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Sidelines National Support Network / Dr. Bryan's Answers
All questions are printed exactly as received. By participating (reading or submitting a question" to drbryan you are agreeing to the conditions located here. Do you have a question for drbryan? Just click here to ask your question and to learn more about drbryan! Last Updated 6/16/2007
Auto-immune Disorders So when I was seven I was diagnosed with JRA, I went into remission until I turned 21 when I suffered a miscarriage, finding out that I had a bicornuate uterus. I just would like your opinion on, the statistics of women with RA getting worse after pregnancy? The thought of having a child and not being able to take care of it scares me. My doctor tells me not to worry, but I am not the kind of person to take just one person's opinion. Thanks for listening, Let me know what you think about my situation. A: JRA is an autoimmune disease. Generally speaking, autoimmune diseases seem to get better during pregnancy (except lupus). During pregnancy, there is a higher level of cortisone which might explain the tendency for remission. Unfortunately, there may be an increased risk of relapse after delivery. Nobody can give you exact answers regarding your chance of remission or relapse or the severity but you should see at least one perinatologist and one rheumatologist for consultation to try and get as much information as possible. drbryan
A: You are being managed very aggressively, good job. The progesterone is safe but not really very effective, especially in light of a uterine anomaly. If the cervix shows funneling at or before 22 weeks, you might still be a candidate for rescue cerclage. Maybe the right horn will behave better since it has been stretched once before. drbryan From A. : First, I really dont have many symptoms of PCOS. I have regular, normal periods with minimal pain, my blood work came back "normal" and I have confirmed that I ovulate (BBT and I can even feel it!). Why would the dr. still consider me PCOS in this situation. We completed an u/s and discovered that I do have some cysts, but they are most likely the ones that come and go with a normal woman's cycle. Any advice? Also, with my dx of BU, my dr. wants me to complete an HSG after the end of my next period. i have read that an HSG cannot determine the extent of my uterine shape. Would you recommend completing an MRI? In addition to the HSG or in place of it? I really appreciate your help! A: There is no easy way to say this, but some doctors have no idea what PCOS is and what it isnt. This particular condition has been greatly revised and updated as gain insight into the hormonal aspects of it. It is no longer correct to say that someone has PCOS just because there were a few cysts on the ovaries. There has to be some evidence of either irregular ovulation or male hormone excess or both. Regarding BU (I presume you mean bicornuate uterus), I have to say I am seeing a lot of women lately who have been told that they might have this. You usually cannot diagnose BU just from an HSG. The reason is that you can have an arcuate uterus (heart shaped) which is normal, or you can have a septate uterus (which creates two partly separate cavities). These look a lot like each other. The only way to diagnose bicornuate uterus is 3-D vaginal ultrasound with visualization of 2 separate uterine fundi (plural of fundus), or MRI (which is the gold standard right now), or surgical exam with combination laparoscopy and hysteroscopy. drbryan From D.C. : A: Here's some information: (ref: Hum Reprod. 1993 Jan;8(1):122-6.) The fertility problems of 176 patients with uterine malformations [arcuate (n = 40), bicornuate (n = 49), bicornis-bicollis (n = 17), didelphys (n = 15), unicornuate (n = 24), subseptus (n = 14) and septate uterus (n = 17)] and of 28 women with other genital and/or urinary anomalies but with a normal uterus were studied. Ten patients with a uterine anomaly experienced infertility without other causes (6%). 142 women with uterine malformations and 26 with a normal uterus achieved pregnancy, the total number of pregnancies to date being 383 and 47 in these groups respectively. The outcome of the first pregnancy from women with uterine malformations was similar to that of all pregnancies though less significant. Only 53% of pregnancies in women with uterine malformations ended with a child surviving > 7 days, compared to 89% in women with a normal uterus. The poorest viability results were found in the bicornuate (40%) (47% of pregnancies in this group ended in early abortions), arcuate (45%) and septate uterus groups (59%). The rates of children surviving > 7 days were around 70% in the bicornis-bicollis, didelphys, unicornuate and subseptus uterus groups. Metroplasty in four cases corrected the infertility or repeated abortions in three patients. Cerclages (21) in 14 women increased the live birth rate from 21 to 62%. These results confirm earlier reports that patients with uterine malformations have higher rates