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Old Dec 11th, 2010, 15:16 PM   551
MikaylasMummy
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i am heartbroken about baby grayson..i dont know what else to say i am so sorry to heychickie i cannot begin to imagine how you feel.im so sorry



 
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Old Dec 11th, 2010, 15:21 PM   552
Sherri81
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Hey ladies, I want to jump in here and ask for some advice.

As you can see from my ticker, I lost a little girl, Devon, 4 months ago on August 7th. She was my 7th pregnancy, and so far, the only baby of mine to make it is Greg, who was born at 25 weeks. Devon was born at 23+3, and she was alive when she was born, but died about 40 minutes after she was born.

Hopefully I'm not jumping ahead of myself here, but as you can see from my new little ticker, I am pregnant again, and just about 9 weeks. As long as everything works out with this pregnancy (knock on wood), I am supposed to be looking into getting a stitch placed, and soon. But alot of Drs have me confused, and I don't know what I should do.

Basically, most of my miscarriages were in the late first trimester, for no known reason. Blood clots were assumed. I have only made it to the second trimester twice, and that was with Greg and Devon.

Now, Greg's birth was different, or so it seems, from Devon's. With him it was a very complicated pregnancy with lots of bedrest and bleeding episodes. At 24 weeks, I had some pink spotting which the hospital told me was the result of a yeast infection. At 24+2 it turned into red blood, with weird looking tissue. There was never any pain. I went to the Dr, he did an internal, pulled out more tissue, sent me for an emergency ultrasound, which showed my cervix was 1.3CM. I was sent out, still not in any pain, and not thinking anything was going to happen. Two days later, the bleeding was worse and I started having labour pains, and then, at 25 weeks exactly, Greg was born.

Most Drs feel confident that his birth was a clear cut case of IC.

With Devon, her pregnancy was perfect with no bleeding episodes, and no bedrest. I did have a preventative cerclage placed at 14+4. It was a TVC; the McDonald Stitch. Everything was going perfectly until I had an internal exam, my first one with this pregnancy, at the end of my 21st week. My Dr was very thorough and very vigerous with her examination, and she caused me quite a bit of pain during the exam. She then followed it with an internal ultrasound which was truly a horrible experience. After that, I didn't feel comfortable, but eventually the pain stopped. Two days after the exam, my pain resumed and I started getting copious amounts of clear thick discharge, with little bits of yellow every now and then. No smell, so although I was thinking infection due to pain, I couldn't be sure. It was the August long weekend, so none of my Drs were available. I was going to wait til Tuesday to see my Dr, but on Sunday night, I went to my ER anyways. I refused an internal, so the Dr walked out on me. I drove to my OBs hospital and saw a Locum (not one of the regular Drs, and she didn't know my case). She did a swab but said she didn't see anything. A pee test showed slightly elevated white blood cells, indicating there was a possible infection. She gave me an antibiotic prescription but asked me not to fill it until Tuesday when the culture came back. I couldn't wait as everything was getting worse, so started them on the Tuesday morning. Anyways, through a lot of medical mismanagement, no one believed I had an infection, so I wasn't treated properly. No one believe I was experiencing labour contractions either. On Thursday afternoon, my cervix was still closed and 3cm long, but by that night, I was dilated to 1. I was sent to a different hospital who tried to stop my labour, and it did work for a bit, but I was too far gone. On Saturday morning, I ripped through my stitches and delivered Devon. The stitch was removed after she was delivered. She smelled bad, the placenta smelled bad, the waters smelled bad.... everything smelled horrible. They said the membranes were yellowed which indicated a severe infection. A Post Mortem on the placenta (I declined an autopsy on her) showed I had chorioamniotitis. The bacterial strain that caused the infection was just regular old bacterial vaginosis. I needed a D&C 3.5 weeks later to remove massive blod clots and necrotic tissue from my uterus.

People are divided about what happened with her birth. Was it IC? Was it PTL? Was everything going to be okay, but then the infection caused everything to happen? And if the infection was the catalyst, did labour ensue because I am prone to PTL, or because the infection weaked my cervix even more?? No one is sure what the pathway was here, so no one is sure what to diagnose me with.

I got pregnant again, thinking that I had a plan in place. I thought I was going to be getting a Transabdominal Cerclage, and I was told I would be getting P17 shots, as well as my regime of Metformin, Aspirin, Fragmin injections, and Prometrium Suppositories.

Now, there is no plan, and this has me worried.

