A bit of relief. A bit of a novel.
Today we met Dr. Assel, she is a perinatal specialist. Dr. Assel was absolutely fantastic, I immediately liked her the minute she walked through the door, despite the fact she was 45 minutes behind schedule.
We discussed options for this pregnancy helping us reach full term or at least 32-37 weeks. The hardest determination of deciding our coarse of action for Bee is the fact that my case is not typical. Dr. Assel was honest in saying she doesn't have an answer to the best coarse of treatment for this pregnancy. During my first pregnancy I showed a lot of signs of incompetent cervix, but following that diagnosis most babies are miscarried between 15-18 weeks typically where I held Harrison 28-29 weeks. Looking at my case though I could have started dilating early on and it just didn't progress as fast as it typically would have in most incompetent cervix cases. Another view into Harrison's early arrival could have simply just been pre-term labor which expectantly occurred and they just don't know why. However, most preterm labor is very painful, which I experienced little to no pain with Harrison's labor and delivery. If you remember I walked into the Emergency Room and was dilated to a 9 with Harrison and my biggest complaint was pressure, not pain which more resembles an incompetent cervix. The real cause to Harrison's preterm birth will never be known. Dr. Assel said to me today, "What I would have given to be your doctor on the day you came in dilated to nine and not knowing it."
We discussed two very good options to approach this second pregnancy.
#1. Cerclage: Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 75% to 80% 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. Ideally, an elective cervical cerclage is done between weeks 12 and 16 of pregnancy. Dr. Assel explained that they want to use the highest part of your cervix and close that off and securing stitches on both sides of the cervix. The procedure is done as a outpatient surgery. I would receive a spinal/epidural before the procedure and abstain from any physical activity for 2-3 days or longer depending on the situation. But like I mentioned early on in this post, if this isn't true cervial incompetence the cerclage WILL NOT prevent preterm labor. However, having a cerclage put in, I might feel contractions I might not have been able to feel if I hadn't had the procedure done and those are very painful because of the cerclage. Knowing this, I maybe able to make it to the hospital and receive medication to stop the labor. In saying this, everything has it's risks. Dr. Assel mentioned in some of her readings she has done the cerclage can actually stir up premature labor if placed for an incompetent cervix when really it's premature labor, not cervical incompetence.
#2. Watch/Wait & Progesterone Injection Treatment: Progesterone is a hormone. It plays a key role during pregnancy.In early pregnancy, the hormone helps your uterus grow and keeps it from contracting. (If your uterus contracts in early pregnancy, this may lead to miscarriage.) In later pregnancy, progesterone helps your breasts get ready to make breast milk. It also helps your lungs work harder to give oxygen to your growing baby.Recent studies show that for some women, especially if they have a short cervix or if they already had a preterm birth, being given progesterone during pregnancy may help reduce the risk of having a premature baby. There are two kinds of progesterone treatment: vaginal gel and shots. Studies to date show that gel may help reduce preterm birth for pregnant women with a short cervix. Shots are recommended for pregnant women who already had a preterm birth. Choosing injections is about 50% effective in preventing preterm labor. I would receive one injection per week starting at 16 weeks and going through 37 weeks. This would be a watch and wait approach would be measuring my cervix regularly (often) using a trans vaginal ultra sound and long with progesterone injections. The benefit to the watch and wait/injection approach is the fact my cervix may not be incompetent Harrison's preterm but was just spontaneous. Spontaneous preterm birth means labor began on its own, without drugs or other methods. Or the sac around the baby broke early, causing labor.
Each of these two options have benefits and risks and Dr. Assel told me I am a big decision maker in this process I should have a say in what I (we) want to do. I really valued Dr. Assel, everything about her (bet you can't tell I really liked her). I asked about a combination of the two options, but we can only choose one coarse of treatment, doubling up does not increase the success rate.
Currently we are in a good position to make any decision we want. I am 13 weeks, right smack in the middle of these options, which both are good, but not a guarantee for a full term baby.
As far as I know I am not dilated at all. We didn't do an ultra sound today (like I hoped)...but Dr. Assel said measuring the cervical length in the first trimester isn't an indicator of what will happen in the second trimester, it's a just a starting basis.
I've done hours and hours of research on prematurity and preterm labor since Harrison was born. I can whip off statistics like crazy and honestly could probably write a book about it. I know pros and cons inside and out and we are choosing to do an elective cerclage. The cerclage will be done this month. I am not sure if my primary OBGYN will do it or Dr. Assel will do it. Dr. Assel was going to call Dr. Birdsall and discuss today's appointment and our decision and we can go from there. Dr. Assel said she has performed many cerclages and never regretted doing one of them. She said,"I can't make decisions for you, but I think you are making a good choice, I don't know if you would be as lucky the second time around."
Overall mixed news at today's appointment...Something I expected, I am not a text book case to anything. Our trip to the ER two weeks ago? Unexplainable. I am mystery, so I must make life more colorful not just black and white.
I see Dr. Birdsall on Thursday next week for a regular prenatal visit and to discuss a surgery date. Other than if Dr. Assel does the surgery I won't see her again as a specialist. She's a specialist that travels and only stays at hospitals for short periods of time and travels on to another hospital, she's great and I wish she could stay. If things progress well my plan is to still deliver in Winona, if complications a rise I will deliver at Gundersen as they are equipped with a NICU we know all to well.
Hoping and praying for the best.
Today we met Dr. Assel, she is a perinatal specialist. Dr. Assel was absolutely fantastic, I immediately liked her the minute she walked through the door, despite the fact she was 45 minutes behind schedule.
