Trying to make sense of it

[AMAW]

Last year I gave birth prematurely at 25,3 weeks. I went into labour and it was discovered my cervix was open and that I had an infection in my placenta. It was the infection that made immediate birth necessary. I can't get a clear answer from the consultants. So I don't know if the infection caused the labour or whether labour (my open cervix) caused the infection. My waters didn't break. My IVF consultant thinks that the infection was probably introduced at the same time as the transfer (marvellous) She thinks that next time I should have a cerclage done at 10 weeks just in case I have an incompetent cervix and forget about it. Easier said than done. I have been reading about the likelihood of a second preemie and am scared to death. We couldn't go through it again. Do you have any experience? I had a cervix check at 22 weeks and it was perfect. Is it possible for a cervix to open so quickly? I have been told that it is more likely that the labour caused the cervix to open and that I shouldn't worry about an IC. It's fine for them to be relaxed about it but this is our life and future. I could not bear to lose another and am feeling very pessimistic.

Hi AMAW so sorry to hear about your baby, it is such a cruel thing to happen particularly after all the stress of IVF.

Can you remember what your cervical length was at 22 weeks? Insufficient cervix is certainly a possibility, and they can go very very quickly, but a more usual pattern is that the cervix starts to shorten and then funnelling occurs, 18-22 weeks is a classic time for it to start. Usually a doctor would see membranes bulging, or the waters would break prematurely. What did they mean when they said your cervix was open, did it dilate painlessly? If so this is a sign of IC.

Did your doctor talk about the possiblity of other things - e.g. regular swabs for infection or prophylactic antibiotics, if it was the infection that caused you to go into labour early (what sort of infection was it?)? Also there other treatments for insufficient cervix now such as progesterone pessaries, did your doctor mention any of those things?

One of the most important things for you in another pregnancy would be that you can trust your caregivers and that you will be given the extra medical care you need. As you know more than 4 out of 5 women will go on to have a full term baby in their next pregnancy, and I am sure some of the others go a lot further e.g. 34-36 weeks when problems are really unlikely. If I were you I would seek a second opinion about this issue from another specialist.

Hi Combinearvester. Thank you for answering. I was in labour with strong regular contractions when I arrived at the hospital. I didn't feel my cervix opening but not sure I would have noticed anything the contractions were so fast. The hospital found that I was 3cm dilated but it very quickly escalated. At the 22 week check up my cervix was just over 5 cm with no funnelling. I have had lots of opinions from lots of consultants and most of them said that it was one of those things that would almost certainly not repeat itself. I just have no idea what to think. Every test has come back normal. It was a normal healthy pregnancy until it suddenly and drastically derailed. In hindsight I had plenty of warning. About 3 days before I felt very bloated with pressure (I thought it was constipation) and then I had a very sore lower back. I will never forgive myself for not going to hospital sooner.

Just looked at my notes. My cervix was 6.1. It was beautiful weather at the time and we went out on several longish walks for about 2 hours each time. This was not extreme for us. We walk a lot but I feel so guilty. And apparently walking can stop the pain so perhaps I delayed the labour for a while while my cervix was opening and that's how I got an infection. It's driving me crazy to not know the order in which it all happened.
I will be with a high risk ob next time with all the checks. This makes me nervous too. Every check through the vagina is a potential infection.

AMAW I know how you feel about the what ifs. I had been gardening all day when my waters broke with my second baby and I really blamed myself. You have to remember that you did nothing to cause this, it is highly likely nothing you did or did not do would have made any difference. In 999 out of 1000 pregnancies a sore back and bloated feeling is nothing, it is really really horrible being one of the unlucky few.

For what its worth, my cervix (which is not incompetent though I had a second trimester miscarriage) was 3cm at 12 weeks with my 3rd (successful) pg, and varied around the 2.8 - 3.2 mark throughout the pregnancy, I'm very surprised to hear yours was 6cm at 22 weeks, that is a good length.

I know the examinations in a subsequent pregnancy are very difficult, my baby died partly due to an infection following my waters breaking. I was terrified the cervical length checks in the next pg would introduce a similar infection but I think in my case the infection came after the waters broke and all my million dildocam scans did not cause harm in the third pg.

By the way on the Bliss messageboard the pregnancy section is very supportive and full of mums of premature babies who feel anxious like you, the SANDS pregnancy after loss boards are also very helpful. I also had counselling from bereavement midwife as I was not really coping with the anxiety.

PS after 22 weeks confirmed my cervical length was ok, I declined any further vaginal examinations due to the risk of infection, most were ok with this when I told them why.

I would ask the docs about prophylactic antibiotics if this hasn't already been mentioned. I expect you are worried about the risk of infection from a stitch so you need to be confident about this.

