winewinn

Hi, I'm trying to collect some opinions here and would appreciate any input so when I talk to my OB next I can bring up some questions. I had signs of miscarriage 9/24 of this year, and subsequently had a D&C performed 9/29/06. My HCG level at the time was around 27,000. I should have been 9-10 weeks pregnant, but all we saw on ultrasound was a sac that measured about 5 weeks. Initially after the D&C, I had very little bleeding and felt fine. About a week after the D&C, I experienced heavy bleeding and clotting, and ran a temperature of about 100. We figured I had an infection, and so antibiotics were prescribed and things slowed down. I had intermittent bleeding/spotting, and at my six-week check-up I was in the clear to try again. I continued to feel pregnancy symptoms, though. I was weepy and fatigued, and occasional headaches. At four weeks post-partum I had taken a home pregnancy test that was +, and since I had read somewhere you can have HCG levels up to 8 weeks post partum I figured it was normal. About 7 weeks post-partum, I tested again at home and had a + test. The next day, however, I had more spotting that turned to heavy bleeding and I passed a huge clot. I went to the OB's office, and we decided to get my HCG tested. At that point, I was about 125. A couple days later, 89. The week after, 59.9. At that point we discussed methotrexate. With it being a chemotherapy medication, I wasn't real keen on trying it and just asked if there was an alternative (I rather would have had another D&C, but that was just my personal fear). My OB said since my levels were so low, we could try progesterone to bring on a period, hoping that would clear things out. The second day of being on progesterone, I experienced pulmonary embolus (both lungs). After the PE, we did the methotrexate. As of Dec. 13, my level was down to 17, so we planned to test in 3-4 weeks again to ensure it went to 0. On Dec. 15, I was at work and basically hemmoraged. I was going through a pad every half hour to 45 minutes, blood trickling in the toilet, and passing clots about half the size to the size of my fist. Wasn't able to get into the OB's office until 1:30pm, and by then things had slowed down. They ran a CBC and HCG. The HCG was down to 13, and CBC checked out fine. My hemoglobin was a little low. (I am also on warfarin, and my OB doesn't believe the warfarin caused the bleeding -- he believes it's still leftovers from the D&C.) My question -- what should the next step be? I'm not at all comfortable with "observation" with being nearly 3 months post-D&C. Hemmoraging at work isn't another option I'd like! Any opinions out there on what to be the next step? Thanks!

Just wanted to let you know that at 7:27pm on Wednesday, April 13, 2005, Jasmine Adrianna decided to make her debut. Just 15 minutes after officially switching and meeting with an OB I was very comfortable with, labor began and despite increasing the mag sulfate and turbutaline it was unstoppable. She weighed in at 4 pounds 1 ounce and 16 1/2 inches long, not too shabby of a size for 32 weeks and 2 days gestation. Mom and baby are doing well. Her Apgar scores I think were great for her age - 8 and then 9. I can only hope she will continue to breathe on her own. Jennifer

Thank you! I scored 8/8, so baby is well. Fluid is very low -- we were able to only find one pocket that could measure "2x2" in order to score the 2 points on the BPP for fluid. At least there is that little bit there. It took quite awhile to show some "breathing" but I am thinking that is probably pretty normal at (now) 32 weeks. I did switch OBs today. Was able to check around and one one that is at least more "personable" and communicates well. Will be meeting with him tomorrow. This is a lot less stress. Although, I am keeping my legs crossed over the weekend as the other OB is on-call. ;-) Thank you so much for all your input! I probably wouldn't have had the balls to switch OBs had I not gotten your opinions. This is a lot less stress on me, and since I'm happier it's a lot less stress on my family now. I have never worked with a physician where I've felt such a personality clash. It feels good to be through this. Jennifer

Thanks to both of you for the words of encouragement. I will ask today for a second opinion. He did seem to be on the opposite spectrum of my former OB who treated my 27-weeker. It would be nice to just get something "inbetween." After three non-stress tests, we finally have a BPP ordered for sometime today. Will keep you posted!

