of preeclampsia. The study included 67 cases of preeclampsia amongst families with two or more affected sisters, identified from databases within 22 hospitals in the Netherlands.

Take this and shove it!

2008-01-17T14:58:00.000-05:00

Emotionalism that is.

Today I had to go to the hospital to get some bloodwork done (non-pregnancy related). The campus that the hospital is at also houses the building for the maternity hospital (different hospitals - confused yet?). The construction around this area is insane.

The hospital I was going to had construction going on - additions to the two largest buildings, one of which spans the street. The maternity hospital has construction going on too. They're building an addition as large as the main hospital. It's just crazy over there. I'm glad I don't have to go there often... yet.

As I rounded the corner to the parking lot I looked close at the construction at the maternity hospital and thought to myself - I hope our next baby doesn't have to see what this new construction looks like (the new building is the new NICU). Then I pulled into the parking lot and parked in a spot I parked in every day for the months Arianna was in the NICU.

Then it hit me.

I could be back here every day at the end of the summer. I could do the NICU ride all over again. I could lose my identity and become a robot going from work to NICU to home to bed and over and over again. I could get to know the cafeteria staff by first names since I'd be eating dinner there every night for moths.

I'm not an emotional person. For anyone that has met me I've fairly level headed (other than the 'short fuse' thing every once in a while *blush*). I pride myself on being pretty composed. I hardly ever cried when Arianna was in the NICU - but I did break down when she went to the PICU just a week after coming home from the NICU.

But today...I cried so hard. I cried for ten minutes. I didn't want to get out of the car and walk to the blood draw station because I knew my face would be all red and puffy. I couldn't find tissues and it made me cry more.

I called my husband and cried to him. All he could understand was "I can't do parking in this lot for months again! I don't want to do the NICU again! I can't, I just can't!"

I hate this emotionalism stuff... pregnancy is for the birds! ;-)

Does premature birth run in your family?

2008-01-17T10:23:00.000-05:00

Premature birth runs in my family - I was born at 30 weeks, my brother at 34 weeks and my daughter at 28 weeks.

There is a study at Washington University School of Medicine that is recruiting people that have a familial history of preterm birth.

If you have a familial history PLEASE sign up for the study.

There are two parts to participating in the F.E.T.A.L. study:
1) Fill out a detailed questionnaire about the births in your family,
especially the premature births. We will mail you this questionnaire
with a self-addressed, stamped envelope for you to return to us at
your convenience to the address you supplied on the web site. We will
also need to send you consent forms that should be filled out for you
and your child stating that you understand the goals, involvement,
risks, and benefits of the research study, which are outlined in the
consent form and will be explained to you by a member of our research
team after you receive it.
2) The second part of the study includes collecting DNA samples from
you and your child (children) to analyze for specific genes which may
be associated with preterm birth. DNA samples can be obtained from a
saliva collection kit which we would mail to you. You can collect the
saliva samples of members of your family who wish to participate, and
then mail them back to us at the Center for Preterm Birth Research.
Regardless of whether or not you choose to provide DNA samples, we
would appreciate your participation by completing the questionnaire.
The information provided in this form will provide us with valuable
information pertinent to our study.

Please click here to learn more.

I hope you can all agree that it would give all preemie moms great joy to know they helped further the study of why preterm birth occurs and possibly find a cure!

Feeling happy?

2008-01-16T13:25:00.000-05:00

Any mom who is in a high risk pregnancy can probably relate to this post.

I'm pregnant again - I should be happy and making plans, choosing names, buying clothes etc. But I'm not.

Instead I'm investigating ways to get to the illustrious 40 week point. I'm investigating cerclage and infection rates. Instead of telling family and friends I'm hoping to make it to my next appointment to get the 'plan of action'.

I feel like I can't get excited and happy. I feel like any excitement I may have will get ripped from my heart in one fell swoop... so why set myself up for that? Why get excited when you could possibly have the worst possible outcome?

I knew, going into this pregnancy, that there would be nothing 'normal' about it. But I didn't really think about the stress that would go with it too much. Like my work - what if they don't let me work from home while on bed rest? Who will care for my daughter if I'm on bed rest? Can we afford to keep the nanny that watches her if my work won't let me work from home? How will I get to doctors appointments? Will my husband totally resent not having sex after I reach 15 weeks and get my cerclage? Will our relationship be stressed beyond repair? How will I keep my sanity laying in bed 24/7?

I hope for the best, but prepare for the worst. I wish it didn't have to be that way.

Today I'm 5 weeks 3 days...

2008-01-14T21:13:00.000-05:00

...and I had to break out the maternity pants. I can't 'suck it in' anymore.

I can't believe this!! SERIOUSLY. I didn't wear maternity jeans with Arianna until I was nearly 20 weeks and went into labor when I was at the store buying my first maternity outfit - this is just unreal to me.

I'm actually a little nervous so I hope some moms of 2 or more can put my mind at ease.

Were you showing this early with your second (or third etc.) or do I have to be worried about multiples?

UPDATE: Ok, took a few days but the 'bloat' is gone. Back into regular clothes! ha!

Women Successfully Treated to Prevent Preterm Labor at Low Risk for Recurrent Episode

2008-01-13T12:22:00.000-05:00

Link to article

ROCHESTER, Minn. — Mayo Clinic and Medical University of South Carolina researchers have found that the large majority of expectant mothers treated to prevent preterm labor will deliver at or near term.

"We found that if you stopped labor once, only one out of nine women would come back with a repeat episode, which is about a baseline risk for preterm delivery," says Brian Brost, M.D., Mayo Clinic high-risk pregnancy specialist and study co-author. "Most babies will do just fine — they are delivered near term or at term."

While expectant mothers treated with magnesium for preterm labor commonly feel queasy or flushed, serious side effects are rare, according to Dr. Brost, and they usually result from improper dosage or monitoring of the patient following treatment.

The investigators also studied whether the expectant mothers whose preterm labor did recur would be candidates for a steroid treatment in addition to the magnesium. The goal of steroid treatment is to promote accelerated development of the baby's lungs and other body systems. In order for the steroid to be delivered and absorbed into the baby's system, the repeat magnesium treatment to inhibit uterine contractions would need to delay labor for at least 24 to 48 hours. In this study, the researchers found that the magnesium could delay labor long enough for the steroid to work in about half the cases.

This study was conducted retrospectively by analyzing delivery records for consecutive preterm labor patients at Mayo Clinic. In 154 expectant mothers treated for preterm labor who were still undelivered one week later, 87.7 percent (135 women) delivered their babies at greater than 34 weeks. After 34 weeks, standard procedure is to deliver the baby rather than treat the mother again if she went into labor, according to the study's researchers.

In 19 women, or 12.3 percent, preterm labor recurred. Repeat magnesium treatment to inhibit uterine contractions delayed labor for at least 24 to 48 hours in 11 women, offering the possibility for steroid therapy. The other eight women with repeat preterm labor delivered within 24 hours of readmission to the hospital, which did not allow enough time for the physicians to consider giving the steroid treatment.

No measures have been shown to definitively prevent preterm labor, according to Dr. Brost. At the same time, he says, rates of preterm labor have been slowly but steadily rising in the last several decades in the United States.

Newborns are considered to be full-term when delivered about 40 weeks after the first day of their mother's last menstrual period.

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.

Magnesium Sulfate More Effective Than Nifedipine in Preventing Preterm Delivery

2008-01-13T12:18:00.000-05:00

Link to article

June 29, 2007 — Magnesium sulfate is more effective than nifedipine in preventing preterm delivery for 48 hours, but nifedipine is linked with fewer maternal adverse events, according to the results of a randomized controlled trial published in the July issue of Obstetrics & Gynecology.

