thread for those pregnant after previous preterm birth

[KD0706]

Hi all
My DD was born at 31+1, as far as I know there was no reason found for why she came early.

I'm now 11 wks pg with DC2 and I've been told that when I have my first scan appointment I'll also have a consultant appointment to discuss how this pregnancy will be managed, answer any concerns I have etc.

I'm sure the consultant will no doubt cover everything but I thought I'd go in with a list just in case I forget something in the meeting and then later wish I'd addressed it.

My current thoughts are

1 brief chat about DD, what happened with her, confirm whether it was unexplained etc

2 chances of another prem birth (think I was told at the time 1 in 3 chance, and likely to be at same stage)

3 elcs or vbac (dd was emcs). If Caesarian then how will that be managed in a premature labour (with DD I was having regular contractions for four days before I was in 'proper' labour)

4 what if any extra scans or checks will I have? Will I have steroid injections as a matter of course - if so when?

5 I considered mentioning the progesterone pessary which I think has had some good trial results. Presumably not available on nhs but maybe privately?

6 what to do if I do start contractions again. Do I go in immediately I feel a twinge or wait till I'm sure it's something? And will they put me on the drip to try to stop it again?

If anybody has any other thoughts or any experiences they'd be willing to share I'd be v grateful.

[missjulie]

Hello hun, I saw that this post was unanswered, and wished to come and say hi.
I too am the mum to a prem DD (33 & 2), it was a dreadful shock, anyway, that is another story.
I want to say that i think you are wonderful for having another DC! I take my hat off to you!
I can't think of any other questions I would have if it were me in your situation.
Keep us posted on the developments! :)
Good luck with the appointments, pregnancy, and birth. Hope you get as far as possible - wish we could have control over that!
Take care. x

_
I have added cool emoticons to this message.
To see them go to x.exps.me?ae2f245047125ade4d25a76f480b1af6

[KD0706]

Hi missjulie thanks for replying.

The second pregnancy wasn't actually planned! Its probably a good thing as if I'd thought too much about it I doubt I would have had another baby.

I'll report back how things go.

[efeslight]

Hello KD0706,

I'm pregnant 2 years after my little boy came at 28 weeks for no reason at all apparently! so am in a similar situation.
We've seen the Dr once, we're in germany so things are slightly different here, I'm not sure we'll actually see a consultant, just my normal gyno at the moment.
The first meeting's message was just we'll have to wait and see... which of course is a bit frustrating, but common sense really, one prevention of problems with the placenta that was mentioned was possible daily injections of heparin, which is an anti clotting agent, as they suspect that's what went wrong with the placenta. Am currently going for blood tests and awaiting results...
good luck and am keen to hear how things go.

[cheekydino]

Hi KD,

I am currently 38 weeks pregnant after having my last son at 31+5 after my waters broke out of the blue, and have (eventually) had quite good antenatal care, but just to prepare you - I think it very much depends where you are booked in and how much you know yourself beforehand. I volunteer for a neonatal board so knew a bit about what I could ask for. My 16 week consultant appt I expected to have a long chat about everything but it was all a bit of a rush - they don't automatically get your notes from your last birth, so she asked me if I knew why it had happened, and I just had the memories of what they had said to me at the time (no infection or preeclampsia etc). All she said was that i should come in if I had any concerns at all, that I was low-threshold for steroids (ie they would give them at the first sign of anything unusual happening). I wasn't offered anything else 'extra' aside from growth scans at 28 and 32 weeks to check baby's development, fluid levels and placenta function. There is a new test available now (called the fibronectin test) that can predict whether you are going to go into labour in the next few weeks which I had heard about, so I asked if I could have it and she said no - it was only used if there were any symptoms. I then referred myself to the preterm birth clinic at UCLH as I wanted a bit more monitoring than they were offering (which I think is fairly standard). At UCLH I was seen at 23 and 27 weeks, where they scanned my cervix (not done as a matter of course at regular scans, but can show if cervix is weakening and hence preterm labour more likely) and gave me the fibronectin test and swabbed for infections. Both are internal and a little uncomfortable! But - the results of both were good and hence my stress levels were reduced massively. I was also told that the chances of something happening again were small and most women go on to have a full term birth - I think my odds were one in 4 or 5. After the fibronectin test result that changed to one in 100, so worth getting for peace of mind if you can.