of reproductive loss, pre-term delivery, breech presentation and complications that increase obstetric intervention and perinatal mortality. Moreover in our study, pregnancy outcome was poorer in the bicornuate and arcuate uterus groups than in the septate group Comment: Bicornuate and Bicollis uterus is very rare. Pregnancy can occur in either side. There is a higher rate of miscarriage, pregnancy loss and preterm birth. Perhaps a cerclage is necessary. But, in my opinion, the above results are not horrible. Over 70% chance of a normal child delivering may not be great but its not that bad either. drbryan From K. : A: The MRI is a good idea. Uterine repair of a bicornuate uterus is rarely done. An HSG would help to see if both "horns" of the uterus are connected to open fallopian tubes. I have many patients with bicornuate uterus get pregnant and deliver full term. Remember, everyone's uterus starts out small and grows bigger with the pregnancy, so a pregnancy in one "horn" of a bicornuate uterus has a very good chance of progressing normally. drbryan From A.L. : I have been diagnosed with a complete bicornuate uterus by way of laparoscopy. Have had two first trimester losses, not due to my uterus. I am currently 15 weeks pregnant and had a prophylactic cerclage placed at 14 weeks and all went well. I am now concerned about PTL and PTD. In your experience what is the general outcome for someone with my condition? Thanks. A: There are many interpretations to a "complete" bicornuate. Do you have one cervix or two? Was this found out before you conceived? Were both sides same size? Dis they do a kidney sono, as some women with this condition have abnormal kidneys. One of my patients with this is missing one kidney. A: Cerclage was a good idea and bicornuate uterus is often considered a traditional indication for cerclage. Surprisingly, in my own experience, I have not yet placed a cerclage for this condition. Why is that? Well, preterm labor is caused by a weak cervix. Bicornuate uterus is not a weak cervix, but it is potentially a weak uterus. In a way, this makes me think preterm labor is less likely. I have 3-4 patients in the past few years with bicornuate, and they all went to term, no preterm labor, and interestingly all had breech babies (with C/S delivery of course). My current bicornuate patient has had many cervical length scans, and the length has remained at 5 cm. which is very long. Her baby is breech also, and she is due is about 2 months. drbryan From J.O.: A: Bicornuate uterus makes for all sorts of weird problems early in pregnancy. I have seen this many times. There are 2 uterine cavities (presumably one common cervix). One cavity is pregnant but the other is not. The side that is not pregnant still has a uterine lining. This lining grows from pregnancy hormones. This lining can bleed. When the fetus is bigger, the sac will fill up all of the lower cervical canal. Then the other cavity will likely not be able to release blood through the cervix. Finding the cause of bleeding using ultrasound of the early pregnancy can be tough. Some areas look like blood, but they are just veins or normal fluid collections. Dont go by what they say. We often try to explain things without really knowing for sure whats going on. People like explanations. (Oops, this is like the magician telling how the magic trick is done!). Bedrest might help if there is a chance that the bleeding is coming from the pregnant side of the uterus. Progesterone is controversial, especially if the bleeding is from the non-pregnant side. Maybe they can check a progesterone blood level first. drbryan
I am being monitored very closely (1x a week) but my doctor had said to go on with my normal routine (no bed rest) with limited physical activity. My questions are: 1) do you have an opinion on what the source could be? 2) should bed rest be prescribed (not that I want to be...)? A: If the spotting is brown and there is no cramping, you can be on light activity. If there is bright red blood, you should be on bed rest (in my opinion). The source can be the degenerating placenta of the twin demise if this fetus closer to the cervix than the viable one. drbryan From S. : A: This is just one of the most difficult situations to deal with, and I am so sorry for what you have been through. The risk of stillbirth is about 1/300 pregnancies that progress into the third trimester. About half the time we find a cause, and most of the time the cause is something unique about that particular pregnancy as opposed to something that might recur. I have to say that I do not consider you at increased risk for a stillbirth next time, assuming that you are otherwise healthy and have no other obstetric risk factors such as high blood pressure, diabetes, toxemia or smoking. I would think that next time starting about 36 weeks (or maybe a bit sooner) the doctors would do ultrasounds and non-stress tests and then try and deliver you maybe about 38-39 weeks ideally. drbryan From S.S. : We don't have much information on this condition! My concern is that when the clot dissipates, the pregnancy will/could terminate. This is their 6th attempt at conception and they are such a emotionally-bruised couple after all the let downs/failures. Can you shed some light on this condition? A: There might be a blood clot behind the placenta, but this does NOT mean that the embryo is attached to it. The placenta has to get blood flow from the mom, or the embryo could not survive at all. Unfortunately, there is no way to predict what will happen. Hopefully she is on restrictions and rest and is being watched closely. drbryan From J. K.: I am pregnant with my first child. I have recently had two episodes of bleeding in my 26th week, both of which have sent me to the hospital. 