"Magnesium sulfate is the most commonly used first-line tocolytic in North America although it has not been demonstrated to be superior to saline infusion, and its use has been a source of controversy," write Deirdre J. Lyell, MD, from Stanford University Medical Center and Lucile S. Packard Children's Hospital in California, and colleagues. "Magnesium sulfate requires intravenous administration, has potential for overmedication with serious maternal adverse effects and may be associated with adverse neonatal effects.... Nifedipine may be more easily tolerated, is administered orally, and appears to have few adverse effects."

The objective of this multicenter randomized study was to compare the efficacy and adverse effects of intravenous magnesium with those of oral nifedipine for acute tocolysis of preterm labor in 192 patients in active preterm labor who were at 24 to 33 weeks and 6 days of gestation. The main endpoint was arrest of preterm labor, defined as prevention of delivery for 48 hours with uterine quiescence.

Compared with women treated with nifedipine, more women treated with magnesium sulfate achieved the main endpoint (87% vs 72%; P = .01). Both groups were similar in delivery within 48 hours (7.6% magnesium sulfate vs 8.0% nifedipine; P = .92), gestational age at delivery (35.8 vs 36.0 weeks; P = .61), birth before 37 and 32 weeks (57% vs 57%; P = .97 and 11% vs 8%; P = .39, respectively), and episodes of recurrent preterm labor.

In the magnesium sulfate group, mild and severe maternal adverse effects were significantly more frequent than in the nifedipine group. Although average birth weight, birth weight less than 2500 g, and neonatal morbidities were similar in both groups, newborns of mothers in the magnesium sulfate group spent longer in the neonatal intensive care unit (8.8 ± 17.7 vs 4.2 ± 8.2 days; P = .007).

Study limitations include lack of double-blinding or placebo control and failure to establish the optimal doses of magnesium sulfate and nifedipine.

"Patients who received magnesium sulfate achieved the primary outcome more frequently," the authors write. "However, delay of delivery, gestational age at delivery, and neonatal outcomes were similar between groups. Nifedipine was associated with fewer maternal adverse effects."

The Division of Maternal–Fetal Medicine at Stanford University and the Department of Obstetrics and Gynecology at Santa Clara Valley Medical Center supported this study. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2007;110:61-67.

Vitamin C supplementation to prevent premature rupture of the chorioamniotic membranes: a randomized trial

2008-01-12T20:43:00.000-05:00

Link to Article

Esther Casanueva, Carmina Ripoll, Maricruz Tolentino, Rosa Maria Morales, Frania Pfeffer, Pablo Vilchis and Felipe Vadillo-Ortega

1 From the Public Health Research Branch (EC, CR, MT, RMM, and FP), the Department of Obstetrics and Gynecology (PV), and the Direction of Research (FV-O), National Institute of Perinatology, Mexico City, Mexico.

Background: Vitamin C is involved in the synthesis and degradation of collagen and is important for maintenance of the chorioamniotic membranes. Inadequate availability of ascorbic acid during pregnancy has been proposed as a risk factor for premature rupture of the chorioamniotic membranes (PROM).

Objective: The objective of the study was to evaluate the effectiveness of 100 mg vitamin C/d in preventing PROM.

Design: A controlled double-blind trial was performed. Pregnant women (n = 126) in their 20th wk of gestation were invited; 120 accepted and were randomly assigned to 2 groups (100 mg vitamin C/d or placebo). Every 4 wk, plasma and leukocyte vitamin C concentrations were measured, and each subject was evaluated for cervicovaginal infection. The incidence of PROM was recorded for each group as an indicator of the protective effect of vitamin C supplementation.

Results: One hundred nine patients finished the study. Mean plasma vitamin C concentrations decreased significantly throughout the pregnancy in both groups (P = 0.001), and there were no significant differences between groups. Between weeks 20 and 36, mean leukocyte vitamin C concentrations decreased from 17.5 to 15.23 µg/108 cells in the placebo group and increased from 17.26 to 22.17 µg/108 cells in the supplemented group (within- and between-group differences: P = 0.001). The incidence of PROM was 14 per 57 pregnancies (24.5%) in the placebo group and 4 per 52 pregnancies (7.69%) in the supplemented group (relative risk: 0.26; 95% CI: 0.078, 0.837).

Conclusion: Daily supplementation with 100 mg vitamin C after 20 wk of gestation effectively lessens the incidence of PROM.

Vitamins C and E in the latency period in women with preterm premature rupture of membranes

2008-01-12T20:34:00.000-05:00

Link to Article

S. Bornaa, Corresponding Author Contact Information, H. Bornab and B. Daneshbodie
aDepartment of Perinatology, Tehran University of Medical Sciences, Tehran, Iran
bDepartment of Pediatrics, Shahed University of Medical Sciences, Tehran, Iran
Received 1 December 2004; accepted 23 March 2005. Available online 23 May 2005.

Abstract

Objective: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. Methods: In this double-blind, randomized, controlled trial, 60 women with singleton pregnancies of 26 to 34 weeks' duration and PPROM were randomly assigned to vitamin C (500 mg/day) and vitamin E (400 IU/day) or placebo until delivery. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis.

Results: Important demographic, as well as clinical characteristics such as number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome, were similar in the 2 groups. A statically significant difference in the mean ± S.D. number of days of latency was found between the groups (10.5 ± 5.2 days vs. 3.5 ± 4.0 days (P = 0.03).

Conclusion: Vitamins C and E supplementation of after PPROM is associated with a longer latency before delivery.

Carbon Monoxide May Help Prevent Debilitating Pregnancy Condition

2008-01-11T15:59:00.000-05:00

Link to article

New findings by Queen's University researchers suggest that administering low doses of carbon monoxide to pregnant women may help prevent the potentially damaging effects to mother and baby of pre-eclampsia.

The study was precipitated by the fact that mothers who smoke cigarettes during pregnancy have a 33 per cent decreased risk of developing pre-eclampsia compared to nonsmokers.

A debilitating condition that affects five to seven per cent of pregnancies, pre-eclampsia is characterized by high blood pressure in pregnant women and is one of the leading causes of baby and maternal deaths. "At present there is no cure or effective treatment for this condition, other than delivery of the baby," says research team leader Dr.Graeme Smith (Obstetrics and Gynecology), an expert in high-risk obstetrics.

In the Queen's study, published in the September issue of the American Journal of Pathology, tissue from the placentas of nonsmoking women who had delivered babies by caesarian section was exposed to the same kind of oxidative stress -- not enough oxygen being supplied through the blood -- experienced by women with pre-eclampsia. When the tissues were treated with carbon monoxide, at levels similar to those found in the blood of smoking mothers, cell death in the placenta was significantly reduced.

"We believe that carbon monoxide found in cigarette smoke, and subsequently carried in a smoking mother's blood, may be the cause of their lower risk of developing pre-eclampsia," says Dr. Smith. He stresses however that any perceived benefit of smoking during pregnancy is outweighed by the many risks: premature membrane rupture, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome.

Produced naturally by the body at low levels, carbon monoxide relaxes blood vessels and may prevent the death of placental cells, which can cause injury to fetus and mother. Future studies will determine whether carbon monoxide can prevent placental cell death in animal models and whether other approaches similar to carbon monoxide may provide protection.

Also on the research team, from Queen's Department of Anatomy and Cell Biology, are: Shannon Bainbridge, Louiza Belkacemi, Michelle Dickinson, and Charles Graham.

The work was supported by the Strategic Training Initiative in Research in Reproductive Health Sciences, the Heart and Stroke Foundation of Ontario, and the Canadian Institutes of Health Research.

Adapted from materials provided by Queen's University.

Old Drug Being Tested As Possible Pre-eclampsia Cure

2008-01-11T15:54:00.000-05:00

Link to Article

Researchers at the University of Texas Medical Branch at Galveston are trying to determine whether a drug already available to heart patients can also be used to delay delivery in expectant mothers with severe preeclampsia. If so, this groundbreaking study would give hope to hundreds of thousands of women who experience this life-threatening disorder each year.