My OB doesn't really know what to do with me. She sent me to an MFM in Vancouver, and we didn't get along AT ALL. I think, being a 60 yr old man, that he is way behind on his research, and I didn't like how he gave me stock answers without looking anything up. He believes I have a clear cut case of IC. He said he doesn't advise a TAC with a future pregnancy, but rather, a Shirodkar, where they use my own muscle tissue to tie the stitch, to reduce the chance of infection. He won't give me anything to prevent PTL, and he refused to give me a low dose antibiotic in case I just have a constant infection. Basically, he didn't want to do anything for me, besides the Shirodkar. He didn't even believe in my blood thinners and wanted me off them, and he refused me hospital bedrest from 22-24 weeks.

He did put me in touch with the one surgeon in BC who will do a TAC. He hasn't performed one on a pregnant woman in 5 years. He doesn't believe it is advisable in my situation, but he said he would go ahead with it if thats what I wanted to do. I didn't like his over eagerness to do the surgery, and I didn't like the 5 yr span of time since the last one he did (He has only done 12 altogether, and 2 of them failed). I also didn't like that even though he doesn't think I need it, he was still willing to do it. I refuse to let him touch me.

A Dr in New Jersey, George Davis, who is one of the best TAC surgeons in the world, just from a phone conversation with me, thinks it is IC. He thinks a TAC is my only shot at having a good pregnancy. I can't afford him, and I don't have a passport, so I can't get to the States anyways.

I heard of a woman called Jackie Thomas who works out of Mt Sinai in Toronto. She performs the TAC and has done many, very recently, on pregnant women. BC Med will pay for her, so my only expense is the flight. MY OB called her up, and she refused to do a TAC on me, as she believes I don't have IC, but that I suffer from PTL. She said if I have a TAC, and then I still start having contractions around 22 weeks, then with a TAC in place, I can't dilate, so the pressure would build up in my uterus and it would cause a rupture. She said in that situation, my OB would be forced to do a C-Section, and the baby would die as there wouldn't be a shot of saving the baby where I live, as we don't have a NICU for 800km. If she didn't do the C-Section in this situation, I would die, or so Dr Thomas thinks.

She did recommend that my Dr put me on a low dose of Erythromyacin throughout the pregnancy in case I have a low grade, constant infection in my uterus which is causing the PTL. She said if my OB wanted a cerclage for me, then she would recommend the McDonald, Shirodkar or CervicoIsthmic (?) Cerclage.

I feel, at this point, that since I just ripped through a McDonald stitch 4 months ago, that any stitch I have needs to go higher up. So that rules out the McDonald. And since Dr Thomas feels so strongly against the TAC, I guess that rules that out (I actually appreciate that she took a hard line on this, as it makes me feel like she knows what she is talking about, and that she has strong opinions for a reason). That leaves me with the Shirodkar, and the CervicoIsthmic.

No one in BC can place a CervicoIsthmic. As far as we are aware, the only surgeon we can find that can do one is Jackie Thomas in Toronto.

She hasn't answered back since the referral was sent.

The surgeon from Vancouver has been calling me incessantly to try and arrange the TAC, even though I told him I don't want it anymore.

I don't know what to do anymore. I will be 9 weeks on Monday, and all Drs agree that if I get a cerclage placed, it needs to be done by 13 weeks. That doesn't give me much time to figure out which cerclage to do, and it doesn't give me much time to find anyone, especially as we are closing in on the Xmas holidays, and I would need the cerclage no later than the 1st week of January.

I don't know what to do. I don't know which cerclage to go for, and I don't know who will do it.... I am getting very worried, as here I am, the baby is fine so far, and I don't think I can go even 20 weeks without one.

What should I do??

And just so you know, here is my regime right now. Along with my Prenatal Vitamin, I take a baby aspirin 1x a day, Metformin 500mg 2x a day, 250MG of Erythromyacin 1x a day, 100Mg Prometrium Suppository inserted rectally (To avoid all contact with the vagina and decrease the chance of a transmitted infection), 2x a day, and 5000 units of Fragmin, injected 1x a day. I eat half a tub of Activia Yogurt daily to replace the good bacteria killed off by the antibiotic.

My OB did take Dr Thomas's advice on the low dose antibiotic. And I almost have her convinced to give me Nifedipene from 21 weeks on. Nifedipene is a toxolytic which prevents the uterus from contracting. It is one of only 2 toxolytics available in Canada, and it is never given preventatively, although it is quite a common practice to use toxolytics preventatively in the U.S. I think my OB has figured out that the MFM she sent me to in Vancouver might not know everything. So I am working on her, as I think the Nifedipene is also very important in getting my pregnancy to a good gestation.

