Need advice for my cousin

(18 posts)(8 voices)
  1. Hi ladies - I need any and all info you can give me for my cousin who is 23w with twins. I also had twins prematurely (32w) but not from an IC so I don't have much info to give her. Here is the story: She went in to the peri last Tues for her regular cervical check and she had gone from a 3 to 1.8. They monitored her for contractions and since she was having some they gave her terb and sent her home. They planned on having her come back on Friday for a cerclage. On Wed night she was having strong contractions so she went to the ER where they measured her cervix at only .96. She was immediately admitted and put on mag. They are now talking about sending her home on a terb pump and complete bedrest with a cervix only measuring .96 and no cerclage. This seems crazy to me! Seriously, what are her chances at only 23 weeks to carry these babies to a safe gestational age? Shouldn't she remain in the hospital with so little cervix left at this point? What should she be asking for? My preterm labor didn't start until 27 weeks so they immediately gave me the steroid shots. Shouldn't she ask for them as soon as she hits 24 weeks? I dont' think they plan on giving them to her at this point. Is it to late now for a cerclage? Any advice you could give me would be much appreciated. TIA.

  2. A cerclage this late is very risky and could cause worse so I think they are being ultra cautious. They don't do steroid shots until 24 weeks but they can also start the fetal fibronectin tests and if positive they will probably do a steroid shot then (they start the ffn tests at 24 weeks).

    I hope the best for your friend. In her case I'd insist on staying in the hospital until they know she has stabilized but I also know alot of people who have done the complete bedrest and made it way past 32 weeks.

    She might want to ask for uterine monitoring if she goes home so that she can know if she needs to go back into L&D if she is having too many contractions. Alot of time insurance won't cover that until a positive ffn test but in her case with her recent hospital visits it might be covered. It was covered for me because of my past history with a positive ffn test.


  3. Thanks Lauren. I spoke to my cousin last night and as of yesterday her ffn test was still negative. They did mention to her requesting a home monitor for her. I just worry since her cevix is so short. Plus it makes me nervous that the hospital she is in doesn't even have a level III NICU.

  4. I agree with barbara_s that it would be very risky to do a cerclage this late into the pregnancy... but she could push to get hospitalized as soon as possible. My OB was able to get me in right after 23 weeks - it's pushing it with insurance because viability is considered 24 weeks, but I think a good doctor can make it happen. She should ask about the steriod shot as well - usually at that cervical length they will give it to her as soon as she's at 24 weeks. I was given the steriod shot at 24 weeks and I think I was closer to 1.4 cm in length (though I had funneling and shortening since 18-20 weeks).

    She needs to try to drink a lot of water (for the contractions) and avoid constipation (puts pressure on the cervix). A lot of women can make it far with STRICT bedrest. I made it to 31 weeks with 1.4 cm at 24 weeks - my last two weeks I had no cervix left at all (no cerclage).

    Is there a better equipped hospital for your cousin to go to? Even if it's an hour away, she'd be better off being hospitalized with a place with a level III NICU.

    Two sites for her: there is an IC Forums site and for bedrest

    It\'s great that the ffn was negative. My Drs. wouldn't even give the ffn to me, they said it would be positive and just freak me out!

    I hope your cousin gets the best care possible - please urge her to do so as much as you can without adding to the already intensely stressful situation.

    Wishing her the best.... the IC Forums site is a good one for her to go to for support.

  5. Thank you Lauren and MM for your responses. I have learned that they did transfer my cousin to a hospital with a level III NICU but plan on sending her home with a monitor most likely at the end of the week. I honestly am shocked they even admitted her prior to 24 weeks but glad they did. They do not have plans to give her the steroid shots when she hits 24 weeks at the end of this week. I just think that is foolish considering her contractions are only controlled by terb. I am going to pass those two websites onto her.

    Thanks again!

  6. The good thing about negative ffn tests is that they are usually close to 99% accurate so if it is negative that is a very good thing. A false one means could be a false positive so they retest in a week and sometimes treat for a yeast infection which can cause it.

    Usually as a practice they do not give steroid shots until there is a positive ffn test. You really do not want to do them too early if it is not warranted. Because she has her contractions under control with terb and a uterine monitor that should help. I used a uterine monitor the entire last pregnancy and it really helped (and kept me out of L&D until the end)

    I used for my bedrest the first with cerclage and it was nice - did not use it on the last pregnancy and I was on bedrest from 24 weeks on.