2 weeks ago, I was allowed off a month-long bedrest following resolution of a low-lying placenta. Due to the bleeding, I have been placed back on bedrest. I'm hoping you can shed some light as to the possibility of problems that may be causing the bleeding. Neither the doctors at the hospital or my OB seem to be able to explain why I am continuing to bleed (spotting the first time, a heavy bleed the second time). There was no sign of pre-term labor and my cervix was fine. The baby shows no signs of distress at this point. My doctor thinks I may have a sensitive cervix or a slight separation of the placenta. How is this diagnosed and are there other conditions that could explain the ongoing bleeding? If I continue to bleed on and off, could it hurt the baby? I have been referred to a perinatologist, but was not able to get an appointment until next week. A: This is a difficult problem. A very careful evaluation is needed. Ultrasound can be done transvaginally (gently) to see if an edge of placenta is visible which may not always be seen abdominally. The doctor should put a speculum in the vagina just to be sure the blood is coming from the uterus and not the cervix itself. We often keep people in the hospital until they deliver after a second bleeding episode, as you are at a very increased risk of bleeding again and of possibly delivering early or needing an emergency c-section. You should be on iron and your blood count monitored. You also need monitoring to see if you are contracting because there is medication to suppress contractions. The harm to the baby is only if you have to deliver prematurely, or if you have a severe hemorrhage where you lose so much blood that lack of oxygen occurs. drbryan
A: Contrary to common sense, short patients dont necessarily deliver early. The abdomen is capable of growing quite huge. For example, I have seen a dwarf woman carry an 8 lb. baby to term. At the end, I think she was wider than she was tall (about 4 ft. tall). Furthermore, the belly can stretch even better on the second pregnancy than the first. You shouldnt worry too much about another premie, just go for it. drbryan
A: Not yet. If the baby is breech at 36 weeks, then you need to discuss Cesarean Section versus external cephalic version with the OB Dr drbryan
Thanks A: your story sounds pretty grim. Are you sure the diagnosis is incompetent cervix? Did they check you for a uterine anomaly? Maybe you have a septum or a bicornuate uterus or something. Did they do cultures to rule out infection? Do you have fibroids? When you were in the hospital, did they look for funneling? Believe it or not, strict bed rest doesnt often make much difference unless you are contracting a lot or the cervix is already funneling. Especially starting at 12 weeks, that seems a bit much to me. Also, have you had previous surgery on your cervix? I thought that abdominal cerclage is for when the cervix is so short that they cant do a good vaginal stitch. Have you had a second opinion from a perinatologist? Can you get all of your medical records from both pregnancies? drbryan From D. : A: Contractions that you dont feel generally are weak. This is what I tell my patients. But I think you do have IC. Therefore weak contractions may not be so good for a weak cervix. 1) Yes 2) Yes 3) NO. Activbe babies do NOT cause PROM 4) 5 to 10% chance next time 5) Yes to cerclage. Maybe to bedrest starting say at 28-32 weeks, something like that. drbryan From B.W. : 1) When would you use the Shirodkar rather than the McDonald cerclage? 2)A Peri told me that 17-P shots can actually CAUSE a patient to go into preterm labor -- do you agree that is a possibility? Thanks! A: 1) I do not ever do Shirodkar. They are bloody, and the data shows no benefit compared to the easier and safer McDonald cerclage. 