Sorry for mammoth post - but I would recommend asking at your later scans if they can check your cervical length (may need internal scan for that if they can't see it on the regular cross-tummy one) and asking if they might give you a fibronectin test between 24 and 28 weeks ish to reassure you (although it is v uncomfortable). There is also a national progesterone trial being done that your hospital might be involved with, but it is a dummy trial with a 50-50 chance of actually getting progesterone. I was offered this at UCLH but decided not to after getting a negative fibronectin result as the side effects were described as being like bad pmt - not sure my husband would have coped with that!

Good luck with the pregnancy, hope all goes well. I am very relieved to have made it this far, it has certainly been a scary experience, but worth it!

[KD0706]

Hi efeslight
wow, 28 weeks. That must have been horrid. I hope things work out for you this time, and this baby 'cooks' for longer. How many weeks are you now? Yes it would be great to hear how you get on too. Maybe we should start a thread something like 'support thread for those pregnant after prem burth' either here or in the pregnancy board and maybe there will be a few of us to hold hands?

cheekydino that was a really informative post, lots to think about. I think deep down I already knew there was a chance I might get crap care. Fingers crossed though. How did you know about the preterm clinic? Although I doubt there will be anything remotely near me if not at my maternity hospital. They do have a fab reputation for 'treating' prems, though of course that may not mean that they are also fab at preventing them!
How fab that you are 38 weeks. I would love love love to get that far. In fact my current dream is 35 weeks, I think the lungs are usually developed by then. All the best with the rest of your pregnancy (though not long now), and I will note down what you said and do a bit of my own research into the Fibronectin test.

[evitas]

Hi ladies

congratulations to all of you, and thank you so much for sharing all this priceless information.
My DS was born at 35weeks with a spontaneous birth (no reason why it was a premature birth). No major problems apart from jaundice.
I'm also thinking about a second child, but I must say I was a bit traumatised by my experience and I keep postponing it.

KD I love your idea about a new thread.

I've been doing some research on this topic (although I don't know anything about medicine) and I have found some interesting statistics.

• Apparently, in the US: "the researchers found that after regression analysis, use of the progesterone was not a significant predictor of reduced risk for preterm birth. Only participation in the preterm birth prevention clinic and having private health insurance were significant factors in reducing risk for preterm birth before 37 weeks". full article here
  
  

• the Tommy's centre the UK found that "although progesterone reduces preterm birth in women with one baby, we found that it did not reduce preterm birth (if anything, it increased it) in women with a twin pregnancy". full article here
  

• as cheekydino mentioned the length of the cervix helps to determine the risk of a premature birth and this has been widely discussed in the scientific journals. I'm just not sure how to convince our consultants to do these tests (maybe it's possible to have the measurement done in a private scan??))
  

• also, according to an article in 2009: "spontaneous preterm delivery, preeclampsia, and fetal growth deviation tend to recur and predispose to each other in a second pregnancy". "Compared with a delivery after 37 weeks, a first delivery between 32 and 36 weeks increased the risk of recurrence of preterm delivery in the second pregnancy from 2.7% to 14.7% (...) a first delivery before 28 weeks increased this risk to 26.0%" full article
  

here

sorry for the long post.
Good luck for your pregnancies!
x

[Mandy21]

Hi there, just wanted to give you my experience too. I had twins at 27+6, again no apparent reason, just one of those things and put down to being a twin pregnancy. I was therefore deemed to be 'low risk' even though I was a nervous wreck. I really pushed for consultant led care which meant I was seen at regular intervals by a consultant as well as a midwife. I had extra scans (I think I had the one at 12 weeks, paid for a private nuchal scan at 13 weeks I think, the 20 week scan and another at about 26 weeks).

Its hard because if there is no reason, the medical staff can't give you an "answer". In my case, the implication was that my body couldn't cope with 2 babies so my question was what would happen when my single baby was as big as my 2 prem babies (if that makes sense). They were 2lb 6oz each so I wanted to know if I'd deliver again if my baby got to 4lb 12 ! No-one could give me an answer but I think by giving me extra appointments just to have a reassurance scan and have my blood pressure checked that I felt they were doing all that they could.

I also pushed for infection monitoring - there was a mention in relation to my 1st pregnancy that I had some kind of vaginal infection although this apparently never appeared on my notes. I was therefore given swabs - just big cotton buds and tubes) that I could swab myself and drop off with the GP every month for testing. It probably made no difference to my pregnancy but it put my mind at rest.

I was still early - but only by a day this time so all was well.

Wishing you a very healthy and long pregnancy!

[Bearcrumble]

Did anyone start the new thread for those pregnant again after prem birth? Or is this it?