The drug, Digibind, has been prescribed for over 20 years to patients who overdose on a certain heart medication, but is not yet approved for preeclampsia, the most common and dangerous pregnancy complication affecting as many as eight in every 100 pregnant women. The disorder is characterized by high blood pressure, protein in the urine and multi-organ dysfunction, all of which can seriously harm both mother and fetus.

"Preeclampsia is the No. 1 killer of pregnant women in the world, and there is no cure except delivery," said Dr. George Saade, chief of maternal--fetal medicine at UTMB. "When it is severe and occurs early in the pregnancy, delivery in order to protect the mother results in a premature baby. That's why this study is important, because if the medication works, then we can protect the mom while allowing the baby to grow and develop without delivering early."

The clinical trial will test whether Digibind reverses or prevents the abnormalities that occur with preeclampsia and allows the fetus to remain in the womb longer. This would give doctors more time to administer steroids to prevent respiratory complications in premature births and reduce the need for costly and lengthy neonatal intensive care.

"Right now, there is no treatment for preeclampsia, so this is truly groundbreaking," said Dr. Nicole Ruddock, the study's principal investigator and an instructor in UTMB's Department of Obstetrics and Gynecology.

UTMB will continue enrolling participants at least through the end of this year. The study is sponsored by Protherics and is taking place in eight states around the country.

Adapted from materials provided by University of Texas Medical Branch at Galveston.

Lack Of Well-Being In A Pregnant Woman May Lead To Premature Delivery

2008-01-11T15:52:00.000-05:00

Link to Article

A group of researchers of the University of Modena has investigated the role of psychological well-being in premature delivery. The study is reported in a recent issue of Psychotherapy and Psychosomatics.

The aim of this study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled.

The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care.

They were matched for parity and gestational age. Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls.

They also displayed a reduced environmental mastery. Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.

Journal reference: Facchinetti, F. ; Ottolini, F. ; Fazzio, M. ; Rigatelli, M. ; Volpe, A. Psychosocial Factors Associated with Preterm Uterine Contractions. Psychother Psychosom 2007;76:391-394

Ya know what's a bit scary about this? Any woman who is pregnant after a preemie is going to be a NERVOUS wreck (I have yet to talk with one who isn't). Where does that put us according to this study? Even more at risk for preterm birth... ugh!

Home Uterine Monitors Not Useful For Predicting Premature Birth

2008-01-11T15:50:00.000-05:00

Link to Article

Portable monitors that detect contractions of the uterus do not appear to be useful for identifying women likely to have a preterm delivery, according to a study by the National Institute of Child Health and Human Development (NICHD).

Although they are widely prescribed for women at risk of giving birth prematurely, the NICHD study confirms earlier findings that the monitors are not useful for predicting or preventing preterm birth. The study also confirmed that several other methods being assessed as ways to predict preterm labor were of little value.

"The study found that while women who gave birth prematurely did have slightly more contractions throughout pregnancy than did women who gave birth at term, there was no detectable pattern that would predict premature birth," said Duane Alexander, M.D., Director of the NICHD.

The study was conducted at the 11 centers participating in the NICHD Network of Maternal-Fetal Medicine Units and appears in the January 25 New England Journal of Medicine. The study was led by Jay Iams, M.D., director of the Division of Maternal-Fetal Medicine at the Ohio State University Medical Center.

The portable, or ambulatory, monitors cost up to $100 a day and may be worn for up to 10 weeks. The monitors relay information to a central monitoring office, where any potential signs of early labor can be passed on to a physician.

The researchers analyzed 34,908 hours of recordings from 306 women. When the women began the study, they were in their 22nd through 24th week of pregnancy. The authors wrote that the women who gave birth before the 35th week of pregnancy had a slightly greater frequency of contractions than did the women who gave birth after the 35th week, but this information did not allow them to predict impending premature labor. A pregnancy is considered full term at 37 weeks.

"…we could identify no threshold frequency that effectively identified women who delivered preterm infants," the study authors wrote in the New England Journal of Medicine article.

The researchers also found little value of some other techniques in predicting preterm labor, including measuring the cervix and collecting a substance known as fetal fibronectin from the cervix.

"Our data indicate that ambulatory monitoring of uterine contractions does not identify women destined to have preterm delivery," the authors wrote.

Preterm birth complicates from 8 to 10 percent of all births, said Catherine Spong, M.D., Chief of NICHD's Pregnancy and Perinatology Branch and coordinator of the Maternal-Fetal Medicine Units. Premature infants are at greater risk for life-threatening infections, for a serious lung condition known as respiratory distress syndrome, and for serious damage to the intestines (necrotizing enterocolitis). Most deaths of premature infants occur among those born before the 32nd week of pregnancy. In addition, the cost of caring for premature infants in the United States exceeds $4 billion each year.

3-D Ultrasound Identifies Women At Risk For Impending Preterm Birth

2008-01-11T15:47:00.000-05:00

Link to Article

To help physicians non-invasively identify women at risk for preterm birth, 3-D ultrasound was used to measure the size of fetal adrenal glands, according to an abstract presented by Yale School of Medicine researchers at the Society for Maternal-Fetal Medicine Conference February 8, 2007 in San Francisco.

Preterm birth is a major public health problem with lasting repercussions on families and society. The authors found that the ultrasound measurements could identify a preterm risk of delivery within five days of the measurement.

"Our results suggest that examining the fetal adrenal gland at the time a woman is evaluated for symptoms of preterm labor, may have major beneficial clinical implications," said first author Ozhan Turan, postdoctoral fellow in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. Turan conducted the study with senior author Catalin Buhimschi, M.D., director of Perinatal Research at Yale Ob/Gyn.

The authors said that understanding the time when a marker becomes positive in relationship to preterm birth is essential for a test with high diagnostic accuracy. "The high accuracy, sensitivity and specificity of the adrenal gland volume in predicting preterm birth within five days from the time of examination proves that 3-dimensional ultrasound evaluation of the fetal adrenal gland has the desired test characteristics to define a population at risk," they said.

The current study creates the basis for further prospective studies to confirm that 3-dimensional ultrasound assessment of the fetal adrenal gland volume can assist clinicians with devising better therapeutic and preventive interventions for preterm birth.

Other authors on the abstract included Sifa Turan, Edmund Funai, Irina Buhimschi and Joshua Copel.

Abstract Title: "Three-dimensional (3D) Ultrasound Measurement of Fetal Adrenal Gland Volume. A Novel Method of Identifying the Patient at Risk for Impending Preterm Birth."

Adapted from materials provided by Yale University.

In Hispanic Women, Genetic Variations Linked To Spontaneous Preterm Birth

2008-01-11T15:46:00.000-05:00

Link to Article

Preterm birth is a major cause of illness and death in newborns. A genetic cause of preterm birth was suggested by racial disparity, a tendency to occur within families and a high rate of recurrence, according to Errol Norwitz, M.D., associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale and lead investigator of the study.

Norwitz and his team prepared DNA samples from 102 mothers with a spontaneous unexplained preterm birth and 408 mothers who delivered at term with no complications. They then compared the distribution of 128 well-known genetic variations, known as single nucleotide polymorphisms, in 77 genes between the two groups. The patients in the study were identified from the March of Dimes Perinatal Epidemiology Research Initiative Project at Yale and New York University between January 1989 and June 2005.

"Our analysis demonstrates that, in an Hispanic population, mothers who carried any one of four polymorphisms were significantly more likely to have a spontaneous preterm birth," said Norwitz.

The four polymorphisms included CYP2C9S144, IL6S174, CCR5S1 and ENPP1S121. The risk of preterm birth was highest among women with the ENPP1 variant.

"The strong association of ENPP1 was particularly compelling, but how this variant functions and why it predisposes preterm births still needs to be determined," said Norwitz.