2) There are at least 2 studies showing a benefit from weekly 17-OHP shots given starting about 16-20 weeks of pregnancy. To be a candidate, you need a history of at least one baby delivered prior to 34 weeks (some docs say 36 weeks). Your doctors opinion is just an opinion. When there is data that contradicts the opinion, doctors that consider themselves scientists are supposed to revise their opinions. drbryan From V.V. : A: Yes, it appears that you need a cerclage since you had two mid-trimester losses with only a small septum. Bacteria dont cause what happened to you. I personally have a problem with the abdominal cerclage. You need an operation to put it in, and another operation to remove it. It is much riskier than a vaginal cerclage done at 14 weeks of pregnancy. In my opinion, abdominal cerclage is for a woman whose cervix has been damaged and/or shortened due to surgery of the cervix such as cone biopsies or LEEP procedures. I worry that some doctors are very aggressive partly because (!gasp!) they can charge more for bigger surgeries. drbryan From J.C. : My second pregnancy,17 months later, I experienced several episodes of spotting during the first 9 weeks.(I was being monitored every two wks) experienced two episodes of bleeding and passing a clot after intercourse. I had 2 transvaginal ultrasounds which turned out to be fine and we heard the heartbeat via u/s. My cervix was also checked and seemed to be fine. At 14 wks an u/s was done to see if I would need to be stitched up. My doc told me, "so far so good." although I was high risk, my doc allowed me to travel for the July 4th weekend. That Friday night I went to the restroom and felt something like a rubbery ball. I thought it was my water sac. I was taken to the emergency b/c L&D was full. We found out via u/s that my cervix was dilated 5cm and there was nothing else to do. I was going to lose my baby at 16 wks 6 days. This hospital out of state was wonderful and comforting to us. They did explain to me that I had a weak cervix and would need to have a cerclage for any more pregnancies I have. everyone tells me that I should get another doc b/c my current one has either too many patients or simply failed to administer to me the stitch when it was necessary. Do I need to find another doc? I was told at the hospital that I need a fetal maternal specialist. My doc is good. I just think that sometimes I may be rushed in and out of my appts. my doc did not even see me when I arrived back in town. all they know is that I loss the baby. I am having a hard time trying to find out what to do bout finding another doc or continuing the care for my next pregnancy with my current doc? I am not pregnant again yet, but I am just weighing out things for baby #3. What would you have done with my situation? I look forward to hearing from you. also I was more worried about heart defects as much as I was about my weak cervix. When is a good time for us to start trying again? I delivered well, even the placenta. no D&C REQUIRED Thank you A: Thank you for sharing your amazing and sad story. You have had way more bad luck than any one person should have had. My impression is that you did have a classic case of incompetent cervix, and you do need a cerclage with each and every pregnancy in the future. You did not do anything wrong, and you had no way of knowing that something bad might happen during your trip. The congenital heart disease is a rare birth defect, and there is a small chance of another baby having a heart defect, not necessarily the same kind, about a 3% risk overall, I believe. The timing for the next pregnancy is hard to say. You did not say how old you were, because this can be a factor. My feeling would be a minimum of 4-6 months after the last delivery, depending on how ready you are to deal with a high-risk pregnancy and all that might happen. On switching doctors or not, I will tell you that many of my patients who have had a bad outcome, such as a stillbirth or a baby dying from a birth defect, will come back to me for care again. Many but not all. The ones who dont come back may believe that somehow I could have prevented what happened, or they feel that I was not caring enough to them after their loss (even though I thought I took good care of them). So, this is what you need to determine. Did you doctor do anything wrong? Did he take good care of you after the loss (explaining why, reviewing the facts of what happened, and offering ideas for next time to try and prevent the same thing)? Lastly, do you trust this doctor to be able to handle your next pregnancy well if any other problems develop? Good luck. drbryan From T.J. : Thanks tj A: Cerclage again sounds reasonable. Bedrest for the first few weeks after the procedure might be a good idea. Steroids, just to clarify, are not a treatment for preterm labor. They are given to help the babys lungs mature in case of a premature birth. They can only be given once during the third trimester, and should be used if it appears that delivery will be longer than 1 day away, but less than 1 week. Some doctors might do a fetal fibronectin test every 2 weeks starting at about 24 weeks, but if cerclage is in place, the test isnt supposed to be done. I might still do one. Heres a reference. http://www.api-pt.com/pdfs/2004Cchem.pdf. drbryan From L.A. : A: Please consider a second opinion on cervical length. For some reason this is a tricky ultrasound to perform, and if done wrong, can lead to misinterpretation. Also, be very wary if the doctor offers to do a cerclage (stitch in the cervix) at