Can I ask how you were during your subsequent pregnancy. Did you carry on as usual or reduce your activity? Did you do anything differently? I'm looking, of course, for the magic formula.
During the barrage of tests in the aftermath I was told in passing that I have a long cervix. At first this gave me comfort but then I pretty quickly realised that it means nothing if it's incompetent!

And sorry - I've been so full of my own troubles. I'm so terribly sorry for your loss.

Thanks AMAW it was a few years ago now and a lot easier to bear.

I did definitely take things easier particularly at the 18-24 weeks stage, no lifting, no gardening, no scrubbing floors, no running for buses or standing up on the train. I also followed quite a strict protocol for infection like no swimming, no baths, no sex - don't know if anything like this has been discussed with you?

I had cervical length checks at 12 weeks then every 2 weeks up to 22 or 24 I think. Also extra scans, doppler scans. They would probably do the foetal fibronectin thing on you wouldn't they?

I take your point about the length but most people I have spoken to who have IC have found there to be a shorter cervix and / or funnelling at a very early stage e.g. 14 weeks. The funnelling thing is v important.

By the way I have a blood clotting disorder so MC was likely down to this but because of the circs (chorioamnionitis, waters broken etc.) I was paranoid about IC and got them to check me for every damn thing there was. I think it is important that you feel you have done everything you possibly can for your baby and if that means getting signed off at 18 weeks and staying in bed, so be it.

HI not sure I can add very much other than to say I was convinced that an infection had led me to go into premature labour at 27 weeks. There was nothing within my notes though, so when I saw the midwife when I became pregnant a 2nd time, they were reluctant to do anything about it saying that my prem labour had just been one of those things. I pushed for more care, and they agreed to process swabs every month for infections - they gave me a number of "kits" and I did it myself and then dropped them into my GPs every month. It gave me peace of mind even if the doctors thought I was over-reacting.

So sorry to hear of your loss. Good luck.

AMAW, I had a premature birth last year - I don't know how much it'll help but I'll share my experience. My DS was born at 28 weeks by EMCS after my waters broke unexpectedly at 27.3 weeks. He spent 2 months in NICU/ SCBU but survived. On the day my waters broke I had a blazing argument with my Dad that had been a long time coming and we both blamed ourselves for a long time afterward. I had also been on my feet shopping that day but who knows if either was responsible. I lost some fluid that morning (prior to the row) but thought it was wee - in hindsight it must have been some amniotic fluid.

I knew there was a chance my DS would be born early as I have very little cervix thanks to a previous operation for cervical cancer. DS was conceived via IVF and I'd had problems from day 1 - I had bleeding starting from my pregnancy test on and off up to week 16ish. These included heavy miscarriage type bleeds with clots - I thought I had miscarried about 3 times. Perhaps I'd been infected from transfer. I'd never considered that until I read your post but now I know it could be a possibility.

Although I wasn't given a stitch, I was monitored weekly for signs of premature labour and we never had a clue - I'd had a check up 5 days earlier which had shown nothing. It turns out that because my cervix is so short that I'd likely picked up an infection in my waters which had instigated the problem. Although I'd been tested when I was admitted to hospital for infection (which was negative), by the time I had my EMCS 4 days later the infection was so bad that the doctor said my uterus smelt 'rotten' when he made the incision. I was so poorly afterwards that I was on strong IV antibiotics for two weeks following the birth.

Because we'd had IVF I'd not considered the possibility of doing it all again - at least not yet. Although DS survived and is now a strapping one year old (9 mo corrected), I still feel traumatised by his birth and the subsequent NICU/ SCBU stay. Imagine my utter shock (and if I'm honest, dismay) to find out that we were expecting naturally when DS was 7 months old (4 mo corrected).

Although I am obviously happy at the prospect of a second DC, I have not allowed myself to get remotely excited about this pregnancy. I just can't let myself. I am 22 weeks now and starting to get more and more worried as the weeks tick by. I am being monitored weekly again and this time I have had stitch - not to keep my cervix shut (it is scarred badly so my consultant doesn't think an IC is a problem) - just to create a barrier between the natural bugs in the vagina and the baby/ placenta/ waters. I am also taking antibiotics every few weeks to combat any infection that could be lingering.

I'm sorry I can't give you any answers or the secret formula which works to prevent premature birth - we're trying what we can but we won't know if it's worked until the baby is born. My consultant does not believe I will get to the 39 week goal for my planned CS, but hopes to get me to at least 34 weeks this time. I will keep you posted if you like.

The best of luck with whatever you decide to do. I'm so sorry to hear that you lost your first baby. Was the baby a boy or a girl? Did you get chance to spend some time with them after they were born?

