A weekly prick in the bum...

Well a lot has happened in the past couple of weeks with my pregnancy so I suppose this blog entry is more of a status update than a deep thought. Unfortunately, the spotting I referred to in my "bit of a scare" blog entry has persisted. While it has been light it has occurred almost daily for the past few weeks. We've been hoping to explain it to ourselves as a result of my low-lying placenta or marginal placenta previa. Dr. B calls it normal (with a low-lying placenta) but not common. The longer it has persisted the less and less "common" it has become for previa & the more it is starting to look like the subtle onset of preterm labor. Dr. B suggested that we start progesterone injections which is a fairly new treatment option for high-risk pregnancies to prevent preterm labor. The treatment has been proven very effective for women with a history of preterm births and there don't seem to be any short term side effects. However, the long term side effects still need more data to be conclusive, which was part of Frank's and my hesitance in going on this med. We were given this option last week and have been tormented over the decision. I found myself having to make a decision that could potentially effect my unborn child's health. While my history makes me a perfect candidate for this treatment I wasn't convinced that the spotting was a sign of preterm labor. Being the perpetual optimist I was convinced that the spotting would subside and that it was due to the low-lying placenta. I just hated the thought of going on a med that didn't have long term data if I really didn't need to. This may sound crazy to bystanders who might be thinking "you lost your pregnancy at 23 weeks last time, go on the darn med!", but keep in mind that being raised in a physician's household where we rarely had band-aids, I continue to be a person who hesitates to take so much as allergy medication. We negotiated our points with Dr. B and settled on the fact that we would fill the medication & keep it on hand just in case I started to have any additional preterm labor symptoms.

Well, it turns out that this med is not easily filled at your neighborhood RiteAid. While prgoesterone is a very common hormone replacement therapy (commonly found in birth control pills, depo provera, etc.) even the hospital doesn't carry this particular formulation of progesterone. We ended up at a specialty pharmacy who had to order in the ingredients and compound the formulation for us, which is an all day process. While still pondering why we were even going to these lengths to get this med filled, again the perpetual optimist, we suddenly found ourselves in Labor & Delievery Triage Wednesday night. Part of my negotiation with Dr. B included me taking it easy for a few days to see if that would decrease the spotting. Well, at the end of my first day "taking it easy" and working from home I just didn't feel right. I couldn't tell if it was contractions or not, but I had some lower back pain and a dull ache in my cervical region. If we learned anything from our experience before we learned to listen to our (well my) gut feeling. So into triage we went. They hooked me up to the monitors to find baby doing well and no contractions. Dr. B happened to be on call and being about as cautious as an OB could be, he ordered an ultrasound to measure my cervix length in response to my complaint of the dull ache "down there". Down to radiology they wheeled me and as luck would have it they wheeled me into the same room where we were told our girls had no heartbeats. I looked at Frank and thought, this has to end differently than last time. The tech did the ultrasound and we found my cervix to have a length of 3.5 cm. Anything above 3 cm is normal, however last Friday they measured my cervix at 5 cm. I'm not an OB, but common sense would indicate that going from 5 cm to 3.5 cm in 4 days is probably not normal this early in pregnancy. My observation was pointed out to the nurses and then to Dr. B and they sent me home on strict bed rest until we could see him in the office on Friday. This is where I stand on my soap box and remind you all that your health is your own responsibility. Had we not noticed the measurement differences they would have told me my measurement was normal and sent me home with a quickly eroding cervix. For those that don't have an obsteterics degree, your cervix erodes (thins & shortens) to 0 and then dialates as you enter labor. They will check your cervical length just about anytime you have an ultrasound, which for most is twice during pregnancy unless there are signs or symptoms of an eroding or incompetent cervix.

Well long story short we met with Dr. B this morning and fairly confidently made the decision to go on the progesterone. With persistent spotting and an eroding cervix, both tell tale signs of preterm labor, the decision became much more obvious. Any potential long term effects of the progesterone far out weigh the potential health problems of having a severely preemie baby. After continued research I was also able to find a study with good 12-year followup data which also made me feel better. So a weekly prick in the bum it is for me, a lot more ultrasounds to monitor my cervix, and a few very valuable lessons reiterated:
-Listen to your gut! if you feel like something is wrong, it probably is and don't let them send you home until they've done all the possible tests.
-Take control of your own health, know what studies they are doing on you and what the results are because as we've learned there is no universal database with all of your health history catalogued. While a reading may appear normal the difference may be in the change from a previous, even better reading. Only you will remember this information and be able to help your doctor make the right decision for your care.
-Medications are not always the answer and make sure you ask a lot of questions and are comfortable before taking anything. When I first went to fill the prescription I was in tears and had a pit in my stomach, this is no condition in which to start a prophylaxis. Now, I feel very good about it and know that I made the best possible decision for myself and for my child.