Is there any hope?

My husband and I are preparing for the worst, but still hoping to be able to hope for the best.

AFter two weeks of contractions and uterine irritability, my cervix went from 35mm to 5mm. I'm only 19 weeks!!! It's a good thing I insisted on going in! Anyway, there is apparently nothing that can be done at this stage to calm the contractions. So the doc gave me progesterone suppositories and sent me home on strict bedrest. The progesterone has apparently been shown in a brand new study with singletons to reduce the risk of PTL by 35%. A similar study with twins is ongoing right now.

The doc said that a cerclage was not a good idea, because it won't help and it may actually hurt.

Anyway, I wondered if anyone had actually got through with such tiny cervix so early.

I'm just glad I have such a great husband and that we are so strong together. I don't know what I would do without him right now.

Thanks in advance for sharing your experiences and knowledge.

 

Oh sweetie I will be praying for you! I know a good magnesium supplement like Natural Calm sure helped my contractions to calm down at 24 weeks, but I also hadn't dialated. Please keep us posted. I'll be thinking of you.

 

Hi! Welcome to TS!!

:hug: I am so sorry that you are having to go through all of this :hug:

First thing I would do, if your Dr has not already put you on STRICT bedrest put yourself on it! I would not be getting up unless to go to the bathroom. You need to be drinking a TON of water, and emptying your bladder often as both of those can also cause uterine irritability and PTL. Have they ran any blood tests to check for infections just in case? Have they done a fFN test?

My Dr told me that if I had gone into PTL prior to 22 weeks (I was 24 weeks) that they definitely would do a cerclage, so is there any way that you can get a second opinion? I know that many women on here have had success with cerclage's...

I have never heard of the progesterone suppositories, but I hope that it works!! Have you talked to your Dr about when they will start giving you some meds that help with PTL? I have a very good friend who started Procardia for PTL at 18 weeks when she was pregnant with her twins, and she made it to 37 weeks!!

Ask a ton of questions, and if necessary seek out a second opinion. You and your babies deserve the best! I am so glad that you have a wonderful supportive husband, you guys will get through this together!! GL!! :hug:

 

Thanks ladies.

To answer your questions: yes, I was sent home on strict bedrest. Yes, I'm drinking a tonnes of water and keeping my bladder empty, and yes they are checking for infections. Apparently, the fFN test cannnot be performed until 22 weeks because the substace it tests for exists naturally prior to that time so the results aren't worth anything.

I am wondering about the cerclage. Most of the research I looked at this morning suggests that the doc is right that it often does more harm than good with twins. But it seems to be so standard around here that I wonder... Luckily, there are 10 docs in this MFM practice who don't always agree with each other, so I'm going to call today and see if I can get a second and maybe third opinion from among them.

Thanks so much for the support and good wishes. We just have to stay positive, while being prepared for the worst.

 

QUOTE(Georgianne @ Oct 2 2008, 07:21 AM) [snapback]1008098[/snapback]
I am wondering about the cerclage. Most of the research I looked at this morning suggests that the doc is right that it often does more harm than good with twins. But it seems to be so standard around here that I wonder... Luckily, there are 10 docs in this MFM practice who don't always agree with each other, so I'm going to call today and see if I can get a second and maybe third opinion from among them.

That is great that you have plenty of Dr's to get other opinions from! Keep us posted on how it goes!! GL!

 

My cerclage was done at 19 weeks, I had a little more cervix left though, about 18mm. It is somewhat risky, but for us it was a risk worth taking since it was either do the cerclage or do nothing. I would definatly get another opinion. I didn't know progesterone supps were used for this kind of thing, but I did weekly progesterone injections which I think also helped.
I was hospitalized for bedrest at week 23. This is certainly not the best or most fun thing, but it is a lot eaiser to stay in bed when you have people to take care of you. I was also nice to be able to check on the babies a few times a day.

 

Welcome to TS. :wavey: I am sorry you are going through this. :hug:


Did you get the steroid shots?