I am pregnant again after having DS at 35 weeks by elcs because of high blood pressure and severe IUGR. He was 4lb 5oz and after 2 weeks in SCBU came home without any problems.

I am now 10 weeks pregnant and nervous as hell about having growth problems again. Don't know how I am going cope as the last pregnancy was like having a 9-month-long panic attack. It was incredibly difficult as I had a lot of bleeding early on (subchorionic heamatoma) then at the 12 week scan I was told I had low PAPP-A and that they'd be monitoring me for growth problems and then when I had the caesarian the surgeon told me I also have a bicornuate uterus which can cause problems. I feel like the odds are against me and this is going to be a rough ride.

On the positive side I am going to be seen by my old consultant a couple of days after my 12 week scan. I am at King's College Hospital which is pretty much the best place to be for complicated pregnancies. I know I will have excellent care.

[KD0706]

Hi all
No bear I don't think anybody has started another thread. I wonder whether I should just ask MNHQ to change the title of this thread, though the first post will maybe look a bit odd.

I've got through my appointment. 4th October. Scan at 8.40 then doc app at 9.10. The letter said the whole thing could take up to two hours. So it doesn't sound like they're planning on rushing it!

Will report back once I've had the appointment.

I think we're at similar stages bear. I'm not 100% sure how far on I am but I'm roughly 10-11 weeks I think.

[Bearcrumble]

Oh don't worry about it - I've found you now that's the main thing. I am also on the April ante-natal thread and the high risk ante natal thread.

Good luck with your appointments, KD0706. My scan is the day after yours and then the consultant is on Friday 7th.

[efeslight]

Hello again, am nearly 10 weeks now and have been put on daily injections of clexane, an anti clotting agent to try to prevent problems experienced last time. My lo was born very small, 1lb 11oz and was in hospital for 3 months with various problems, but is now 2 and doing extremely well.
I didn't go into premature labour, but it was found that the flow of blood etc to him was almost in reverse, so he had to be delivered quickly by c-section at 28 weeks. Really hoping that things go better this time!
Good luck to all, have next scan etc on Oct 7th, so will keep posting.

[iowmum88]

Hi can I join please my DS was born at 34 weeks is now 2. I'm now 5 weeks pregnant and got GP appointment Tuesday. I'm so so scared that it's going to happen again.
My experience was I was having contractions all day but was unsure as they where all in my back was suffering from constipation (lovely I know sorry) but then that evening my waters broke so instantly went into hospital and I'm sure no one believed me as took so long for me to get seen.
My DS was a normal birth but obviously had to be rushed down to NICU, ( I found out at a later date that he had had respiratory problems straight after birth which I had to read in a letter after a check up ( not good)) but he was in NICU for 2 weeks suffered from jaundice a couple of times and few other minor problems.
It was one of the most terrifying things I have ever had to go through and really don't want to go through it again so if anyone has any advice and its great for support with people that have been through it before!

[KD0706]

Hello everybody. How are you all getting on?
Hope the appointment went well yesterday iowmum let us know how you got on.

I had my scan and consultant appointment yesterday. It all went really well and I feel much more relaxed now, just because I feel in safe hands. I will try to remember everything but if I miss anything out please do ask. I think it really helped that I went in there fairly well informed (albeit mainly by dr google!)

As I really expected they said they can't give me any concrete guidance on whether this baby will come early or not. In my case I just started contracting so they don't think it was caused by cervical incompetence. Although on the 9th centile, DD wasn't unusually small so they don't think it was a problem w the placenta. Basically it was just one of those things.

I had some niggles throughout my pregnancy with DD which I just dismissed at the time but they've given me a number to ring if that happens again do I can be checked out. Said I can go in and be checked out as many times as I want, due to my history (they say) I won't be fobbed off.

They took a lower vaginal swab at this appointment and will take further swabs at 22 and 30 weeks.

I'm going in at 22 weeks for a scan to double check blood flow through the placenta, Fibronectin test and an upper vaginal swab for infection. Regardless of the Fibronectin result I am eligible for the progesterone trial (which my hosp are taking part in). Although that is a double blind so I may not necessarily get progesterone.

I'm also in for another scan plus whatever other tests seem appropriate based on the 22 week tests, at 30 weeks.

I felt very much that I wasn't being dismissed and certainly the doctors said that I can make appointments any time I need reassurance or I want checked out. They seemed very approachable and helpful. So my mind is at ease. I hope the medical care I receive matches up to what I was told.


The scan went really well too. The baby was much more active than DD had been at her first scan and I think that helped me to really believe that this is a different pregnancy, and won't necessarily follow the same pattern as my previous pregnancy. The nuchal measurement was only 1mm so I was really happy with that.