In another abstract using the same study subjects, Norwitz and colleagues explored whether polymorphisms in the gene that encodes the progesterone receptor may identify women at risk for preterm birth. The team found no such association.

"Progesterone supplementation may prevent preterm birth in about 30 to 40 percent of women at high risk by virtue of a prior preterm birth, but exactly how progesterone supplementation works is still unknown," said Norwitz. "While this was a negative finding, it was an important question to answer."

Other authors on both abstracts included Thomas Morgan, Victoria Snegovskikh, Edward Kuczynski, Hee Joong Lee, Frederick Schatz, Se-Te Joseph Huang, Catalin Buhimschi, Edmund Funai, Irina Buhimschi, Antonette Dulay, Guoyang Luo, Sonya Abdel-Razeq and Charles Lockwood.

Abstract #297: "Identification of Single Nucleotide Polymorphisms in Maternal Genes Associated with Spontaneous Preterm Birth."

Abstract # 316: "Single Nucleotide Polymorphisms in the Human Progesterone Receptor (PR) Gene and Spontaneous Preterm Birth."

Adapted from materials provided by Yale University.

Progesterone Injections Do Not Prevent Preterm Birth In Twin Pregnancies, Study Finds

2008-01-11T15:43:00.000-05:00

Link to Article

The result came as a surprise to the researchers, who previously discovered that weekly injections of the naturally occurring hormone, called 17 alpha-hydroxyprogesterone or 17-OHPC, reduced additional preterm births by one-third in women whose previous babies were born prematurely.

"Based on the results of the first study, which showed that 17-OHPC reduced preterm birth in the group with the highest risk, we were hopeful that it would also prevent preterm birth in twin pregnancies, which represents an intermediate level of risk," said John Thorp, M.D., a study co-author and professor of obstetrics and gynecology UNC-Chapel Hill. "The mechanisms that lead to preterm birth are complex, and I think our current study shows they may not be amenable to a single solution."

The study results are published in the Aug. 2 issue of The New England Journal of Medicine. The lead author is Dwight J. Rouse, M.D., of the University of Alabama at Birmingham. The study was conducted for the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, which provided grant funding. It took place at 14 sites across the United States, including UNC-Chapel Hill, WakeMed and the Wake County Health Department.

For the study, 655 healthy women with twin pregnancies and no prior preterm births received weekly injections of either 17-OHPC or placebo, starting at 16 to 20 weeks into their pregnancies and ending at 35 weeks. The results showed no meaningful difference between the 17-OHPC and placebo groups. Birth or miscarriage before 35 weeks gestation occurred in 41.5 percent of the 17-OHPC group and in 37.3 percent of the placebo group.

The researchers concluded that treatment with 17-OHPC did not reduce the rate of preterm birth in women with twins.

"Why 17-OHPC is effective in reducing the rate of preterm birth in women with a prior spontaneous preterm birth, but not in women carrying twins is a question that will be answered only when the mechanisms underlying preterm birth and the actions of 17-OHPC are better understood," they wrote, adding that additional research is needed to see whether 17-OHPC is effective in other conditions in which the risk of preterm birth is increased.

Thorp said the same research network is currently working on two other 17-OHPC studies. One involves women with triplets while the other focuses on women with a short cervix. Both groups are considered to have an intermediate risk of preterm birth.

Another question for future research, Thorp said, is whether or not injections are the best method for administering 17-OHPC. It's worth investigating whether other methods, such as daily vaginal suppositories, might be more effective, he said.

A commercial formulation of the drug, marketed under the name Gestiva, has been granted orphan drug status by the Food and Drug Administration and an application for full FDA approval is pending.

Metronidazole to Prevent Preterm Delivery in Pregnant Women with Asymptomatic Bacterial Vaginosis

2008-01-11T15:40:00.000-05:00

Original Article

Background Bacterial vaginosis has been associated with preterm birth. In clinical trials, the treatment of bacterial vaginosis in pregnant women who previously had a preterm delivery reduced the risk of recurrence.

Methods To determine whether treating women in a general obstetrical population who have asymptomatic bacterial vaginosis (as diagnosed on the basis of vaginal Gram's staining and pH) prevents preterm delivery, we randomly assigned 1953 women who were 16 to less than 24 weeks pregnant to receive two 2-g doses of metronidazole or placebo. The diagnostic studies were repeated and a second treatment was administered to all the women at 24 to less than 30 weeks' gestation. The primary outcome was the rate of delivery before 37 weeks' gestation.

Results Bacterial vaginosis resolved in 657 of 845 women who had follow-up Gram's staining in the metronidazole group (77.8 percent) and 321 of 859 women in the placebo group (37.4 percent). Data on the time and characteristics of delivery were available for 953 women in the metronidazole group and 966 in the placebo group. Preterm delivery occurred in 116 women in the metronidazole group (12.2 percent) and 121 women in the placebo group (12.5 percent) (relative risk, 1.0; 95 percent confidence interval, 0.8 to 1.2). Treatment did not prevent preterm deliveries that resulted from spontaneous labor (5.1 percent in the metronidazole group vs. 5.7 percent in the placebo group) or spontaneous rupture of the membranes (4.2 percent vs. 3.7 percent), nor did it prevent delivery before 32 weeks (2.3 percent vs. 2.7 percent). Treatment with metronidazole did not reduce the occurrence of preterm labor, intraamniotic or postpartum infections, neonatal sepsis, or admission of the infant to the neonatal intensive care unit.

Conclusions The treatment of asymptomatic bacterial vaginosis in pregnant women does not reduce the occurrence of preterm delivery or other adverse perinatal outcomes.

Terbutaline: Can it prevent preterm labor?

2008-01-11T15:37:00.000-05:00

Can beta-mimetic therapy help prevent preterm labor?

There is no evidence that beta-mimetic drugs, such as terbutaline and ritodrine, prevent preterm birth. However, beta-mimetics are effective in temporarily reducing or stopping contractions in women who are having preterm labor.

Beta-mimetics are best used to delay delivery long enough — usually 24 to 48 hours — to allow treatment with corticosteroids to speed fetal lung development. Beyond that use, it isn't clear that the benefits of beta-mimetics outweigh the potential risks for the mother. Adverse effects from beta-mimetic drugs may include fluid in the lungs (pulmonary edema) and abnormal heart rhythms (arrhythmias).

Relaxation Techniques during pregnancy

2008-01-11T13:48:00.001-05:00

Relaxing during pregnancy is important. Research has shown that stress can increase the likelihood that you will have a premature birth. Personally I try to have some amount of time during the day that is dedicated to stress relief. This is something I did not do in my first pregnancy.

Pregnancy can be a stressful time. Your body is going through major changes you’re supporting a tiny growing baby inside you and you’re thwarted by all sorts of pregnancy side-effects, like morning sickness and aching legs. If you’re trying to cope with working, looking after the rest of your family and keeping up with your usual routine, it can all get too much at times.

But it’s important to take time out for yourself and relax and both you and your baby will benefit. Research shows that if you’re regularly stressed, anxious and tense during your pregnancy, you’ve got a greater chance of having a baby that also suffers from stress and anxiety. So if you need some inspiration as to how to relax, here are some helpful tips!

1. Put your feet up. Aching legs and ankles are a common problem in pregnancy, especially in the third trimester, so give yourself regular breaks and take the pressure of your feet. Sit in a comfy chair with your feet on a footstool or propped up on cushions, lie on the sofa or lie on your bed – whatever is comfortable for you. If your ankles are swelling, stack several cushions together to raise your feet up higher, as this helps reduce swelling.

2. Listen to calming music. Take time out from the madness of life and whisk yourself away to a calmer place, with the help of some relaxing music. Choose one of your favourites or treat yourself to a special pregnancy relaxation CD. Sit back, close your eyes and let the music wash over and relax you.