QUOTE(Georgianne @ Oct 2 2008, 10:21 AM) [snapback]1008098[/snapback]
I am wondering about the cerclage. Most of the research I looked at this morning suggests that the doc is right that it often does more harm than good with twins. But it seems to be so standard around here that I wonder... Luckily, there are 10 docs in this MFM practice who don't always agree with each other, so I'm going to call today and see if I can get a second and maybe third opinion from among them.

I think the main reason they wont' do a cerclage is your cervix is so small. I did have one done at 24w (the latest they would do it) and I was just over 1 cm. They said I was still a good candidate for it. It did hold for 10 more days, so I am extremely glad we did it. My little girl would not be here with us today (probably) if we did not do the cerclage.

Keep us posted, I hope things turn around for you. :hug:

 

I woudl see about a Terbutaline pump! I was put on one at 20 weeks....and made it to almost 32 weeks. I really think the Terb pump & strict bedrest (mix of home & hospital) helped. I was hospitalized off/on from 26 weeks on.

GET ANOTHER OPINON. MFM opinons vary and another Dr may have another opinon- that way you have more knowledge.

I agree that I have heard good things about progesterone.

Good Luck and keep us updated!


KC

 

Hello,

And thanks again for your comments and suggestions.

I spoke with another doctor and she was very helpful. She respected that my husband and I like to understand everything and have all the information, so she explained why each possible intervention was not appropriate or actively harmful. We also went onto a science search engine and read up on all the latest research.

Sure enough, it seems that the very latest research strongly suggests that a cervical cerclage is counter-indicated in twin pregnancies (doesn't seem to statistically affect rates of preterm labor, but it DOES cause lots of other problems...in fact the study said that it "significantly increased" the rate of problems and preterm birth... so ask lots of questions before you get a cerclage!!!! ). And tocolytics, despite being administered so commonly for long periods of time are only scientifically proven to work for 48 hours.

According to what I read in a meta-study in the New England Journal of Medicine, even bedrest has absolutely no effect (statistically) on preterm labor, but it DOES affect the weight of preemies, and so can be indicated for that reason (they are bigger).

Research going on now and published between 2003-2007 suggests that progesterone may have a really dramatic effect in both singleton and twin pregnancies, although the results are not conclusive yet and some insurance companies won't pay for the drug.

I asked the second opinion doctor why twin moms still get cerclages and take tocolytics for weeks if they don't help, and what's what with bedrest etc and she said that a lot of it is psychological, and that pre-term labor stops spontaneously on its own, so women THINK it's the drug or the cerclage, when actually it would have stopped anyway. There's no way of knowing in a specific case whether it was the drug or the body itself that stopped the labor. The only way to know is statistically by looking at large numbers of women. And when that is done, the drugs seem to have no effect beyond 48 hours, and the cerclages cause harm.

Well, we are satisfied with that, being scientifically minded people, and having read for ourselves tonnes of research that backs this up. Given the dramatic effects of this new progesterone treatment, we are putting our hope in that.

And I am feeling better and having fewer contractions after 3 days of rest and progesterone. Time will tell.

Still, I think in our heart of hearts, neither of us really thinks our sons are going to make it. 5mm is just too short, and the time to viability too long.

Each time I feel one of my babies moving my heart just breaks.

 

QUOTE(Georgianne @ Oct 4 2008, 10:00 AM) [snapback]1011363[/snapback]
Still, I think in our heart of hearts, neither of us really thinks our sons are going to make it. 5mm is just too short, and the time to viability too long.

:cry: I am sorry you are feeling this way! Please try and stay positive , I know it's hard. :hug: There are so many success stories on here. Hang in there and please keep us posted. :hug:

 

:hug: :hug: I am so glad that you found TwinStuff ~
I agree with Amy, please try to stay positive, rested and hydrated.
We are all pulling for you :grouphug:

 

QUOTE(Georgianne @ Oct 4 2008, 06:00 AM) [snapback]1011363[/snapback]
Each time I feel one of my babies moving my heart just breaks.

