Post by LaurAnnHere on Jan 26, 2006 17:41:29 GMT -5
If you have suffered a 2nd trimester loss, my advice to you is to first try to convince your doctor to give you a preventative cerclage. Often doctors for some reason prefer two second term losses before doing that. I had a 17 week loss and nobody even mentioned the possibility of IC to me. I was totally unprepared for that surprise. Your OB may say that your previous loss was due to Preterm labor and that a cerclage will not help with that. Often it is hard to diagnose IC because by the time you go to the hospital, often you are already in labor. Then the doctors don’t know if you began dilating due to the labor or if you dilated before going into labor. Push for a cerclage, demand one. The risks of a preventative cerclage are minimal. If you absolutely can't get a cerclage, don't fret. I've read a lot and it seems that bed rest can be an effective treatment in and of itself. Some people with IC have carried to term just by staying in bed. Some doctors even believe this is just as effective as a cerclage. I'm possitive that is not true, but I believe bed rest will take you further along. During the time before my cervix opened with Jamie I had spent a considerable amount of time in bed due to the bleeding and an unexplained pooling of blood outside of the placenta. When I was finally released to return to work I almost immediately began to dilate. I think that's why I made it all the way to 24 weeks before it happened. That's pretty far for IC. Even at 24 weeks had I not gotten to the hospital in time for the cerclage Jamie would have had a chance at survival, though it would have been very rough.
One possible cause of IC is low progesterone. There are some studies that show there may be a link. I stayed on progesterone until about 16 weeks and then my OB didn't feel that it was necessary any longer. He really didn't think I needed it past 12, but I just kept using it until I ran out. That may also have played a key role in keeping Jamie in those extra weeks. Finally, try to get extra transvaginal u/s to check your cervix. Again, your OB is likely to balk at the idea. This is no more intrusive than sex and completely necessary if you suspect IC, especially without a cerclage. If they detect early shortening of the cervix demand a cerclage. Please visit our website www.fightic.com for a more complete list of factors that may cause IC.
Okay, now for what to watch out for. I had no warning. I felt nothing that made me think something was wrong. I had my cervix check only two days before. There was no reason to think I had any problem, that I knew about. The signs I saw, but didn't know were 1. A thick discharge tinged with blood. It was my mucus plug. I lost it the day before I went to the doctor. I had no idea what it was. I thought it was just normal icky pregnancy discharge. 2. Some extremely mild, but regular cramping. They were hardly noticeable, but they were contractions. I actually thought they were the baby moving. They almost felt like nothing. Many people do not have any signs at all.
After you get a rescue cerclage you need to remain in the hospital at least a week and receive IV antibiotics. Infection will force you to deliver your baby anyway. Preventing infection is the most critical thing now. Make sure when you do go home they send you with Brethine (Trebutaline) to stop contractions if you have any.
A rescue cerclage can be performed up to 4cm dilation. If you do have IC and miss your opportunity for a rescue cerclage, all hope is still not lost, even if your membranes rupture. You might have to demand the proper care b/c a lot of OB's give up at this point. Demand IV antibiotics immediately. Refuse to leave the hospital and demand they do everything in their power to save the baby. Refuse to get out of bed even to use the bathroom. They can bring you a bed pan or catheterize you. Don't even sit up to eat. Don't let them convince you of anything else. If you have started dilating, your membranes are exposed or ruptured, no longer allow them to perform cervical checks. You need something to stop contractions if you are having any. Brethine if they are mild, Mag if they are stronger. Don't let them tell you they can't stop them. Make them try. You might have to fight. Get u/s every day. They can check your cervix that way. It's not as easy from on top of your belly, but this is how they kept on eye on mine. They should check your temps several times a day to watch for infection. They will have to deliver if there is infection. However, don't let them deliver with just one slightly elevated temp. There were many times during my stay that my fever rose to around 100 and later would be normal. Those IV antibiotics I spoke of are critical to prevent infection, which is your #1 enemy.
If you go to the hospital in labor, strong contractions, make them give you mag. They might tell you they don't do that for really early labor or that they can't do anything. All the rules above apply here. They may say you can't have a cerclage b/c you are having preterm labor. That is not true. I was in labor by the time I got to the hospital with Jamie. I got Mag (it's horrible, but it worked) and stopped it. They may tell you your membranes are bulging and there's no way they can put in a cerclage. That's simply not true. Mine were bulging. The membranes were beyond the cervix. They had to push them back in. I've read on here several methods of doing that. Don't ever let them tell you they can't. There is a very real risk of rupturing the membranes by pushing them back in, but if they don't do it, they'll rupture anyway, so it's safer to try than not to try. The window of opportunity for a cerclage does close after 4cm from my research. I was 4cm when I had mine. This means they have no time to waste or debate about doing it. If they refuse get some family member to start making calls immediately to find someone to help you.
Last, don't worry about being one of those mothers who freaks out every time the baby gets the hiccups. If you have any reason to think something just might not be right, even if there's nothing you can put your finger on, don't hesitate to get checked out. Don't second guess your own judgment. Mother's intuition is a powerful thing.