We discussed options for this pregnancy helping us reach full term or at least 32-37 weeks. The hardest determination of deciding our coarse of action for Bee is the fact that my case is not typical. Dr. Assel was honest in saying she doesn't have an answer to the best coarse of treatment for this pregnancy. During my first pregnancy I showed a lot of signs of incompetent cervix, but following that diagnosis most babies are miscarried between 15-18 weeks typically where I held Harrison 28-29 weeks. Looking at my case though I could have started dilating early on and it just didn't progress as fast as it typically would have in most incompetent cervix cases. Another view into Harrison's early arrival could have simply just been pre-term labor which expectantly occurred and they just don't know why. However, most preterm labor is very painful, which I experienced little to no pain with Harrison's labor and delivery. If you remember I walked into the Emergency Room and was dilated to a 9 with Harrison and my biggest complaint was pressure, not pain which more resembles an incompetent cervix. The real cause to Harrison's preterm birth will never be known. Dr. Assel said to me today, "What I would have given to be your doctor on the day you came in dilated to nine and not knowing it."
We discussed two very good options to approach this second pregnancy.
#1. Cerclage: Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 75% to 80% 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. Ideally, an elective cervical cerclage is done between weeks 12 and 16 of pregnancy. Dr. Assel explained that they want to use the highest part of your cervix and close that off and securing stitches on both sides of the cervix. The procedure is done as a outpatient surgery. I would receive a spinal/epidural before the procedure and abstain from any physical activity for 2-3 days or longer depending on the situation. But like I mentioned early on in this post, if this isn't true cervial incompetence the cerclage WILL NOT prevent preterm labor. However, having a cerclage put in, I might feel contractions I might not have been able to feel if I hadn't had the procedure done and those are very painful because of the cerclage. Knowing this, I maybe able to make it to the hospital and receive medication to stop the labor. In saying this, everything has it's risks. Dr. Assel mentioned in some of her readings she has done the cerclage can actually stir up premature labor if placed for an incompetent cervix when really it's premature labor, not cervical incompetence.
#2. Watch/Wait & Progesterone Injection Treatment: Progesterone is a hormone. It plays a key role during pregnancy.In early pregnancy, the hormone helps your uterus grow and keeps it from contracting. (If your uterus contracts in early pregnancy, this may lead to miscarriage.) In later pregnancy, progesterone helps your breasts get ready to make breast milk. It also helps your lungs work harder to give oxygen to your growing baby.Recent studies show that for some women, especially if they have a short cervix or if they already had a preterm birth, being given progesterone during pregnancy may help reduce the risk of having a premature baby. There are two kinds of progesterone treatment: vaginal gel and shots. Studies to date show that gel may help reduce preterm birth for pregnant women with a short cervix. Shots are recommended for pregnant women who already had a preterm birth. Choosing injections is about 50% effective in preventing preterm labor. I would receive one injection per week starting at 16 weeks and going through 37 weeks. This would be a watch and wait approach would be measuring my cervix regularly (often) using a trans vaginal ultra sound and long with progesterone injections. The benefit to the watch and wait/injection approach is the fact my cervix may not be incompetent Harrison's preterm but was just spontaneous. Spontaneous preterm birth means labor began on its own, without drugs or other methods. Or the sac around the baby broke early, causing labor.
Each of these two options have benefits and risks and Dr. Assel told me I am a big decision maker in this process I should have a say in what I (we) want to do. I really valued Dr. Assel, everything about her (bet you can't tell I really liked her). I asked about a combination of the two options, but we can only choose one coarse of treatment, doubling up does not increase the success rate.
Currently we are in a good position to make any decision we want. I am 13 weeks, right smack in the middle of these options, which both are good, but not a guarantee for a full term baby.
As far as I know I am not dilated at all. We didn't do an ultra sound today (like I hoped)...but Dr. Assel said measuring the cervical length in the first trimester isn't an indicator of what will happen in the second trimester, it's a just a starting basis.
I've done hours and hours of research on prematurity and preterm labor since Harrison was born. I can whip off statistics like crazy and honestly could probably write a book about it. I know pros and cons inside and out and we are choosing to do an elective cerclage. The cerclage will be done this month. I am not sure if my primary OBGYN will do it or Dr. Assel will do it. Dr. Assel was going to call Dr. Birdsall and discuss today's appointment and our decision and we can go from there. Dr. Assel said she has performed many cerclages and never regretted doing one of them. She said,"I can't make decisions for you, but I think you are making a good choice, I don't know if you would be as lucky the second time around."
Overall mixed news at today's appointment...Something I expected, I am not a text book case to anything. Our trip to the ER two weeks ago? Unexplainable. I am mystery, so I must make life more colorful not just black and white.
I see Dr. Birdsall on Thursday next week for a regular prenatal visit and to discuss a surgery date. Other than if Dr. Assel does the surgery I won't see her again as a specialist. She's a specialist that travels and only stays at hospitals for short periods of time and travels on to another hospital, she's great and I wish she could stay. If things progress well my plan is to still deliver in Winona, if complications a rise I will deliver at Gundersen as they are equipped with a NICU we know all to well.
Hoping and praying for the best.
Wow - being 13 weeks along myself, this post kicked up my emotions! I have not read anything about preterm labor (other than snippets of complications that can sometimes lead to preterm labor). All around just scary. When will they measure your cervix for the first time - prior to cerclage I presume? Well, my thoughts are with you and I WILL be reading all of your updates to see how things are going. :)
ReplyDeleteoh wow, what a lot to be dealing with. praying for you as you go through this journey, for peace and calm and strength.
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