I am so sorry. I am glad you are educating yourself to try to ge tthe best care possible.

Please keep us posted.

 

You are in my thoughts and prayers

 

:hug:

I just wanted to tell you that my cervix was around 5mm from 20-something weeks until 36wks. At 22 wks I did have an emergency cerclage though. (We decided to risk it so that we could possibly make it until viability.)

 

Thanks everyone. Part of me feels like we ought not to give up hope, but it's fighting against the part that's terrified that hoping will make it harder. We are still doing EVERYTHING we can: keeping up my nutrition even when I'm not hungry, staying hydrated, following the doctor's orders to a T.

Gina, Your story does give us hope! Can you tell me whether you continued to have contractions after the 5mm reading? That's the part that worries me the most. These contractions won't let up, even though they are now fewer, so I keep thinking that it must be even worse than 5mm by now.

I'm usually so optimistic about things, and have been throughout this pregnancy until now, despite all the trouble of mono/di twins. I don't know why I find it so hard and scary to let myself hope now though.

We are first time parents, and I think we're both pretty shocked at how intense and how sudden this parental love thing kicks in. We both feel we would do ANYTHING to keep these babies alive and well. I knew that people said this about being a parent, but it is quite something when you feel it yourself for the first time.

 

Did you see this story posted on Oct. 2...This will give you hope!

http://www.twinstuff.com/forum/index.php?s...c=96476&hl=

 

:hug: I just wanted to let you know that I am thinking of you and hope all goes well!

 

I had contractions for a month with my last little one and didn't dialate at all. They kept giving me procardia to put things off, until I was 38 weeks. So, hopefully the contractions are unproductive ones like I had.

 

I was on Procardia to control my contractions through out. I took it every 12 hours, but don't remember the dosage. Is there reason why they don't want to put you on anything to control the contractions? I've heard of people being on Procardia from very early on. Or terb.

Hang in there! I know how scared you are. :hug:

 

QUOTE(Georgianne @ Oct 4 2008, 09:00 AM) [snapback]1011363[/snapback]
Research going on now and published between 2003-2007 suggests that progesterone may have a really dramatic effect in both singleton and twin pregnancies, although the results are not conclusive yet and some insurance companies won't pay for the drug.

I asked the second opinion doctor why twin moms still get cerclages and take tocolytics for weeks if they don't help, and what's what with bedrest etc and she said that a lot of it is psychological, and that pre-term labor stops spontaneously on its own, so women THINK it's the drug or the cerclage, when actually it would have stopped anyway. There's no way of knowing in a specific case whether it was the drug or the body itself that stopped the labor. The only way to know is statistically by looking at large numbers of women. And when that is done, the drugs seem to have no effect beyond 48 hours, and the cerclages cause harm.

Well, we are satisfied with that, being scientifically minded people, and having read for ourselves tonnes of research that backs this up. Given the dramatic effects of this new progesterone treatment, we are putting our hope in that.


Georgianne,

My heart goes out to you and your family at this time. I also have a shortened cervix that I just found out about on Friday and am now in the hospital. I'm 27 weeks with twins. We don't know if it's shortening or just short, but I also have been doing tons of research on possiblities. Seem I can rule out everything, BUT the only study I found about progesterone and twins said it they didn't find it to be effective. If you have the time and energy would you mind posting the citations for the studies you've posted on the topic? It would really help me make decisions with my own doctor about what to do...hang in there and stay strong for those bebes! I have read MANY MANY stories like yours with positive outcomes over the past few days so there is hope.

 

Hi, I haven't stopped in awhile because I am so very swamped. But I wanted to respond to your post.

I was about 20 weeks when I had an emergency cerclage (they were able to get in 2 stitches) in my "dynamic", funneling and dilating 0.9mm cervix. It was risky, but it was recommended to me. I remember seeing one of my OBs sweating bullets during and sighing after the procedure in the OR. I admit that I was very, very scared. But it worked for us. I was warned that they might accidentally rupture the amnio sac(s).