3. Have a massage. Massage is great for easing tension and relaxing the muscles. Rope your partner in to give you a massage or book a treatment with a specialist (many places offer special treatments for pregnant women).

4. Try a reflexology treatment. Reflexology is a natural therapy that believes your feet are in a sense a ‘map of your body.’ A reflexologist will clear blockages and ease ailments by putting a small amount of pressure on your feet – it’s a bit like a foot massage. It can be very relaxing, can relieve tension and help any pregnancy ailments you’re suffering from. (but get someone who is trained in this and has pregnancy experience as some reflexology can actual start labor in a more advanced pregnancy)

5. Have a go at antenatal yoga. Yoga designed for pregnancy can help tone up your body, but most classes also teach special relaxation tips too. These can help relieve any stress you’re experiencing during pregnancy, as well as ease worry about the birth itself. Ask you midwife for antenatal yoga class recommendations.

6. Try meditation or visualisation. Relaxing your mind is just as important as relaxing your body, but it can be hard to do. Meditation or visualisation could help and there are lots of CDs and classes available that teach it especially with pregnancy in mind.

7. Have a laugh. Laughter is a great form of natural – and free – therapy. Meet up with your friends, or watch your favourite comedy or film and have a good laugh. Your baby will pick up on the feel-good factor too.

8. Get some fresh air and sunshine. It’s good to get fresh air and sunshine when you can and can be a good pick-me-up if you’ve been inside all day. Have a stroll around your neighbourhood, walk to the park or even walk around the shops, breathe in the fresh air and relax.

9. Enjoy a night out with your partner. Spend some time unwinding and relaxing together – especially if it’s your first baby, as life will change when it arrives. Have a lovely meal, go to the theatre or indulge in your favourite pastime.

10. Enjoy water. Water is another form of natural healer. Swimming is ideal during pregnancy, as the water is supportive, and it’s not too exhausting. If you fancy a class, most places offer antenatal swimming sessions, but if a swimming pool isn’t your cup of tea, enjoy a nice long soak in the bath instead.

And finally, enjoy the course of your pregnancy. The nine months will fly by and a new baby will soon be part of your life.

Cervical Cerclage

2008-01-11T12:45:00.000-05:00

Cervical Cerclage

When a woman’s cervix is weak (sometimes called an incompetent cervix) she is more likely to have a baby born prematurely because the cervix shortens or opens too early. In order to prevent premature labor, a woman’s doctor may recommend a cervical cerclage. A cerclage is used to prevent these early changes in a woman’s cervix, thus preventing premature labor. A closed cervix helps a developing baby stay inside the uterus until the mother reaches 37-38 weeks of pregnancy.

What is cervical cerclage?

Treatment for cervical incompetence is a surgical procedure called cervical cerclage, in which the cervix is sewn closed during pregnancy. The cervix is the lowest part of the uterus and extends into the vagina.

Why is cervical cerclage used?

A cervical cerclage procedure may be used if a woman’s cervix is at risk of opening under the pressure of the growing pregnancy. A weak cervix may be the result of:

History of second-trimester micarriages
A previous “cone biospy” or a “LEEP” procedure
Damaged cervix by pregnancy termination

When is a cervical cerclage used?

The best time for the cervical cerclage procedure is in the third month (12-14 weeks) of pregnancy. However, some women may need a cerclage placed later in pregnancy; this is known as an emergent cerclage and is necessary after changes such as opening or shortening of the cervix have already begun. If an emergent cerclage is required, future pregnancies will probably also require a cervical cerclage.

What are alternatives to the cervical cerclage procedure?

If changes in the cervix are found very late in pregnancy, or if the cervix has already opened up significantly, bed rest may be the best alternative.

What are the benefits of a cerclage?

Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases. Cervical cerclage appears to be effective when true cervical incompetence exists, but unfortunately the diagnosis of cervical incompetence is very difficult and can be inaccurate.

Why doesn’t every woman who has had a preterm baby need a cerclage?

Only women with an abnormal or “incompetent” cervix can be helped by a cerclage. However, even with the help of a cerclage, other problems can cause labor to begin too early. Women who have a cerclage placed will need to be checked routinely for other complications such as infection and preterm labor.

What should I expect before my cervical cerclage is placed?

Your medical history will be reviewed
A thorough exam of your cervix including a transvaginal ultrasound performed by a doctor who specializes in high risk pregnancies
Your doctor will discuss pain control options for the procedure
Write down any questions or concerns you may want to discuss with your health care provider

What happens during the cervical cerclage procedure?

Most women have general, spinal, or epidural anesthesia for pain control during the procedure. A doctor will stitch a band of strong thread around the cervix, and the thread will be tightened to hold the cervix firmly closed.

What can I expect after the procedure?

You may stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor.
Immediately after the procedure you may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge, which may continue for the remainder of the pregnancy.
You may receive medication to prevent infection or preterm labor.
For 2-3 days after the procedure, plan to relax at home; avoid any unnecessary physical activity.
Your doctor will discuss with you when would be the appropriate time to resume regular activites.
Abstinence from sexual intercourse is often recommended for one week before and at least one week after the procedure.

How long is the cerclage stitch left in?

Generally the thread is removed at the 37th week of pregnancy, but it can be removed before if a woman’s water breaks or contractions start. Most stitches are removed in the doctor’s office without any problems. The procedure is similar to having a pap smear and may cause some light bleeding.

What are the risks of having a cerclage placed?

The likelihood of risks occuring is very minimal, and most health professionals feel a cerclage is a life saving procedure that outweighs the possible risks involved. Possible risks could include:
Premature contractions
Cervical dystocia (inability of the cervix to dilate normally in the course of labor)
Rupture of membranes
Cervical infection
Cervical laceration if labor happens before the cerclage is removed
Some risks associated with general anesthesia include vomiting and nausea
Are there signs I should look for after the cerclage is placed that indicate a problem?

It is important to contact your doctor if you experience any of the following symptoms after your cerclage is placed:
Contractions or cramping
Lower abdominal or back pain that comes and goes like labor pain
Vaginal bleeding
A fever over 100 F or 37.8 C, or chills
Nausea and vomiting
Foul-smelling vaginal discharge
Your water breaking or leaking
What about future pregnancies?

Most women who need a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.

Dizziness in Pregnancy

2008-01-11T12:30:00.000-05:00

Dizziness in Pregnancy

Dizziness or feeling faint is a normal symptom during pregnancy. It is more common in the first trimester, but it may also be prevalent throughout your pregnancy.

What causes dizziness during pregnancy?

The main cause of dizziness in pregnancy is due to the rising hormones that cause your blood vessels to relax and widen. This helps increase the blood flow to your baby, but it slows the return of the blood in the veins to you. This causes your blood pressure to be lower than usual, which can reduce the blood flow to your brain, temporarily causing dizziness.

Dizziness is also caused by low blood sugar levels that may occur as your body adapts to changes in your metabolism. Women who are anemic or who have varicose veins may be more susceptible to dizziness than others.

During the second trimester, diziness may be caused because your growing uterus puts pressure on blood vessels.

Dizziness may also occur later in your pregnancy if you lie on your back, allowing the weight of the baby to press on your vena cava (a large vein that carries blood from your lower body to your heart).

What remedies exist to prevent dizziness during pregnancy?

There are a number of things you can do to reduce the amount of dizziness you may experience. Here are some helpful suggestions to reduce dizziness during pregnancy:

Avoid standing for long periods. If you must stand, make sure that you keep your feet moving to help increase circulation
Get up slowly from either sitting or lying down (This is very important when you are getting out of the bath)
Eat regularly. Avoid long periods between meals; it is better to snack throughout the day
Avoid hot baths or showers
Avoid lying on your back once you reach the middle of your second trimester
Wear loose, comfortable clothing to avoid restricting circulation

What do I do if I feel faint during pregnancy?