this late gestational age., The risks of losing the pregnancy go way up. Bedrest when there is a chance of IC is a very good idea, probably not easy for a teenager. drbryan From S. : So Dr. my question to you is would it be wise to consider another pregnancy? If so, would I have to have another cerclage placed, be on extreme bedrest in a hospital, and take the steroid injections? I hope that you may be able to answer some of these questions for my husband and I want to try again, but the fear of another loss just keeps creeping up on me which makes me not want to become pregnant at all. Also when is it the appropriate time to deliver a preemie i.e. how far along does one need to be in their pregnancy journey to deliver a healthy child especially if they are at risk? A: This is a hard question to answer. There is no way to know for sure what will happen, but you would have to prepare for the worst. In order to have a baby, you have to be willing to get pregnant. Can you handle it if you need bedrest for months? One option is to hire a surrogate mother, not available in all states, and also very expensive (possibly more than $50,000). Can you see a perinatologist for a consult before getting pregnant? That might help. Premies do very well if they are born at 32 weeks or later. Some babies come at 24-25 weeks, and we do everything to help them but many die and many survive with severe handicaps. By 28-30 weeks, the baby might stay a couple of months in the hospital, but has a pretty good chance of developing normally drbryan From C. : A: I think you should see your doctor. Have the cervix checked. This might be just ligament pain, which gets better with position changes, but you are high-risk and need to keep your doctor informed about any pains in the pelvic area. drbryan From T.P. : A: I might till 35-36 weeks just in case, but you are doing very, very well so far. Delivery at 34 weeks is not too bad in terms of long term outcome, but about 25% of these babies have breathing problems, and might stay 1-2 weeks in the NICU. By 36 weeks, less than 5% of babies will have any problems requiring NICU care. drbryan From T. : A: I have no idea what this means. Presumably, it means the cervix hasn't changed, which is usually good news at this stage. drbryan From K. : A: You had a slip up did you? That's cute. Anyway, intercourse won't affect the cervix. The concern is the increased risk for preterm labor with a short cervix. We tell patients to engage in pelvic rest meaning no sex, and no exercise involving pelvic pressure, hoping to reduce the chance of preterm labor. If you feel fine, I would not worry. If there is a lot of pelvic pressure or labor-type pains, I would call your doctor. drbryan From T.J. : What risks am I facing for my upcoming abdominal cerclage? I will be 15 weeks pregnant just starting week 16. 35 years old. Please include risk concerns for the baby as well. Thank you. A: I'm sorry,I cannot answer this question without more information. Is it open surgery or laparoscopic? How many has the doctor done? Why is it needed? drbryan From J.H. : On May 28 2002 I had a preterm delivery at 25.5weeks, baby girl. She passed on the 30th. I had a cerclage with my 2nd pregnancy and had a sceduled c-section at 37.4weeks, a healthy 8lb13oz son Dec 16, 2003. I am currently pregnant with twin girls due 8-27-05 (no fertility treaments). On Wednesday I was 23.5weeks and diagnosed with cervical funneling. I have been undergoing weekly sonograms with a specialist for over 2 months now, this is the first sign of the funneling. We opted for a wait and see option for the cerclage with this pregnancy, so I do not have a cerclage at this time. My Dr has put me on bed rest and I go back Thursday for another sono. If everything is the same then we will continue bed rest and if changes have occurred then we will go forward with the cerclage. He has not mentioned ffn testing, should I request that? Also should I just request that we go forward with the stitch for a better safe than sorry approach? Also what are my chances with strict bedrest to make it another 10 weeks or more? Are there any suggestions that you have, or any other options that we should consider? Thanks for your time and information. A: Your situation is difficult to analyze without being actively involved in your care. I am surprised you did not have a cerclage. Perhaps the events of the first delivery suggested other causes not likely to repeat? I think that if I were taking care of you, if the funneling were significant (say 50%) I would opt for the urgent cerclage as it seemed to work during the second pregnancy, but there are risks also. A negative ffn would be helpful, but there is less data with twins. Bed rest in the face of risk of preterm delivery is always a good idea. I really am not able to make a prediction for you. Be sure you feel adequately counseled and informed by your doctor, and make your best decision together, as a team. drbryan From A.T. : Hello I am 21 weeks pregnant today and I had a cerclage placed at 18 