We also had Stage I TTTS, PTL symptoms. I had been on bedrest before for PTL, and I always have dilated early BUT gone full term with my singletons.

After the cerclage procedure, I went home on strict bedrest. I went to the Maternal Fetal Specialists weekly to check on the babies and my cervix. At 27 weeks, I was put on bedrest in the hospital because my cervix appeared to be getting shorter and they wanted me there in the hospital in case I went into labor (also having had VERY quick labors before). The doctors thought I would deliver by 28 weeks. . . We went to 34 weeks 1 day miraculously. I even had polyhydramnios which contributed to the PTL for weeks.

I also started the progesterone suppositories (vaginally) when I had the cerclage placed. Did it work? I don't know. But I was willing to do anything to help. I do remember at the hospital that NONE of the nurses wanted or acted like they were going to handle or insert the suppositories. They'd bring them in the room, and were like, "Uh, you know what to do with these?" After awhile I laughed about it. My friend, an antenatal nurse who took care of me in the hospital, told me that they weren't even 'approved' yet or something.

I was on STRICT bedrest for 13 weeks, 7 of those weeks at the hospital. Had a cerclage that held up (they had to remove it when I went into labor, Baby A's water ruptured - they were only able to partially remove it due to quick labor, so I ripped UGH). And I took progesterone suppositories. I was very fortunate.

Would I recommend the cerclage? I can't answer that question for anyone because I still just don't know. Twin pregnancy was so hard for me.

I wish you all the best and will pray for you this evening!

 

Stay in bed!! I wasn't as early as you were, but I was admitted to the hospital at 24 weeks with a cervix of 1.5cm and contractions (didn't know I was even having contractions). Stayed in the hospital for 4 weeks and my cervix continued to shrink down. At 28 weeks my cervix was 3mm...at that point my dr. gave me the choice to go home. I was convinced i was going to deliver at any moment, but I still chose to go home. I could tell by the look on my MFM Drs face that it was not looking good. Well, I made it to 34 + 2 weeks. That is more than 6 weeks with a barely there cervix. I think I could have lasted longer, but my Dr said I could come off strict bedrest at 34 weeks. I went for a walk and the next morning my water broke. I wish I had stayed in bed for another 2 weeks, I am convinced bedrest worked. I pretty much stayed on my left side, too. Anytime I would be on my back I would have contractions. It wasn't a fun summer, but it was worth it. I will pray for you and your boys, but just wanted to let you know you can go the distance with no cervix. Oh and my MFM wouldn't do a cerclage or toxs either. Just IV fluids and bedrest, then when I went home lots and lots of water! Oh and I was on the Progesterone suppositories as well...maybe that is what did it!

 

I thinned out pretty quickly and had a cerclage and went on bedrest at 18 weeks. From what I remember, once you're past a certain thickness, it becomes too risky because there's a chance or puncturing the amniotic sack. I'm not sure if the cerclage helped much because I continued to thin out but I cheated a bit with bedrest. I delivered at 29 weeks and 4 days but not because of my cervix. I think if you're really good about bedrest you can definitely get your twins to a viable gestation.

Good luck

 

Just looking for an update, how are you doing? :hug:

 

At 22 weeks, I was admitted to hospital after a routine ultrasound measured my cervix length to be 0.5cm. That evening, I had a cerclage put in.....I was told that there was a 50/50 chance of the twins survival and there was no other option at this point. Thankfully the surgery went well. Four days later, the doctor put a second stitch a little higher up in the cervix to ensure that enough of the cervix is closed. After the 2 surgeries and 8 days in hospital, I was sent home and put on bedrest. I am now starting my 27th week, and the doctor is convinced that I can make it to at least 32 - 34 weeks. Bedrest is tough, but I am sure that it will be worth it in the end. Through all of this, the babies have been fine. They are developing well and are at the appropriate size and weight for this time in my preganancy. Also, I am going for the steroid shots next week. So yes, there is hope with such a thin cervix.