There are a few things you can do to help relieve the feeling that you are going to faint. It is common to faint during pregnancy, so be cautious. Here are some helpful suggestions:

Avoid getting up quickly from sitting or lying down positions. This is a common reason for dizziness, lightheadedness and fainting.
If you feel faint, try the following things:
sit or lie down and lower your head
take deep breaths
loosen any tight clothing
open windows and move towards circulating air
eat foods rich in iron

When to contact your health care provider because of dizziness during pregnancy:

You should contact your health care provider immediately if your dizziness is accompanied by vaginal bleeding and/or pain in your abdomen. This could be a sign of an ectopic pregnancy, a low-lying placenta, or placental abruption.

You should also contact your health care provider immediately if you have persistent dizziness or dizziness accompanied by blurred vision, headaches, or palpitations; this may be a symptom of severe anemia or some other illness that could have a negative effect on your pregnancy.

Week 5

2008-01-11T12:08:00.000-05:00

Today marks the start of week 5... and I guess that means I have to start complaining about all my new pregnancy quirks huh? :-)

The day I found out I was pregnant with Arianna started out strange. At 3 o'clock in the morning I woke up with my first asthma attack in years. I remember debating on going to the ER or not as I didn't have a nebulizer anymore. Instead I grabbed a pillow and went to the living room to sleep in the recliner. I slept like crap. That morning, in my sleep deprived haze, I forgot to pack a lunch on my way to work, so I was very hungry throughout the day. My asthma got significantly better as the day went on and I decided to keep my weekly appointment with my personal trainer.

Andrew worked me hard - we were doing upper back and arms that day and toward the end of my 5 set/15 lbs/30 rep arm curls I got dizzy... really dizzy, but I managed to stay standing and finish. I was pretty sure it was due to me not eating that day.

I was totally exhausted when we finished, I got my money's worth! But I knew I wouldn't be up to cooking dinner so I decided to go next door and get us dinners from Boston Market.

While waiting in line I got super dizzy and before I knew it I had passed out - cold. On the floor. The staff was generous, helped me up. Got me water and offered to call an ambulance. I turned down that offer but sat in one of the booths for a few minutes before driving home with, my free, dinner.

I pulled into the driveway the same time my husband was arriving home. He reminded me he was meeting friends for dinner, but in true 'guy fashion' offered to still eat the dinner I got him. I told him about my dizzy spell and that I was just going to lie down for the evening.

We ate dinner. He left. I settled into the bed with my laptop and started surfing the net looking up reasons to be dizzy, mostly for my own amusement. The first thing that came up was being pregnant. I knew my period was late but I was used to erratic periods and was on the birth control patch. In fact I had taken a test 2 days prior and it was negative. But I still had one left in the pack and decided to take it.

Sure enough it came up pregnant.

I freaked. No way could I be pregnant... no freakin' way. I tried calling Shawn, he didn't answer. I called my Mom and cried to her. I was so upset. My dad was there and had been drinking. He flipped out. He kept saying 'you can come home' blah blah blah (not sure where that train of thought came from, we'd been married for 3 years) and eventually over the course of the evening would say something really stupid that caused such a big rift he wouldn't see his granddaughter until she was 6 months old. Finally got a hold of Shawn and told him he needed to come home right now.

I was shaking and crying when he came home and showed him the test. He was so happy (huh?) and excited. He immediately called his family. They were happy - what a contrast to my family. I was devastated - I was going to CA in 2 weeks to participate in a world record skydiving jump... and now I couldn't. I was so sad.

Fast forward 2 years 4 months. Pregnancy #2.

We're actually trying to get pregnant and succeed! I'm happy, he's happy, his family is happy. Mine doesn't know and won't for some time. (oh but I did tell my brother and his girlfriend who I know will keep it quiet)

No major asthma attack. But dizzy? Oh ya...

All. The. Time.

I feel like I'm in a fog, like I don't have control over my body - my hands are shaking alot and I feel like I could fall over even when I'm sitting. I'm not overly concerned but don't know if I should be.

Maybe that means this one is a boy? ;-)

Prevention of recurrent preterm delivery by 17 Alpha-Hydroxyprogesterone Caproate

2008-01-10T14:46:00.000-05:00

Learn more about 17p shots here: http://www.hydroxyprogesterone.com/

New England Journal of Medicine Abstract

Volume 348:2379-2385
June 12, 2003
Number 24

Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate

Paul J. Meis, M.D., Mark Klebanoff, M.D., Elizabeth Thom, Ph.D., Mitchell P. Dombrowski, M.D., Baha Sibai, M.D., Atef H. Moawad, M.D., Catherine Y. Spong, M.D., John C. Hauth, M.D., Menachem Miodovnik, M.D., Michael W. Varner, M.D., Kenneth J. Leveno, M.D., Steve N. Caritis, M.D., Jay D. Iams, M.D., Ronald J. Wapner, M.D., Deborah Conway, M.D., Mary J. O'Sullivan, M.D., Marshall Carpenter, M.D., Brian Mercer, M.D., Susan M. Ramin, M.D., John M. Thorp, M.D., Alan M. Peaceman, M.D., for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

Background:
Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies. The results of several small trials have suggested that 17 alpha-hydroxyprogesterone caproate (17P) may reduce the risk of preterm delivery.

Methods:
We conducted a double-blind, placebo-controlled trial involving pregnant women with a documented history of spontaneous preterm delivery. Women were enrolled at 19 clinical centers at 16 to 20 weeks of gestation and randomly assigned by a central data center, in a 2:1 ratio, to receive either weekly injections of 250 mg of 17P or weekly injections of an inert oil placebo; injections were continued until delivery or to 36 weeks of gestation. The primary outcome was preterm delivery before 37 weeks of gestation. Analysis was performed according to the intention-to-treat principle.

Results:
Base-line characteristics of the 310 women in the progesterone group and the 153 women in the placebo group were similar. Treatment with 17P significantly reduced the risk of delivery at less than 37 weeks of gestation (incidence, 36.3 percent in the progesterone group vs. 54.9 percent in the placebo group; relative risk, 0.66 [95 percent confidence interval, 0.54 to 0.81]), delivery at less than 35 weeks of gestation (incidence, 20.6 percent vs. 30.7 percent; relative risk, 0.67 [95 percent confidence interval, 0.48 to 0.93]), and delivery at less than 32 weeks of gestation (11.4 percent vs. 19.6 percent; relative risk, 0.58 [95 percent confidence interval, 0.37 to 0.91]). Infants of women treated with 17P had significantly lower rates of necrotizing enterocolitis, intraventricular hemorrhage, and need for supplemental oxygen.

Conclusions:
Weekly injections of 17P resulted in a substantial reduction in the rate of recurrent preterm delivery among women who were at particularly high risk for preterm delivery and reduced the likelihood of several complications in their infants.

Preterm delivery — that is, delivery before 37 completed weeks of gestation — is the major determinant of infant mortality in developed countries.1 Preterm delivery is more common in the United States than in many other developed countries and is the factor most responsible for the relatively high infant mortality in this country.1 The rate of preterm delivery in the United States has increased progressively from 9 percent to 12 percent over the past two decades.2 Despite many trials of reduced activity, tocolytic therapy, antibiotic therapy, and other strategies for prevention, no effective and reproducible method of preventing preterm delivery has been demonstrated.3

One treatment that showed promise in small trials was prophylactic treatment with progestational compounds.4,5,6,7 Not all trials reported positive results.8,9 One meta-analysis found no evidence of effectiveness of progestational compounds in the prevention of preterm delivery or the prevention of recurrent miscarriage.10 Another meta-analysis, restricted to trials of 17 alpha-hydroxyprogesterone caproate (17P), a natural metabolite of progesterone, showed, in composite, a significant reduction in the rate of preterm delivery.11 We therefore chose this pharmacologic agent as the active drug for our study.