I also discussed an elective section and the docs were very supportive if that. With DD I was 10cm dilated and the docs were unable to deliver her by foreceps. The two doctors I spoke to said they'd been discussing me in the doctors room beforehand and everybody was shocked that it had been impossible to deliver a 31 weeker (and not a huge one at that). They also said that the ob who had attempted the foreceps delivery was one of their most experienced doctors and that if he couldn't get her out then nobody could have. That all fitted with my memory which was that the staff thought without a doubt DD would come out. And would explain why the doctor had five (!!) shots.
So it was left that they are obliged to give me a leaflet about the benefits of vbac but in the doctors words 'if you are inclined towards elective section we would not in any way try to dissuade you from that'.
If I go into prem labour obviously they will leave me as long as they can but once I reach the point of no return they will section me rather than move me to a delivery room.

Sorry that was epic! Would love to hear how you're all getting on. I must change the title of this thread!
It would be good if we could all chat about our boring everyday stuff as well as this stressful prem malarkey!

Oh, almost forgot, scan put me at 12 weeks so due 17 April.

[KD0706]

iowmum I had a similar experience to you - when we went to see the geneticist (DD had suspected 'some sort of syndrom' but it turned out her face was just so bloody mangled by the numerous foreceps attempts )

She looked at DDs file and commented how lucky she was to be here and how it's fairly unusual to see a baby born with an apgar score of 2 survive, and when they do it's usually not without serious brain damage.

I was like
I'd known she was on a ventilator at first but hadn't really known just how close we came to losing her. Still makes me shiver to think of it.

[iowmum88]

Hi spoke to GP and she didn't help me at all or tell me anything I didn't know all ready. So hoping to get my booking in appointment soon so midwife will possibly help me fingers crossed. GP basically told me 2 just wait and see which doesn't help at all.
KD0706 thanks so much for getting back to me. So glad it's all going well for u especially the progesterone trial that will be interesting to see how that goes. I live on the isle of Wight so I doubt very much anyone can help me here but if not will possibly look into going private. Not feeling confident at the min with the NHS which is a shame!!

[OB1sMum]

hi all, I had ds at 29+4 same as many of you for no aparrent reason, waters trickkled for a few days (i thought i had lost my pelvic floor and was peeing myself!!) and then went into labour (but thought i had trapped wind!)
after 6 loooong weeks ds came home and has grown from strenght to strenght - to look at him now you would never know! anyway....recently sufferred a very early misscarriage and wondered if perhaps my body just doesn't like/isn't very good at growing babies?? anyone else sufferred this after prem labour b4? x

[KD0706]

iowmum that's rubbish about the GP. If you went into prem labour would you be sent to the mainland (or is that me being stupid about the IoW?).
Maybe at your booking in app with the midwife you could ask to be referred for a chat with whatever hospital would care for you if you did go into labour prematurely?
To be fair to GPs their job description is really jack of all trades, master of none, so I guess that might be why yours wasn't much help - he/she just maybe didn't have a clue.

OB1sMum I'm very lucky that I've never had a miscarriage (unless I've had a vv early one that I wasn't aware of). But I think unfortunately miscarriage is fairly common and many women miscarry, sometimes multiple times, then go on to carry one or more babies to term. I'm sure it's not that your body is unsuited to carrying a child. But maybe worth seeing if your gp could refer you to somebody who could discuss it with you?

My understanding from my docs yesterday is that in the majority of cases they don't know why a baby arrived early, which I guess is why things like this progesterone trial are so important.

I think bear had her scan today. Hope it went well.

[iowmum88]

KD0706 no dont have to travel to the mainland they actually have just updated the NICU unit since having DS and have heard really good things about it.
when my DS was in there they where ok but i think they tend to forget your a mum and was doing things like changing my DS nappy and giving him a wash when i couldnt go in and see him during the "quiet periods" and then calling the ward and getting the midwife to tell me that they had done it! so me being me was very very upset as that was pretty much the only contact i was allowed.
it was also obvious there was a devide between NICU staff and staff on the maternity ward and i was encouraged to complain about the NICU staff so felt very stuck in the middle and it shudnt of been that way so added to the stress of the whole situation so am not looking forward to it again but i am going to make it known that i was soooo not happy last time and hopefully i will get treated a little better if not will look into going private if possible.

[KD0706]

Ah, I see. I am fairly crap at uk geography. I'm from Scotland and all our islands must be much much smaller. Good that you have a 'local' nicu.