weeks and 5 days after a transvaginal ultrasound showed my cervix length was 1.7 cm. My first ultrasound after cerclage was 2.5, the next was 2.2. What does this mean? How long is a cervix for a women without incompetancy? Will my length ever stabilize? Please help, this is my first and I am so concerned? A: I do not see much difference between 2.2 and 2.5 cm. The technique to measure cervix length is not easy. Either way, the length is better after the cerclage than it was before. This is good. A normal cervix can be 4 to 5 cm in length. Cerclage and incompetent cervix becomes a concern when the length is 2.5 cm or less by 18-20 weeks, or if there is a progressive funneling or shortening of the cervix. Ultrasound of the cervix after the cerclage is in place is not really helpful, since the stitch is there to prevent further effacement. The issue now is whether or not the water is going to break (impossible to predict this from an ultrasound) and whether or not the patient is going to go into active preterm labor, again this is tough to predict drbryan From: J.W. : A: I do not advise the permanent cerclage. This is major surgery to insert, and can cause bleeding and possible damage to the bladder, you have to have a Cesarean, plus these cerclages are hard to remove also. Of course you need some type of cerclage again with this pregnancy. I am not sure why the bedrest for months. Its usually one or the other. I do 3 weeks of bedrest after a cerclage, then I gradually increase activity. If you are having lots of contractions, the treatment is different. A new protocol is the use of weekly injections of progesterone starting about week 16, and continuing to about week 32 or 34. This is a lot of shots, but if there is a preterm labor issue, it might be worth considering. Other medication is used for lots of contractions such as Procardia. Hopefully each pregnancy with the cerclage gets easier. We see this with preterm labor sometimes, where the patient carries the baby longer with each pregnancy. Maybe the uterus gets softer, doesnt act up as much. However, with weak cervix, we often see it get worse with each pregnancy, meaning that the cervix gets softer each time which is bad. So, its hard to predict what will happen. The thought of having a child and then being pregnant and in bed for months must be scary. I have one unusual idea, perhaps hire a surrogate? This would be very expensive (about$60,000 in Pasadena), but if youve got a rich uncle&? drbryan From L.R. : PS I am waiting for the opinion of a mat. fetal spec. but it takes two weeks to get into their office :o) A: If the patient is stable at home on bedrest, not having active bleeding, not having too many contractions, it is reasonable not to do frequent ultrasounds. The issue is whether or not the ultrasound will change the patients management. Some doctors (like me) do more ultrasounds than others. We know patients like to see whats going on, but some practices take into account the costs and availability when they order sonos. I think that in the above situation, I would be doing sonos to look at cervical length and cervical funneling. Then I could decide about fetal fibronectin testing, possibly managing the patient in the hospital rather than at home, and maybe administering steroids if it looked like a high chance of early delivery. Your situation requires careful review and good judgment, and the perinatologist should be able to determine just what needs to be done. drbryan From J.C. : I have had two subsequent pregnancies end in deliveries at 24 weeks. Both times, around 18 weeks I began having 1 contraction or so a day, by 20 weeks, multiple contractions, by 23 weeks, 1 or more contractions every hour. (My second pregnancy was twins, and these contractions continued even on bedrest.) What I was told was that in future pregnancies, I would be given weekly progesterone shots and cervical sonograms, and potentially a cerclage. Would I have a significant chance of success with those methods? It seems to me if I'm contracting and dilating from 18 to 24 weeks then those measures wouldn't make much difference that late. I'm hoping to have a successful pregnancy. I'm just having a hard time finding anything else like my history, and any indications for the future. I look forward to your response. A: There are many differing views on the benefits of cerclage. If you were my patient with this history, I would place a cerclage about 13 weeks. Contractions often start to occur after the cervix has already begun dilating from the inside out. We can see this on ultrasound and it is called funneling. If you wait till funneling is present and then try to do the cerclage, it may be too late. The weekly progesterone shots are a good idea. Additionally, you would be on pelvic rest (no intercourse, no exercise). Plus starting 20 weeks, probably a lot of bed rest, weekly visits, cervical sonos, and at 22 weeks, fibronectin testing http://www.marchofdimes.com/professionals/681_1149.asp. drbryan Click here to request information about the fFn.