This may sound funny after all that, but my next advice is to savor every moment of your pregnancy and try not to spend it in constant fear and dread. You know the things that can go wrong, but you also know what to watch for. I regret not enjoying my pregnancy. I was so afraid of losing Jamie that I couldn't really talk to him, sing to him, or read to him. I think subconsciously I was afraid to bond with him because I was so sure I was going to lose him. I feel like I really missed out on something special now that it's over. Rub your belly everyday and tell your baby you love him/her. Give him/her a nickname for now, until you've picked out a name. Even if something goes wrong, you'll have spent the time you were together telling him/her how much you love him.
One possible cause of IC is low progesterone. There are some studies that show there may be a link. I stayed on progesterone until about 16 weeks and then my OB didn't feel that it was necessary any longer. He really didn't think I needed it past 12, but I just kept using it until I ran out. That may also have played a key role in keeping Jamie in those extra weeks. Finally, try to get extra transvaginal u/s to check your cervix. Again, your OB is likely to balk at the idea. This is no more intrusive than sex and completely necessary if you suspect IC, especially without a cerclage. If they detect early shortening of the cervix demand a cerclage. Please visit our website www.fightic.com for a more complete list of factors that may cause IC.
Okay, now for what to watch out for. I had no warning. I felt nothing that made me think something was wrong. I had my cervix check only two days before. There was no reason to think I had any problem, that I knew about. The signs I saw, but didn't know were 1. A thick discharge tinged with blood. It was my mucus plug. I lost it the day before I went to the doctor. I had no idea what it was. I thought it was just normal icky pregnancy discharge. 2. Some extremely mild, but regular cramping. They were hardly noticeable, but they were contractions. I actually thought they were the baby moving. They almost felt like nothing. Many people do not have any signs at all.
After you get a rescue cerclage you need to remain in the hospital at least a week and receive IV antibiotics. Infection will force you to deliver your baby anyway. Preventing infection is the most critical thing now. Make sure when you do go home they send you with Brethine (Trebutaline) to stop contractions if you have any.
A rescue cerclage can be performed up to 4cm dilation. If you do have IC and miss your opportunity for a rescue cerclage, all hope is still not lost, even if your membranes rupture. You might have to demand the proper care b/c a lot of OB's give up at this point. Demand IV antibiotics immediately. Refuse to leave the hospital and demand they do everything in their power to save the baby. Refuse to get out of bed even to use the bathroom. They can bring you a bed pan or catheterize you. Don't even sit up to eat. Don't let them convince you of anything else. If you have started dilating, your membranes are exposed or ruptured, no longer allow them to perform cervical checks. You need something to stop contractions if you are having any. Brethine if they are mild, Mag if they are stronger. Don't let them tell you they can't stop them. Make them try. You might have to fight. Get u/s every day. They can check your cervix that way. It's not as easy from on top of your belly, but this is how they kept on eye on mine. They should check your temps several times a day to watch for infection. They will have to deliver if there is infection. However, don't let them deliver with just one slightly elevated temp. There were many times during my stay that my fever rose to around 100 and later would be normal. Those IV antibiotics I spoke of are critical to prevent infection, which is your #1 enemy.
If you go to the hospital in labor, strong contractions, make them give you mag. They might tell you they don't do that for really early labor or that they can't do anything. All the rules above apply here. They may say you can't have a cerclage b/c you are having preterm labor. That is not true. I was in labor by the time I got to the hospital with Jamie. I got Mag (it's horrible, but it worked) and stopped it. They may tell you your membranes are bulging and there's no way they can put in a cerclage. That's simply not true. Mine were bulging. The membranes were beyond the cervix. They had to push them back in. I've read on here several methods of doing that. Don't ever let them tell you they can't. There is a very real risk of rupturing the membranes by pushing them back in, but if they don't do it, they'll rupture anyway, so it's safer to try than not to try. The window of opportunity for a cerclage does close after 4cm from my research. I was 4cm when I had mine. This means they have no time to waste or debate about doing it. If they refuse get some family member to start making calls immediately to find someone to help you.
Last, don't worry about being one of those mothers who freaks out every time the baby gets the hiccups. If you have any reason to think something just might not be right, even if there's nothing you can put your finger on, don't hesitate to get checked out. Don't second guess your own judgment. Mother's intuition is a powerful thing.
This may sound funny after all that, but my next advice is to savor every moment of your pregnancy and try not to spend it in constant fear and dread. You know the things that can go wrong, but you also know what to watch for. I regret not enjoying my pregnancy. I was so afraid of losing Jamie that I couldn't really talk to him, sing to him, or read to him. I think subconsciously I was afraid to bond with him because I was so sure I was going to lose him. I feel like I really missed out on something special now that it's over. Rub your belly everyday and tell your baby you love him/her. Give him/her a nickname for now, until you've picked out a name. Even if something goes wrong, you'll have spent the time you were together telling him/her how much you love him.