Women who have had a preterm delivery are at especially high risk for preterm delivery in a subsequent pregnancy.12 We therefore conducted a multicenter trial to test the effectiveness of 17P as compared with placebo in the prevention of recurrent preterm delivery in this group of women.

STUDY: Diet influence preterm delivery?

2008-01-10T14:09:00.000-05:00

Diet influences preterm delivery?

Issue 23: 14 Nov 2005
Source: American Journal of Obstetrics & Gynecology 2005; 193: 1292-301

Adopting a cholesterol-lowering diet could reduce the risk of preterm delivery in low-risk pregnancies, according to the findings of a new study.

Specialists from centers in Oslo, Norway, randomly assigned 290 women aged 21-38 years to, from 17-20 weeks’ gestation onwards, either continue their usual diet or to adopt a diet with a high intake of fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, and legumes.

The women in the dietary intervention group met with a dietician at the start of the study and at weeks 24, 30, and 36 of their pregnancy. The diet (described in detail in the published paper) included limiting the intake of cholesterol to 150 mg/day, reducing saturated fat to 8% of total energy intake, and aiming at a weight gain of 8-14 kg from pre-pregnancy levels.

All of the women in the study were non-smoking, white, with singleton pregnancies, and had no previous pregnancy-related complications. About two-thirds were nulliparous.

Lipids lowered
Writing in the latest issue of the American Journal of Obstetrics & Gynecology, the researchers report that maternal levels of total cholesterol and low-density lipoprotein were significantly lower in the intervention group than in the control group. There were no differences between the two groups in levels of cord and neonatal lipids.

Overall, one of the 141 women in the dietary intervention group had a preterm delivery (defined as a live delivery before 37 completed weeks of gestation), compared with 11 of the 149 women in the control group. This was a statistically significant difference. There were no differences between the groups in the incidence of other pregnancy complications.

The researchers write: “In conclusion, a diet that was reduced in saturated fat and cholesterol, and enriched in a number of micronutrients, modified maternal cholesterol levels, but not cord and neonatal lipids. It was associated with a lower incidence of preterm delivery in low-risk pregnancies and had no adverse effects.”

They say the findings warrant replicating the study in a larger population of pregnant women, involving both low-risk and high-risk pregnancies: “The marked observed effect of this diet on the reduction of preterm delivery in low-risk pregnancies should encourage future larger studies to clarify the role of such a diet in the prevention of preterm birth.”

STUDY: Prior Miscarriage Raises Risk for Low-Birthweight Infant

2008-01-10T10:51:00.000-05:00

Prior Miscarriage Raises Risk for Low-Birthweight Infant
THURSDAY, Dec. 20 (HealthDay News) -- Women who've had a miscarriage or an abortion are much more likely than women who haven't to experience a low-birthweight or premature baby in the future, new research shows.

A team at Virginia Commonwealth University looked at data on more than 45,500 mother-and-child pairs enrolled in the United States Collaborative Perinatal Project.
About 40 percent of the mothers had one or two children, and almost two-thirds of the mothers were between ages 20-29. The researchers found that rates of low-birthweight (under 2,500 grams or 5.5 pounds) and premature babies (less than 37 weeks gestation) were highest among women who were black, young or old, poorly educated, and unmarried.
The study also found that women who'd had one, two, or three or more miscarriages or abortions in the past were almost three, five and nine times, respectively, more likely than normal to have an underweight baby.
Women who'd had one miscarriage or abortion were 67 percent more likely to have a premature baby, while women who'd had three or more miscarriages or abortions were more than three times as likely to have a premature baby, compared to women who hadn't had a miscarriage or an abortion.
The study is published in the Journal of Epidemiology and Community Health.
The researchers noted that previous studies have been inconclusive, with some reporting no increased risk and others identifying a significantly increased risk of low-birthweight or premature babies among women who've had a miscarriage or abortion. Despite the conflicting evidence, women and doctors need to be aware of the potential risks, the authors concluded.
-- Robert Preidt

I always have to chuckle at these studies...

"The researchers found that rates of low-birthweight (under 2,500 grams or 5.5 pounds) and premature babies (less than 37 weeks gestation) were highest among women who were black, young or old, poorly educated, and unmarried."

Hmm... so where do I fit? I had a micro-preemie, I'm white, 27 (is that old or young?), am college educated and married... also had extra prenatal care. Where does that put me?

That puts me in the "we don't know why and don't know how to prevent..." category. Just where I longed to be! (that was sarcastic if you didn't catch that)

Causes of preterm birth

2008-01-09T16:58:00.000-05:00

Some causes of preterm birth

Although the cause is often unknown, a variety of factors play a role in preterm birth:
• Certain genital tract infections, such as chlamydia, bacterial vaginosis (BV), and trichomoniasis, are associated with preterm delivery.

Substances produced by bacteria can weaken the membranes around the amniotic sac and cause it to rupture early. Even when the membranes remain intact, bacteria can cause preterm labor if they get into the amniotic fluid or sac.

You may have been checked for chlamydia and gonorrhea at your first prenatal visit, and you would have been treated immediately if you'd tested positive for either of these sexually transmitted infections.

If you've had a previous preterm birth, you may also have been screened for bacterial vaginosis. Although some studies show that treating BV in the second and third trimesters reduces the risk of preterm labor in women with a history of preterm birth, other research has found that it makes no difference. So experts don't agree on whether it's worthwhile to test pregnant women who don't have symptoms. (If you have symptoms of bacterial vaginosis, you'll be tested and treated with antibiotics, if needed.)

You probably won't be tested for trichomoniasis unless you have symptoms. Some research suggests that treating women for trichomoniasis during pregnancy actually increases the risk of preterm birth.
• Having a problem with the placenta, such as placenta previa or placental abruption.
• Having structural abnormalities of the uterus or cervix, such as a cervix that's shorter than 25 millimeters and that effaces or dilates without contractions (cervical insufficiency).
• Having an excessively large uterus, which is often the case when you're pregnant with multiples or have too much amniotic fluid.
• Certain chronic maternal illnesses may be related to preterm labor, such as diabetes, sickle cell anemia, severe asthma, lupus, inflammatory bowel disease, and chronic active hepatitis. Other conditions to watch for include non-uterine infections, such as a kidney infection or pneumonia; abdominal surgery, such as having your appendix taken out; trauma to the abdomen; and periodontitis (a gum infection that goes into the bone and other tissues that support your teeth).

Preeclampsia

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.

Typically, preeclampsia occurs after 20 weeks gestation (in the late 2nd or 3rd trimesters or middle to late pregnancy), though it can occur earlier. Proper prenatal care is essential to diagnose and manage preeclampsia. Preeclampsia, Pregnancy Induced Hypertension (PIH) and toxemia are closely related conditions. HELLP Syndrome and eclampsia are other manifestations of the same syndrome. It is important to note that research shows that more women die from preeclampsia than eclampsia and one is not necessarily more serious than the other.

Preeclampsia and other hypertensive disorders of pregnancy are a leading global cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 deaths each year.

Week 4

2008-01-09T14:13:00.000-05:00

So week 4 is almost finished... and I feel really good. I'm getting pretty constant headaches but they're dull and bearable. I've had some significant dizzy spells the last few days but I expect them as I had a pretty severe 'passing out spell' when I was pregnant with Arianna. I'm only a little tired and my breasts are only a little sore. Honestly, if I didn't have a positive test (ok, so I took a dozen of them) I doubt I would realize I was pregnant!

I'm already making adjustments to my diet - more protein and water throughout the day. I've also added a fish oil capsule to my regular prenatal vitamin and am eating Dannon Activia yogurt during the day to help maintain a healthy balance of the good bacteria in my system. Hopefully this will help my body fight off any infections that could threaten my pregnancy.

My first appointment is still many weeks away and I'll be on pins and needles until I get to see our new miracle on ultrasound and get to talk to my doctor about 'the plan of action' for my pregnancy.