Right now, the baby is measuring right on track, with a heartrate of 170. I have had one small bleed which may have been attributed to a small sub chorionic hematoma which was found on my first ultrasound, but is no longer visible. I also have a Nabothian Cyst on my cervix, which was a result of my damaged cervix trying to heal itself and accidentally covering the mucous glands with new tissue. This usually isn't serious, but if it grows, it may have to be removed. It is apparently quite common in women who have just delivered.

So there is the situation and what I am dealing with. What do you girls think? I need some ideas on what to do, and as you can see, I am running out of time...



 
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Old Dec 11th, 2010, 15:56 PM   553
HelenGee
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Hi all
Where to start.....
Jen and chad, I am so very saddened by your loss, you have all fought so bravely, it is tragic and unfair and I wish I could change things for you. Our thoughts are with you.

Dmj - I am so sorry for the tragic losses you have suffered, again it is so unfair to have suffered in this way. I am inspired by your courage and resolve to have a successful pregnancy. I truly hope that it will be smooth and perfect for you.

Jen- I understand about not being able to read Grayson's blog. I only realised what happened when I looked on here today. I too cannot bring myself to read it and feel utterly selfish for not checking in. I have been at a loss as to what to do since I heard the terrible news and am grateful to you all for keeping us updated. I also get that discharge - I'll explain more later- but my docs are 99 per cent sure it's coming from my stitch. Please take heart from mich, it sounds like you have a short, but not incompetent cervix and the chances are that it will hold.

Susannah - congrats on 24 and thank you for your kind words. I'm glad all was well at your scan. Like you and lizzie I am becoming increasingly angry at the lack of screening/action by various maternity departments. Is there anyway that we can force different trusts to take note of this thread and realise the suffering their indifference is causing? I have told 2 consultants to look at this thread if they are interested in the human side of this condition.

Mich - the moving around is much the same as you described, I have days where I can shuffle a bit, and days where my body screams at me to lie down. I do get a lot of pressure, so I get off my feet. I have bought a few more things- a nice changing bag as a treat for myself and a carrycot for our pushchair. Fingers crossed that all is ok. I don't know what my cervical length is, I just know that it's still closed.

It's been an eventful week, with a poorly 3 year old and another scary discharge moment. I ended up at the labour ward as I had loads of creamy mucous then a thinner clear dribble. Anyway, my stitch is apparently producing a clear, thin, slightly watery discharge (they are 99 per cent sure it's not amniotic fluid), but I am also getting a White, normal discharge, albeit heavy, and the clear mucous that you described mich, which comes from the cervix and is quite normal according to the consultant. As long as it is sticky and not bloody, then it's ok. Anyway, they monitored the baby and found I was having tightenings so kept me in overnight. I think the contractions were spurred on by my squashed up bowels, as they weren't painful and felt more rectal than abdominal. When I left the ward, the midwife kept insisting that I come straight back if there was any pain etc. She then said "these babies are just ready when they're ready so don't hang around." That worried me a little, like she was trying to say that labour's not far away.

So we all soldier on and keep our legs crossed and hope for the best.



 
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Old Dec 11th, 2010, 16:51 PM   554
MikaylasMummy
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sheri i am so happy u are pregnant again hun i followed ur posts with beautiful devon..i am sorry i am not very knowledgable about stitches i just hope u find the right answer and carry to a safe gestation for bub..i took nifedipine from 20weeks when i had mild contractions and a shortening cervix with funneling and with bed rest and progesterone(no stitch as i had a previa extending into the shortening cervix) and i beleive the nifidepine really helped as i stopped taking it at 34 weeks and at 36 weeks my waters broke and i went into labour..good luck hun glad ur on this thread and looking forward to following ur pregnancy.x



 
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Old Dec 11th, 2010, 17:22 PM   555
lizziedripping
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Sherri81 - I remember you really well from the last IC thread hun, and the nightmare journey you have faced. I am really pushed for time tonight to geive you an in depth answer to your questions a this moment, but didn't just want to leave you stressing.

I will be back to answer more fully when I can sit down properly, but for now just wanted to remind you that I had a shirodkare with the twins and it was fantastic. Tho I haven't had your difficulties in pregnancy, my cervix was incredibley floppy and atonal at 12wks, but the stitch created an overall tension in it and it didn't even begin to funnel until 25wks (by that point I was carrying the same weight as a 32wk singleton pregnancy, so the stitch really did do its job.

My doc insisted I have a shirodkar becuase it was twins, and it is so much stronger and higher up the cervix so theoretically more reliable. My feeling is that you have IC complicated by other factors which may not be as significant in your pregnancies if the IC was eliminated as a complication. Any stitch can be torn thru if you begin to contract, but contracting is as a result of infection, PROM etc and is not a a consequence of having a stitch in place. Invasive TVUs are always kept to a minimum in women like us becuase the risks of infection are so great, so it is possible that this is what triggered labour for you in Devon's pregnancy.

