pain management for arthritis

Our Journey

2002 Uterine Fibroid Surgery #1

2003 1st consult with an RE, you know, just in case

2003 Got Married (at 37 (me) & 34 (DH) years old)

2003/2004 Naturally conceived pregnancies BFPs #1, #2, & #3 and miscarriages #1, #2, #3

2005 Uterine Fibroid Surgery #2

2005 IVF #1, BFN #1

2005 IUIs #1 and #2, just because, BFN #2 & #3

2005 FET from IVF #1, BFN #4

2006 Exploratory surgery to remove scar tissue from fibroid sugery #2

2006 IVF #2 (w PGD), BFP #4

2006 Emergency cerclage for IC @ 16w6d (5 months + 1 week of complete bed rest at home ensues)

2007 Our son is born @ 38w by scheduled c-section

2007 IVF #3 for baby #2, BFN #5

2007 IVF #4, BFP #5, miscarriage #4

2008 IVF #5, BFP #6, miscarriage #5

2008 IVF #6, BFP #7, miscarriage #6

2008 DE IVF #7, BFN #6

2009 DEFET #8, cancelled, embryos don't thaw

2010 Decide to adopt domestically

12.17.10 Profile is live with our agency

November 2011 Consult with RE re: donated embryo cycle

Early January 2012 Cleared to proceed with deFET

January 2012 Freeze our profile

1.20.12 deFET begins
2.12.12 eSET of one compacted morula
2.22.12 BFN

3.23.12 deFET #2 begins
4.14.12 transfer 3 embryos (1-8 cell, 1-5 cell, 1-4 cell)
4.22.12 + HPT
4.24.12 Beta #1 = 48.4
4.26.12 Beta #2 = 125.7
4.30.12 Beta #3 = 777.8
5.11.12 1st U/S - Singleton!
7.12.12 It's a Boy!
12.26.12 C-section: Baby G is born, 9#5oz, 20.5"

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WWYD #3

My MFM appointment was pretty straightforward.  Cervical length is 1.1-1.2cm, funneling is about the same as yesterday.

We did the fFN test but given the lateness of my appointment, likely won’t have the results until tomorrow morning.  Two residents joined the appointment, one of which performed the test.  My MFM decided to also visualize the external OS of my cervix (which is a first for this pregnancy) and it appeared closed upon inspection.

We agreed that if the fFN is positive, we’ll administer the first round of steroids to promote fetal lung development tomorrow and Friday.

However, if the fFN is negative, it will be up to me to decide whether to proceed with steroid administration or hold off.  My cervical length of 1.2cm (anything under 1.5cm) makes me “at risk” for preterm delivery, but my prior at term delivery bodes well for me making it to term.  A shortened cervix alone, in the absence of symptoms or evidence of preterm labor is not a solid predictor of preterm delivery.  MFM still thinks I will make it to at least 37 weeks, but, of course, cannot say for sure.  I could deliver at 32 or 34 weeks.

So, here is the thing, fetal lungs mature in utero between 36-38 weeks.  Research has shown that the greatest intervention for positive fetal outcomes in babies born prior to 36 weeks, is the administration of corticosteroids within 7 days of delivery.  Anecdotal information shows there is a benefit even if delivery occurs after 7 days.  One round = 2 injections given 24 hours apart.  It was once believed that only one round was beneficial but recent studies have shown that a follow-up round, given two weeks later, was also beneficial but not crucial in determining positive outcomes.

If I weren’t being monitored this closely, we wouldn’t even know of my shortening cervix and prophylactic steroid administration wouldn’t even be an option.  But, I am and we do, so the question is what to do.  There isn’t really a play book for short cervix = administration of steroids.  I am not sure if there is any downside, other than waiting to get full coverage between 30-34 weeks (two rounds, 2 weeks apart).

I also learned today that my last cervical measurement will be at 32 weeks.  After that, it is inconsequential, in terms of case management, what happens (we will have exhausted all interventions and would proceed in just delaying delivery, if possible).

If anyone has any experience with having steroid injections to promote lung maturity, please comment.  I am interested to know what went into the decision and if it was, ultimately, of benefit.  Certainly, if pre-term labor was threatened, that is a usual factor, but I would appreciate any anecdotal information so that I can decide tomorrow.

1 comment to WWYD #3

  • Paula

    Hi there
    I haven’t commented before, but having been in a somewhat similar boat, I have lots of empathy! Firstly let me say we live in South Africa where the protocols regarding steroids are a bit different. Secondly, I am a health professional myself, and avid googler too! I was pregnant with twins, who were ultimately born at 34 weeks 2 days. Here we get the first round of steroids (also 2 doses 24 hours apart) at 28 weeks, then weekly shots till 34 weeks. The reasoning is that the benefit lasts for 7 days, so repeating weekly is taken as giving added protection. It is also stopped at 34 weeks. Obviously the risk for growth retardation is weighed against the benefit – my girls weighed 2.2kg and 1.85kg – the smaller one did have placental problems though so I don’t subscribe her size to the long course of steroids. As to their lung maturity, the smaller twin had no respiratory problems at all, she never even needed oxygen, The bigger girl however was on CPAP for 2 days and then still needed nasal prongs for 2 more days. She hasn’t had any problems since then though, and neither had any gastrointestinal problems (as steroids also protects against NEC). Their NICU stay (20 days, mostly feeding/growing) was unremarkable. Given the outcome I think I would do it the same again. I know giving such a long course is controversial however I wonder how bad the bigger twin’s lungs would have been without it? Given your somewhat different situation, I would personally go ahead with the shots. (Incidentally, I did not have cervical shortening although the last time it was measured was at 30 weeks, so I don’t know what happened after it, and I also didn’t have any other signs of preterm labout, however as I am quite small statured and carrying twins there was a big chance of early delivery, correctly as it turned out so the timong of the steroids were also quite problematic.) Anyway, I don’t think you are doing the wrong thing at all. Sorry for the long comment, but it is such a complex invovlved story!

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