My chart

2008-01-03T15:08:00.001-05:00

Hubby and I used fertilityfriend.com to track my cycle. I also used ovulation predictor tests (OPK) and timed intercourse around my most fertile time frame. Then I used pregnancy tests from 8 days past ovulation to test for a positive pregnancy.

I order my a super large batch of ovulation predictor tests and pregnancy tests on eBay, from the Medical Diagnostic Test store

This was our first month trying... I think I should change my name to Myrtle.

I'm pregnant!

2008-01-03T09:49:00.000-05:00

Isn't that a great New Years Day surprise?

Our anniversary is tomorrow and I'm going to surprise my husband with the news!

WOW!

Freedom!

2007-10-25T10:32:00.001-04:00

The IUD is out, as of this morning - suprisingly easy taking it out too!

I'm so nervous yet excited. I can't believe we're doing this after everything we went through but I have high hopes and am optomistic - in my opinion there is no other way to be!

The 'Talk'

2007-10-14T15:12:00.000-04:00

I saw my OB a few weeks ago and was armed with all sorts of studies and sat down in her office to talk to her. When she came into the room I was actually shaking... I was so nervous. Then she started asking me about my daughter and my worries about another pregnancy and I just broke down. I couldn't stop crying - talk about embarrassing!

Short of it is that I'm going to get the cerclage I want - she thinks its a good idea. I'm going to get 17P shots too. She doesn't think its necessary, at this point, to be referred to a peri unless there is a need. Since her office handles high risk patients and has admitting rights at the hospital she doesn't feel there is anything they can't do at this point - they'll even give steroid shots if they feel delivery could be impending. She said I'd get ultrasounds every 4 weeks after the cerclage - but I'm going to push for AT LEAST every 2 weeks, my piece of mind needs that. I'm also going to make some dietary changes, cranberry extract for UTIs (I'm prone to them) fish oil, and probiotics.

I'm really nervous, obviously. My daughter is a 3rd generation preemie and its so strange for me to be getting the SAME treatment my grandmother got in the 60s - bedrest and mag! Grandma also got DES... which may be a reason my mom had us early and there is traces of it going into subsequent generations. Its unfathomable. I was born at 30 weeks and my brother at 34 and my mom spent 2 months on hospital bed rest - on mag. My OB told me to expect the same if I have pre-term labor. You think there would be advancement there huh?

So next week I'm having my IUD taken out...

Number 2!

2007-09-18T13:31:00.000-04:00

We've finally decided to add to our family - but we can't take this decision lightly.

Arianna's first year was VERY VERY hard on us (me more than my husband) and we don't want another preemie. I've learned alot about the long term affects of prematurity in the last year. I've learned about gestation viability and all the various medical terminology that goes with it - you know, stuff that a normal pregnant woman wouldn't have to know...

Based on my first pregnancy and my possible cervical insufficiency I want a preventative cerclage. It involves 'sewing' my cervix shut to prevent pre-term labor/birth. When I first saw my OB at my 6 week post-delivery appointment she inserted the Mirena IUD I wanted and I asked her if they knew of any reason why Arianna arrived early. She said no but next time I would get 17P shots and would be watched more closely. I asked about a cerclage and she told me that I was in pre-term labor and didn't need one.

The research I have done in the last few months does not lead me to believe that is the case. I pretty much painlessly dialated and didn't feel any real pain until I was already 4 cm! That's scary! The research I've done says a cerclage can do more good than harm in cases like mine and I want to be sure that EVERYTHING possible is done to avoid having another preemie.

So I have a pre-conception appointment on Tuesday during which I will bring all the studies I can dig up supporting my cerclage request and hope to get a referral to a perinatologist for a pre-conception appointment soon after. I have my yearly pap smear on October 25th and will have my IUD taken out at that point.

Then its party time!

Just Begining

2007-09-18T13:06:00.000-04:00

Hello! Welcome!

I'm starting this blog to document my first pregnancy 'after preemie'.

My first pregnancy began around the 1st of September 2005 - very unexpectantly! I was using the Ortho Evra birth control patch and apparantly it doesn't work so well because I got pregnant! I was not happy about it. At the time I was a skydiver and being pregnant and jumping out of planes don't mix - it was going to ruin my fun! I spent the majority of my first trimester in a depressive fog - crying alot and sulking in the bedroom watching TV (something I never do!).

After week 13 or so I started to come around. I assumed everything was going fine - the doctor appointments I had indicated nothing different. I had minimal morning sickness and nothing to complain about.

I am a preemie - I was born at 30 weeks in 1978. My grandmother had many second trimester losses and took the miscarriage drug DES - this is why we believe my mother had both my brother and I too early. When I was 18 I went through 16 months of bad pap smear after bad pap smear... I ended up having a LEEP procedure and 2 cone biopsies. Difficulty in pregnancy was mentioned as a possibility, but who thinks of that at 18?

I told my OB group about this familial connection and my possible cervical insufficiency and the first doctor I saw said I would get weekly ultrasounds until week 20. The second doctor I saw - the next week - said everything look good you don't need anything until week 20 (biophysical ultrasound).

At our 20 week ultrasound (just after Christmas) we found out we'd be expecting a girl! My husband was so excited, I was too (although secretly hoping for a boy, shh!).

Everything progressed fine.

At 28 weeks 2 days I went to a wholesale club near our house to buy cases of water. I couldn't find anyone to help me lift them, so I did it myself - two big cases of water into the cart. My back hurt for a while after that!

The next day I was volunteering to help at the local cat show - which involved being on my feet alot. My mother came to the show at noon and offered to take me to a local restaurant for lunch. While in the restroom at the restaurant I noticed I had an unusual amount of discharge - I chaulked it up to 'pregnancy goop' and went back to the table and casually mentioned it to my mom, who didn't seem concerned either. She then offered to take me to the maternity clothing store to buy my first maternity outfit. I was so excited. I was 7 months and was starting to need them now.

I found a nice outfit which my mom purchased and then we went back to her car. We were going back to our apartment so I could show her the baby's room we had just finished 3 days earlier. While sitting in her car I noticed my back was really hurting. It had actually been nagging me since the night before, at the wholesale club.

We got back to the house and I was sitting in the rocker in the baby's room when the pain started to come in waves. I commented how pulling a muscle in your back really hurts and I was going to lay down on a heating pad. My mom left and my husband and I laid down on the bed to talk about my day. While we were talking I noticed my stomach was making wierd positions with each wave of 'back pain'. I knew this wasn't normal and called my OB office and got the OB on call. She told me to go to the ER and she would meet me there, saying "It's probably JUST contractions"...

We get to the ER and find out that I'm fully effaced and already 4 cm. I was amazingly calm though - I thought she'd be ok since I was also a preemie. I was wheeled up to L&D floor and thats when the pain REALLY started. I was quickly given an epideral and steroid shots and would stay on my back for the next 38 hours...

Arianna Frances was born at 6:43 AM on March 13th, 2006. She weight 2 lbs. 15 oz. and was 15" long. She didn't come out screaming... and I was so exhausted the nurses had to lift my head for me to see her. I heard her cry after they got her into the adjourning room to clean her up. My husband said he watched as they put her into an incubator and the nurse wheeled her down the hall to the NICU "like she was wheeling a ham at the grocery store"...

I don't remember what happened after that except that they stitched up my episiotomy (yes, a 3 lb. baby got me an episiotomy), got me some food and eventually wheeled me, gurney and all to the NICU to see my tiny baby girl.

fter 6 long long long weeks in the NICU she came home - only to go to the PICU with breathing problems a week later... Her first year was riddled with many prematurity related issues and we're very very very scared to try again...

But every day I see my girl my heart aches for what could have been - for a normal pregnancy - and for the baby that has now grown into a toddler. I miss a baby and really am ready to try again - with the hope that this one will be a healthy, full term baby!