Dear Snowboarder, I have changed my name from AMAW. Thanks so much for sharing your story. It sounds dreadful and I'm not at all surprised that you're struggling with your pregnancy. Are you having any counselling? My heart goes out to you. I would really love to be kept posted.
We will transfer two embies on Wednesday if they survive the thaw. I am desperate to hold a baby in my arms but terrified of the process of getting there. I can so understand how you must feel.
Our little boy lived for 5 days and did very well. He could breathe on his own and was a good weight. Unfortunately he had a huge brain bleed. We held him as he drifted off and had time to love him and marvel at his tiny but perfect body.

Hi Expat, sorry I have been a long time coming back to this thread. I was so saddened to hear about your little boy, but I'm sure his short life brought you a lot of pleasure and happiness.

I just wondered how you'd got on with your egg transfer? My fingers are firmly crossed for you!

Hi Snowboarder, how are you? Have you had any counselling yet?
Well, I was totally prepared for my eggs to not survive being defrosted but they both did well and were transfered and I've had positive hpts since 4 days after the transfer. My beta isn't until next Wednesday and I'm going insane waiting. It's very very early days but I'm totally overwhelmed and emotional at having another chance.

Are you 24 weeks now?

Expat! Yesssssssssssssssssssss!!! I cheered out loud when I read your post. I'm keeping everything crossed for you here. I'd be climbing the walls waiting for Wednesday but SO positive that you got +hpts. I know it's a bit naughty but I did the clear blue digital ones with the conception indicator after my transfer so I could see if my levels were increasing - albeit in a very rudimentary way. I must have spent about £50 on those bloody things! Please let me know how you get on. I'll be thinking about you and hoping for the best.

I am 24 weeks exactly tomorrow and starting to feel big, cumbersome and tired - but not complaining as I know how lucky I am to be pg. My obstetrician has warned me to rest all I can from this point onwards but my 1 yo has just started cruising and wants to be on his (very wobbly) feet all day long so I am not getting much rest. I am on antibiotics too just to stave off possible infection and my check up this week showed no sign of anything untoward so all-good so far.

I started counselling arranged by Bliss last week. I have had 2 sessions on the telephone so far and they are helping immensely. I am feeling much more positive about the pregnancy and feel like I am starting to bond with my baby at last. I have been thinking about names and even picturing him as part of our family - something I had not allowed myself the luxury of before.

Hi Snowie, brilliant to hear that the counselling is helping already. I can't imagine what it's like to head towards the week it all went tits up the last time and you seem to me to be coping fantastically. You do have a gorgeous healthy boy already and will have another. Are you managing to put your feet up at all?? I feel quite teary reading your post. Just don't steal the name we've earmarked ;-)

I started with super sensitive hpts and progressed to digitals and others - it's pretty gross to think of how much pee there is at the back of my bathroom cupboard but I keep on going back to look at those beautiful 2 lines. Have decided to bring the beta forward to tomorrow. It will be 12 days past transfer so good enough!

My beta was 429. Am very happy!

Just seen this!!! Yay, am so happy for you

are we talking in the realm of multiples with a beta that high or is it impossible to tell at this stage? Virtual (pink) champagne

Ps managing to put my feet up a bit, luckily I have fantastic retired stepdad up the road who takes my DS for a few hours on a Tuesday and PILs have started helping out more too. My lovely DH keeps telling me to 'sit down' and effectively takes over all baby care when he's at home so that's good.

I'm 25 weeks on Sat - I'm keeping absolutely everything crossed for us both for a good outcome!!

I had my second beta yesterday and it had gone up to 1634 - doubling time of 37 hours so was super happy. However, today I have had a huge bleed and passed what looks like 2 clots (sorry, tmi) and so feel it's all over. The clinic said I should have another beta on Monday and that this is common. But I feel absolutely gutted.
Anyway, Snowie. Many thanks for champers, cheers
25 weeks eh? Fantastic! And so glad you have lovely people around you. Keep me updated. X

Hi Expat, I'm so sorry I haven't been back to this thread. I hardly dare ask you how you're doing but my fingers are crossed tightly. FWIW I had bleeding from my first beta with DS up until about 16 weeks and all was fine (if you ignore him coming 12 weeks early of course). I am hoping beyond hope for good news from you.

I am 28 weeks tomorrow and very very anxious still. I am having telephone counselling sessions paid for by Bliss which are helping me cope just about. I am ok as long as I don't think beyond the here and now.

Hi Snowie. Sorry to take so long to reply. I saw on another thread that you're 29 weeks +!! Brilliant news! How are you feeling?

So it was bad news for me. I'm fine and my consulant is confident that it will happen for us. I hope so. My friends are on their second and third pregnancies now and it's hard.

Anyway, I don't want to rain on your parade. Well done you!