I am still leaking fluid, and the leaking has been quite a bit today. I inquired with this OB today about testing for fetal lung maturity as I had the betamethasone shots at about 26 weeks. He said we may as well assume they are immature until about 35 weeks. Over the weekend, the fluid leaking had decreased. Today, though, there is an increase of fluid gushing. Could be from the baby's position, I guess. So... the lung maturity test was a no-go with him... Jennifer

Thank you for your advice. I would like to get a second opinion, but at this point I don't know how to go about doing it. At this point, since I don't have a rapport established with this OB (I was supposed to deliver at a different hospital), I'd prefer to switch physicians. We clearly have a personality clash -- I need someone who can communicate for I don't buy completely into his vision, and he pretty much dismissed my ideas of Nifedipine to replace the mag sulfate. He didn't say anything bad about Nifedipine, just that "this is what we do and the mag sulfate is better." Should I pursue a second opinion or switching OBs through patient services or attempt to contact different OBs on my own? Baby is pretty non-reactive right now, although I know that due to the side effects of mag sulfate that is probably normal... She was capable of having reactive non-stress tests when i first arrived, though, so naturally I'd prefer to watch things a little closer. How often do most OBs order fetal monitoring when on mag sulfate? This OB has not even ordered the non-stress tests; the on-call over the weekend did, and this OB didn't have intentions of ordering any... The fetal heartrate is checked it seems once a day by a nurse. I'm kind of wondering if I was "spoiled" for having gotten a two non-stress tests every day with my 27-weeker while on Nifedipine? While on mag sulfate with the 27-weeker, I was constantly monitored and on complete bedrest. To date, there is also no ultrasound or biophysical profile scheduled, and this is something my regular OB was to follow up with, so I mentioned this when I spoke with this OB... I've had a fetal demise at 36 weeks, m/c @ 10 wks, and m/c @ 8 wks in addition to the PTL history, so I wonder if my emotions are doing the thinking and if what is being done is "standard," or if I should have valid reason to be concerned? Thanks!

Is Nifedipine dehydrating or the magnesium sulfate? I know I've read some others are, so just curious. Even with a full rupture with my first (the 27 weeker) I had the Nifedipine. Once when contractions acted up on the Nifedipine, a fluid IV to hydrate the uterus helped subside contractions. I just want to be able to make an informed choice and know the risks of each, along with what is best for gestational age at this point. It was very hard to hear one OB say magnesium sulfate is the only way to go after my first experience with PTL and the OB wanting to try and avoid mag sulfate because of the fetal/maternal risks he felt. Perhaps consulting with the neonatalogist might be a good idea to see what they like to see at this point? I've met once with the neonatalogist and know he would like to see me reach 34 weeks if possible. The OB actually wanted to deliver me at 31 weeks when I presented with PROM since I had the betamethasone shots at 26 weeks. (I had been home on bedrest since and not on any meds -- just a positive fetalfibronectin result @ 26 weeks and uterine irritability.) So far, my labs have come out okay. No infection or GBS. Should I ask about assessing fetal lung development? Is it possible to do with ruptured membranes without an amnio? I'd hate to take water away with an amnio. I wasn't comfortable delivering right away at 31 weeks without knowing if I had infection or not or knowing how the lungs are at this point. I remember all too well how long my 27-weeker was in the NICU. But, I also realize it's important to assess each day and go with the flow. I did bring up Nifedipine to the on-call OB over the weekend to see what they think of it here and he basically said, "We are better at dealing with magnesium sulfate." Not quite sure what to make of that, other than he probably didn't want to go switching orders over the weekend on the other OB. ;-) Jennifer Thanks to all for your feedback!!

