Second pregnancy after 30+2 weeker

[Biscoff2024]

Hi all,
im just hoping someone can give me a bit of reassurance and advice. I had my first baby 5 years ago (6 in one week!) and we have always been cautious about another baby after DS was born 30+2 weeks. After many years of getting over the traumatic birth and NICU stay (spontaneous labour, no waters breaking just contractions) I am currently 6 weeks pregnant again.

I went to see the midwife today and she said I would be referred to the preterm prevention clinic but something that set alarm bells ringing was that she said they might only see me from 16-24 weeks? She said I was in good health and if my cervix looked ok they might refer me back to midwife care at 24 weeks once baby reaches viability?! I really thought the whole point would be to keep a baby in for as long as possible, not just until it’s 24 weeks! I honestly don’t think I have it in me to do another long NICU stay . I’ve stalked enough mumsnet forums to know many ladies have had extra scans, cervical lengthening etc but she seemed to think I wouldn’t be offered this as I didn’t have IUGR. Honestly I feel SO worried!

Is this information correct? It really doesn’t feel like it. I honestly thought I’d done enough research to know you’d be more looked after?

Does anyone have any tips on how to advocate for the extra scans, cervical lengthening, progesterone, etc etc? I’d be happy to take anything given to me, as long as it felt like I was doing something!

any help greatly appreciated and thank you for reading x

If you had a spontaneous PtB at 30 weeks before, then yes preterm birth clinic will look after you. That would often involve a first visit at 12-ish weeks (but not always) to take a history and go through plans with you, +/- cervix exam and swabs. If you have a very high risk of the same thing happening again then they might offer you a history indicated cerclage (things like previous extensive surgery to the cervix would be triggers for this). Without additional risks, studies have shown it is safe to wait and monitor the cervix by ultrasound. If the cervix length is normal >25mm there is no evidence for progesterone either. They would usually start cervix length checks at about 16 weeks, by internal scan, and you’d get a quick check of baby at those. Scans. Typically done every 2 weeks. If there’s shortening <25mm at <24 weeks then it would be discussed with you with options being either a cerclage (stitch) or progesterone.

The reason your midwife has said they would stop at 24 weeks, is that if your cervix length is normal and everything is going well at that point, then you have a low risk of birth before 34 weeks. Routine cervix length checks after 24 weeks if you aren’t having any symptoms aren’t evidence based (they don’t actually help predict early birth).

regarding extra growth scans, it depends a little bit whether you have risk factors for baby being growth restricted. Was your previous baby small for gestation, or just small but normal size for 30 weeks? If there’s no risks for growth restriction and everything is fine at 24 weeks then you wouldn’t strictly need any more scans.

where I am (not UK) there is some flexibility and we will often order scans in the later part of the pregnancy anyway for mums who have had previous complications +/- who need extra reassurance. There’s nothing to stop you asking for that :)

I’d encourage you to keep an open mind, when you go to the first PTB clinic appointment perhaps take someone with you and write down some of your questions, hopefully you’ll find your team go through everything with you and you can make a plan together that you’re happy with.

congratulations on your pregnancy, wishing you all the best :)

How are you getting on @Biscoff2024?

so sorry for my late response - I didn’t get the notifications that people had responded on here, and now I’ve come back on I’m so grateful that you’ve both taken the time to come back to me.
Im currently 12+5 weeks today and last couple of weeks have been a bit of a rollercoaster. Started getting very light spotting (almost just tiny dots) of pink which went away, had our 12 week scan and saw a lovely wriggly baby with a heartbeat. But the day after the spotting returned and it was more red in colour :( Went to the EPU who were so lovely and couldn’t see anything of concern (no blood coming from cervix or around baby) in internal and abdominal scan as it had stopped again. Then today, I’ve had more brown discharge with slight cramping plus my results from DS screening came back with low levels of Papp A so could indicate another preterm birth (amongst other things). I feel like today is just tipping me over the edge. With that result and the spotting / cramping, I’m just so low and don’t feel in control at all. My first obstetrician appointment is next week but my intrusive thoughts are telling me this is the end anyway :(

@TenThousandSpoons00 honestly this is so useful thank you so much! I will be sure to ask as many questions as possible next week. My little boy was a decent weight for his gestation so in that respect I wouldn’t need extra scans but with the Papp a results, they’ve told me I’d need to be on that pathway alongside the preterm clinic ( nothing showed up in bloods when I had him). very very stressful x

Aw I understand the stress. But, PappA is not a very good predictor (we don’t use it for this where I am because it’s not that predictive). The vast majority of people with low PAPP A will still have a normal full term pregnancy. Yes there’s a higher chance of growth restriction/high blood pressure/preeclampsia and I believe that’s what drives the increased chance of preterm birth (rather than spontaneous labour causing PTB). Have they started you on some aspirin?
I would try to flip it a little bit - the PAPPA result means that you’re going to get extra checks, you’ll see your baby more often on scan, they’ll make sure there’s no chance of missing anything worrying; ultimately you’re still quite likely to go to full term without problems.