Dear Dr. Bryan, I will be 40 in May; a DES daughter. I had a D&C 11/12 wks at 25 yrs & a 4 1/2 yr old was born at 37 wks after 9 wks full bedrest. I'm on complete home bedrest starting wk 23.5 when "short cervix" went from 3.5 to 2.2cm & 1.7. 1 wk later w/funneling. My Dr. advised emergency cerclage & perinatologist said not to, to my relief. It's wk 28. 6 contr/BH daily until last wk. Dr. home visits at 27wk =had to request pelvic. to do Fetal fibro test at 30; then office after 32. When wld you do next sono, other tests, & was cerclage nec. at 14 wks (I requested one)?? Shld perinatologist be more involved? Wt. gain is 18 lbs., 1 per wk now - ok with bedrest atrophy? Thank You SO MUCH for advice! A: Sounds like you got to 28 weeks so far, on bedrest, with good surveillance. Cerclage was a judgment call. I can tell you that recent research shows cerclage not to confer as much benefit was we used to think, so they are being done less often than they used to. FFN test every 2 weeks is helpful. A negative test gives us a 99% chance you won't deliver within the next 2 weeks. Sono of the cervix probably doesn't matter anymore. We know it's short, it's too late for the stitch, so why bother. Maybe taking po terbutaline every 4 hours will help if you are experiencing contractions. Recent data has proven the ability to prolong pregnancy with po terbutaline alone, contrary to what many doctors think.. I would not worry about atrophy from a few months of bedrest. The body has amazing abilities to recover, and besides, the bedrest is very important. Your wt gain is fine also. GOOD LUCK! From:K.G.: DES a hormone drug that was given to pregnant women in the 50's, 60's, and early 70's was completely stopped in what year in the United States? I am questioning whether I am a DES daughter. Are there any tests that you can take to find out whether your mother was given the hormone? I am trying to get medical records, but so far at no-avail. A: In 1971, the Food and Drug Administration (FDA) issued a Drug Bulletin advising physicians to stop prescribing DES to pregnant women because it was linked to a rare vaginal cancer in female offspring. Here's a good web site for more info: http://www.cdc.gov/DES/consumers/about/index.html drbryan
Have you had much experience with FFN testing? If a test comes back positive what are the precautions you take to delay labor? Do you find that this test has a highly accurate predictive value? Thanks. A: I have been doing ffn for 2-3 years. I worry quite a bit about a positive. The data suggests that 1/6 women with a positive ffn will deliver within the next 2 weeks. I think it's even higher. I have only had about 5-10 patients with positive ffn. Most of them delivered early despite all treatment. Luckily, some went all the way. It's hard to predict. One patient I immediately hospitalized for monitoring and steroids with a positive ffn at about 28 weeks. She did not have PTL, yet we kept her about a week, put her on oral Terbutaline. She ended up delivering about 35 weeks, still early but not a bad outcome. A good protocol for positive ffn would be to check cervix length, admit for steroids if they haven't been done, monitor for ptl, and then send home if stable on bedrest, perhaps oral medication, till about 35-36 weeks. After a positive, I wouldn't test again. Also, make sure it is not a false positive. The test should not be done if the patient had intercourse in the previous 24 hrs or if there is any vaginal bleeding, if there is a cerclage, if the cervix is open to 3 or more centimeters, if the doctor has just done a pelvic exam. drbryan From R.Y.: Hello! I'm a 22 weeks pregnant, and I'm gonna get a 3rd. sonogram, the last one was 3 weeks ago, and the next is coming in 2weeks, and I'm gonna have another one in 3 weeks, What is the risk of having to many fallow by other? A: In over 25 years of performing OB sonograms, we have never discovered there to be a risk to the mother or baby assuming the equipment is working properly. Sonograms have revolutionized modern obstetrical care, and I could not practice OB safely without my sonogram machine! drbryan
A: I am sorry for your loss. With a history of regular cycles, you should expect a normal period about 1 month after the ectopic pregnancy was removed. If the period is delayed, the doctor may want to give you a medicine called Provera to force the body to have a period drbryan
A: Occasionally the epidural does not seem to work. Perhaps it was inserted wrong. Maybe a stronger one is needed. Most anesthesiologists will replace the epidural if it is not working at all. I have never seen a properly placed epidural fail to work at all, therefore I do not believe that people are somehow immune to the epidural medicine itself. drbryan From A.C. : A: It is hard to know what will happen. This baby seems to be doing better than the first. They should watch the fluid weekly. If it gets low, then maybe they should do a C/S and take the baby. But if both kidneys are damaged, the baby might not make it. Theres no way to know until the baby is born. drbryan |
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