Hello! I am presently at a hospital where I was admitted for PROM at 31 weeks. Was about 2cm dilated and put on magnesium sulfate. I am wondering what others think of using Nifedipine as a substitute for mag sulfate? For the past three days, I've experienced only 2 contractions on the mag sulfate and the dose has been lowered to about 1.5 grams. The reason I ask, is because in a pregnancy where I delivered at 27 weeks (also due to PROM - complete rupture), I was put on mag sulfate as a first line of treatment for two days in order to receive betamethasone shots, and then put on Nifedipine. I was able to carry about 3 weeks on the Nifedipine before delivering in this situation. The reason my OB chose Nifedipine at the time was because it seemed to carry fewer side effect for both myself and baby. Being in a different hospital with this baby, I do not even have a rapport with the OB who was assigned to me. He is an older OB and pretty set in his ways, and I can understand he probably has had many babies delivered fine on mag sulfate. In this hospital, I was told that their usual course of treatment is magnesium sulfate until I deliver, which is hopefully three weeks later. Since this child shows enlarged kidneys (having fluid) on ultrasound, that has increased my worry as to what medication is best for fending off preterm labor. At this point, I would like the least amount of risk for both baby and myself. Can Nifedipine and Magnesium Sulfate both be as effective in preventing pre-term labor? Which has the least amount of risk? Any opinions are welcome... Oh, also... my baby that was born at 27 weeks did quite well in the NICU. She was able to breathe on her own initially; no brain bleeds. She really seemed to beat the odds. She is a walking and talking 3.5 year old today. With her treatment being so successful, I guess that I why I am hesitant to remain on the mag sulfate and would prefer to switch to Nifedipine at this point.

I don't know what is up with thumbsucking, but my husband is a correctional officer and says about half the people in his jail suck their thumb!

My great-grandfather had 24 children. His first wife died after having 12. His second wife must have been quite a woman to take on the first 12 and then have 12 more together! Must have been cheaper by the dozen back then. :chuckle

I had a cute comment from a nurse I got to know well while I was on bedrest in the hospital. She was newly married, and while I knew she actually wanted a baby -- she said that at the end of her shift she already had that "baby fix" taken care of from working in L&D and on the maternity floor. :) Jennifer

This is wonderful news! I began reading your posts from January and just wanted to say that I am a mom of a 27-weeker (a girl) with no problems to report at 3-1/2 years old! :-) (My water had broken at 24 weeks and I had lost so much fluid that the OBs thought I would have delivered within 48 hours. We held out on bedrest for 3 more weeks. I delivered because my placenta began to abrupt.) Here's hoping to a safe labor, delivery, & healthy baby girl! Jennifer :)

I delivered a stillborn (36 wks), and was actually given a choice between an OB floor or another floor as we were leaving the birthing suite. I don't know which type of nurse would have been assigned had I chosen a different floor, but I opted for the OB floor anyway. I was in a quieter, c/s area, and that was fine. I just wanted to say that it was a nice "administrative" move on the hospital's part in considering the emotional needs of the patient and giving the patient that choice during my stay. Probably not every hospital is always willing or really able to volunteer such an option. From a patient's perspective, though, it was a class act on the nurse's/hospital's part to give that choice, and the hospital really made me feel valued as a patient because of that consideration. They acted proactive rather than reactive to the circumstances. (I didn't think to request a different floor, but it was nice to have been offered.) I think the OB floor was just fine, and I agree -- it's nice to have the nursing expertise from that area in such a situation. :) The nurses were super during my stay!

From another standpoint, since the woman just delivered a stillborn infant, it could have been easier on her emotionally at the time to not be around other women with newborns or near the nursery...

I'm not a nurse, but wanted to add my point of view from a patient's perspective! I didn't have a very good experience with Cytotec. I was administered a half tablet at 36 weeks due to stillbirth. I was already about 3-4 cm dilated. Very painful, on-top-of-another contractions and it probably hyperstimulated me. The nurse even overrode my dose of morphine several times but to no avail for any relief. Pain finally stopped when my baby pretty much shot out of me! Just my 2 cents, but I'd never touch the stuff again. Jennifer