Wednesday, March 31, 2010

Phew!

I got good news at my 2 week cervical length check at the high risk clinic! My cervix is now 3.6 cm (it was 3.3, I think, 2 weeks ago)! The technician said that the difference could be just due to different techs doing the measurement. I don't care - I'll take it!

I was greatly relieved because I had cluster contactions again Monday night. My OB is on Spring break, so I had to talk to one of her partner's nurses Tuesday morning, who was also really good. That is just such a good clinic. She said that I could take 400-800 mg of ibuprofen that day, but no more. And I couldn't take ibuprofen for more than 3 days. It's supposed to be a temporary fix for cluster contractions in mid-pregnancy. It did the trick! I also rested at home and drank gallons of fluids. I felt much better.

I can't think of anything that would have "brought it on" Monday night. My OB did say that it is really normal for many women to have braxton hicks starting around this time. I was also told that with Alden, but it didn't turn out to be benign contractions in that case. So it is really hard to know if my contractions are safe or not, and I am just so happy, again, that I am being taken VERY seriously this time, watched like a hawk, and the clinic's doors are open any time I want to get checked out. Like I said: PHEW!

Another perk of going to the high risk clinic for cervical lengths every 2 weeks: 4D ultrasound pics!! Here's the latest of Thumper (taking a rare moment to sleep!), 21 weeks, 4 days today. Heart rate: 150. Hubby said that it looks like Thumper is crying in this pic - must be the amniotic fluid, because on the screen, we watched him/her smiling in his/her sleep...

Physical Assessment Guidelines to Establish Risk

Here is a good link, that really explains preterm labor and defines high risk. It also points to the evidence behind doing routine cervical checks. It gives me hope!

http://emedicine.medscape.com/article/260998-overview

Here is an exerpt:

Physical assessment guidelines to establish risk

Previous preterm deliveries, including autopsy reports and medical records, if appropriate and available, should be reviewed. 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.6 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.7 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.8 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%.

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 Network10 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.4

Friday, March 26, 2010

Rough night...

Last night I had about 7 contractions in 4 hours, and some more this morning. Alden and I are sick with colds, and were up coughing all night. I also started to freak about my contractions, so ended up with very little sleep. About 6 contractions/24 hours has been the norm for me - not 7 in 4 hours! Luckily, my amazing OB agreed to see me first thing this AM. It is her "on-call" day, so she doesn't even have patient appointments scheduled, but she saw me and did a cervical u/s. My cervix still looks long and closed, with no funneling. I am so relieved! My blood pressure was also great, and Thumper was kicking away at the doppler again, with a heartrate of 152. She told me to call anytime, even if I just need a peace of mind - and she wasn't kidding! I was also instructed to take some Robitussin tonight. I will have a much more enjoyable weekend now. I can't describe enough what a difference it make for me, mentally, to feel so well cared for.

21 weeks tomorrow!

Friday, March 19, 2010

20 week anatomy scan and cervical length

19 weeks, 6 days today, to be exact! We saw our beautiful, 12 ounce babe for the first time today. The Perinatologist also said our little girl/boy is beautiful - the opinion was shared by all. Everything looked perfect, including my cervix - thank goodness! I was greatly relieved, because Thursday was a little rough for me. After a Wednesday with lots of walking, stair-climbing, and playing on a playground with my 3 year old, I was feeling more contractions than I liked. They were still not frequent or regular - I just HATE feeling them at all. I feel much better after taking it easy yesterday and today. The good news also helps. I am learning my limits!

We had the technician write the gender in a little baby card that we are keeping sealed, unless I have to go on bedrest... then we would find out! I have to admit it is difficult to not just rip it open...!

OK, now for the show!

Blowing a bubble?!




Another profile...




Hi there!




A secret smile...

Wednesday, March 10, 2010

18 week check

18 weeks, 4 days today. So far, so good! Heart rate was 160. Baby was kicking the heart Doppler so much, that it was difficult for the nurse to read it! My new name for this babe is "Thumper." I am feeling him/her kick all day - does Thumper ever sleep?

I am still having infrequent, irregular contractions. My OB is not worried - this can be completely normal for some women. To ease my mind, she did a cervical ultrasound, and my cervix is nice and long at a little over 4 cm. Phew!

Another shot today. 17 more to go!

Our full anatomy scan is next Friday! We are SO excited!