That sounds really bad the way you were treated. My nicu were actually really good and once dd was out of intensive care they basically forced me to do her tube feeds, wash and nappy change. I'm pleased they did as I just didn't want to interact with her. I think partly because I was scared I would hurt her because she was so small. But also, I couldn't reconcile the little bundle in the incubator with the baby I had been expecting.

Even with me doing so much of her care I still really struggled to find with her. I think she'd been home for about six weeks (after one month in hospital) before I started to actually feel I loved her.

[Savannahrose]

Hi

My DD is 20 weeks born at 35 weeks. I am currently 14 weeks pregnant and anxious

X

[KD0706]

Hi Savannahrose
have you had a chance to talk to any of your care team about what happened with DD, and how your care will be managed this time. Do you know why your DD was prem?

I hope your DD is fine now. Out of interest, was she in NNU and how long for?

Sorry lots of questions!!

It's nice that there are a few of us at similar stages in our pregnancies, we can hand hold as the weeks pass!

[efeslight]

well, life seems to have been non stop scans, blood tests, appointments but its all settled down a little now. had a scare last week during a nuchal fold? measurement that seemed too high (possible downs syndrome) and was sent to a specialist, but happily after more tests, it came back with better odds that we had expected. I'm 37, so lots of potential problems.
urine test is showing blood and protein so not good news.
and whenever i go for a blood test to check the clexane injections are not too high a dosage i seem to faint, one time that thought i was having a fit with clenched teeth and fists...

iowmum88, i agree, it was absolutely terrifying, so am trying to keep positive, otherwise i think i'd start to unravel...

KD0706, i am due around the same time as you, april 22nd

OBIsmum, i understand your point about just feeling that you're not being very good at carrying a child, i feel exactly the same, although no miscarriage that i know of, it just sometimes feels like many people breeze through pregnancy (i know they don't!) and we seem to lurch from worry after another at the moment. am sending positive thoughts to all...

[harrygracejessica]

Hey - can I be slightly positive :-)

I had twins prem at 33+3 due to twin 1s waters breaking for no reason, was in scbu for 20 days with both mainly for feeding and growing a bit of temp control and one had sleep apnea. When they were 2 I ended up with an unplanned pregnancy and it turned out to be more twins so I was warned it was likely to be even earlier than last time and at 29 weeks I was ambulanced from my hospital to another with neonatal for younger babies!! I was let out after 4 days as still contracting but not doing anything and less painful so was constantly waiting and waiting for it all to start when it did - at 36+5!!!!! So I practically got to term with twins - unfortunately one was poorly at birth so had a stay in scbu on c-pap but home quickly this time.

The main thing i did the 2nd time was rest tonnes!!! i was basically bed ridden with SPD anyway - the first time I decided my sons bedroom needed wallpaper stripping 4 days before the girls were born lol so this time I was warned by my famly not to be decorating AT ALL :-)

[KD0706]

Sounds like you're having a rough time efeslight
Pleased the test results were clear in the end, but it must have been a worrying time for you.
I know nothing at all about the injections you're having, but I guess it will be good to feel you're doing something to hopefully prevent a repeat of last time. Seizures at the blood tests don't sound good though. Are you able to take it easy? I don't remember how old your DC1 is, but I know I'm struggling to rest with my active 17mo. Family come to visit to help out when they can, but there's nobody close enough to help on a regular basis.

Harrygracejessica thank you for your positive story. You're right it's not all doom and gloom. And plenty of women go on to carry to term after a previous preterm birth.

I also think that even if this baby does come early, I'll be a bit better equipped emotionally to cope with it. Of course practically it will be so different with a toddler at home. But I think I'll be much more aware that the baby won't be in hospital forever, and that it will pass.

[Bearcrumble]

Efeslight I'm sorry to hear you're having a difficult time of it. Thinking of you.

I am now on 75mg aspirin daily, and due to see the consultants again at 20 weeks. My scan and bloods were fine (especially happy that the PAPP-A was normal). I am collecting my wee today for a 24 hour urine - extremely glamourous. Going to take it into the hospital tomorrow, see the midwife and have some more blood tests.

I went to the GPs today and used their blood pressure machine in the waiting room - reading was a bit higher than I would like it to be but obviously more accurate results when done by a human being so hoping the readings done by the mw will be better.

Have managed to find the heartbeat a couple of times with my doppler. I don't do it that often because I get so nervous moving it around and waiting to hear anything. I am now 14+2 by my reckoning and 14+5 according to the 12 week scan.