    She seems to be in good care. The good thing about the uterine monitor is that it can be done as much as she needs it and she'll get a quick response if she needs to increase her meds and/or call the doctor. It is much nicer to do bedrest from home in this scenario.


  7. Hi There, I definately agree that it is too late and risky to do a cerclage.

    Here is my story. I went for my first cervix check at 25w4d and I had no cervix to measure, all you could see was Baby A's bag hourglassing through my cervix, dialated 3-4 cm with internal funneling. I was immediately taken to L & D and given steroid shots and a grim prognosis if the twins were born anytime soon. I was admitted to the ante-partum unit on strict bedrest until the twins arrived which they expected in a few days. Everyday I kept them in was a god send. I managed to keep them in for 3 weeks when Baby A's bag finally ruptured. They let me stay with A ruptured for as long as I could because it was helping Baby B who hadn't ruptured. I went for 6 days with A ruptured before having contractions and going into labor. I was already 4 cm dilated so when labor started it didn't take long before I was in the OR having a C-Section. Mia & Jake were born at 29w4d weighing 2.14 lbs & 2.15 lbs. Neither required any O2 and both babies didn't have any complications from prematurity. They spent 32 days in the NICU and came home weighing 4.5 & 4.3 lbs.
    They are of course the light of my life and are now almost 6 months adjusted.

    Once your cousin hits 24 weeks the hospital are much more likely to admit her on strict bedrest. I would chose one with a level III Nicu even if it means travelling to another town/city etc. She does need to get those steroid shots on board, it made all the difference to my twins. Keep her on strict bedrest, up to the b/room only and lying completely horizontal as even sitting up puts pressure on the cervix. I had one of those body pillows which was wonderful to use in those hospital beds. My IC was not caused by contractions, I never had the turb just had irritability of the uterus.

    Please keep us updated, sending hugs and prayers her way.


  8. Tracy - she currently has been admitted to a hospital with a level III but they want to send her home, she will be 24 weeks this weekend.

    This is all so new to me since when I went into pre-term labor with my twins I was already 27 weeks and had a positive ffn. I immediately was given the steroid shots and admitted to the high risk floor. I just have no experience in IC to share with her.

    Lauren - thanks for reassuring me about it being safe to home on the home monitor. It just seemed so scary to send her home with barely any cervix left especially since they wouldn't send me home when I was much further along than her and in a better hospital.

    I am sharing all this info with her and she very much appreciates it.

  9. She needs those steroid shots on Monday when she will be 24 weeks, however going to and from the Dr's Office isn't going to help her any with barely no cervix left. I,m pretty sure she could have those shots administered in a Dr's office. 24 weeks is the magic # when Dr's start paying attention.
    She won't last long at home with barely any cervix left. You can increase/decrease a few cm's in a day! Sorry to sound so blunt but if it were me I would be going to the L & D Level III on Monday (being 24 weeks) and requesting steroid shots. It made all the difference to my twins having those shots. Don't want to alarm you but I don't want this woman to end up with a lifetime of heartache because she wasn't more proactive.


  10. Tracy - I agree with you 100%! I talked to my cousin yesterday and she is home from the hospital and the doctors have no intention of giving her the steroid shots unless her cervix gets shorter(???) or she gets a positive FFN. I just think it's foolish but she seems to think this can only end fir the good. I so hope she is right but I have seen things like this go so wrong. I swear the steroids are what helped my boys do so well when they were born.

  11. I just wanted to thank everyone that responded to this thread. My cousin gave birth to her twin boys at 35w5d and they both are doing amazingly well. I was so afraid for her when this all started happening and just couldn't see how this could end well.

  12. congrats!!!!! that gives me hope that i will make it that far with a singelton...

  13. OMG Meg, I've got goose bumps reading this. How wonderful for your cousin & family. What a great outcome!

  14. It's so wonderful that your cousin had such a great outcome... 35W with twins and such a short cervix - that's just a wonderful miracle really. Thank you so much for updating us with the great news!

  15. Yahoo! Glad to hear she went so long and that the boys are doing well.

  16. That is awesome! I am so glad she was able to carry them for that long.

  17. Thanks all for your well wishes for my cousin. It truly was a miracle that she was able to make it as far as she did. My cervix was much longer than hers and I only made it to 32 weeks with my twins so I really was frightened for her.

  18. I am so happy to hear that she made it that far, quite amazing. Send her my congrats. Happy endings make my day

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