Hope that has helped for now, and I will be in touch again soon hun. Please be assured of the shirodkar's success tho - many women don't have it done because there aren't as many consultants experienced in placing it - it is really quite involved x



 
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Old Dec 12th, 2010, 00:03 AM   556
Sherri81
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Thank you ladies for welcoming me back here. I have to say, I am scared out of my mind right now. I am so waiting for your advice Lizzie, and anyone else!! But Lizzie promised....

Now with your Shirodkar, did they remove your thigh tissue to do the stitch? See, this is the way Dr Marquette, the old male MFM from Vancouver explained it to me. He said that with the Shirodkar, they will start by cutting open my thigh miuscle, and removing tissue which they will use to make the stitches. He said they prefer to do this as the thigh tissue is the strongest tissue in the body, and since it is from my body, it is less prone to becoming infected, since my body won't see it as foreign.

Then he said they will AND PLEASE DON'T READ IF YOU ARE SQUEAMISH!! He said they will cut the walls of the vagina away from the cervix, so that they can access the midway point of my cervix. They will then use my thigh tissue to suture the cervix closed. Then they will release the walls of the vagina so that they settle back onto the cervix, and they will stitch the vagina onto the cervix, once again using my thigh tissue.

He said they are less prone to infection as it is my organic material being used, and also, because the site of the stitch will be covered immediately by my own tissue, therefore it is already more 'closed' off than a traditional TVC.

Now, as it sits for me right now, my cervix is only 3CM. So it appears to me that I will never get more than that, as that is usually my measurement during later weeks in a pregnancy.

So if I am only 3CM long, then a Shirodkar will go 1.5CM up, which puts it about 1CM higher than where my McDonald was. So in theory, it should be able to hold up better...

I am so positive that it was the examinations that caused the infection. This pregnancy, we have a nothing in, nothing out policy. So that is why I am placing the suppository in my back door. That way I am not exposing the bacterial flora to outside bacteria. The fear is that they actually pushed bacteria that just naturally resides on the outside of the vagina and rectum, into my vagina, and into the irritated site of my stitches.

So this time, there will be no Transvaginal scans, and no internal exams either. Although this has only been agreed to by my OB, Dr johnson, and my GP, Dr Craig.

Dr Marquette is... 'stuffier.' He claims I am limiting his ability to care for me by not allowing internal scans and exams. So he is VERY against that. He said if nothing else, he would like to use the transvaginal probe on the outer most extreme of the vagina, and look in that way. I said no to this too. He doesn't like me.

So he was the one who was really advocating for the Shirodkar. I don't know if this means he would be the one to place it. I know my OB doesn't, so I do have to leave town for it. That is where the problem resides... who can do which cerclage, and who will agree to do it for me. I am assuming since the MFM in Toronto performs TACs and CervicoIsthmic's that she would do a Shirodkar as well... but she isn't responding to us anymore.

I really don't feel comfortable with this Dr Marquette doing anything with me quite honestly. I think his training is way out of date, and I don't want someone like that doing anything with me. Especially since he disagrees so much with what my OB is doing. I'm afraid that if I go into his hospital, he won't let me continue any of the regime that I have started for the duration of my stay, which of course would greatly compromise this pregnancy.

He was so against the Antibiotic usage, when a bigger, more prestigous institute has found it to be quite useful. So thankfully, my OB has taken Toronto's advice there. And I do think I am working on her with the Nifedipene. It IS available in Canada, it just isn't used for preventative use. BUT, as an OB, she is more than qualified to prescribe it for me, and I think she might be coming around now, since she came around with the antibiotic. But I did have to agree to go to my hospital everyday for blood pressure monitoring. That is her concern with that. It can lower your blood pressure and cause less blood to cross the placenta. So I said I would stop the instant my blood pressure got too low. So she is hemming and hawing now on that one.

But that still leaves the question of which cerclage do I do, and who will do it for me?

I have to say, I would like to lean more towards the Shirodkar, simply because the surgeon stays further away from the baby, so there is less danger of piercing the gestational sac. And I think my McDonald was holding up good before the infection. So I am kind of leaning towards that one, but I am afraid if I say that one, then it will be Dr Marquette who will do it. So that's why I've pushed for the CervicoIsthmic, simply because I know he can't do it. But, they are working closer to the gestational sac so there is greater risk of rupturing the sac. And that worries me....

I really don't know what to do.

Hey MikaylasMommy, you got any Nifedipene leftover you want to mail to me.... Just kidding. I know I can't solicit on here. But damn, sometimes I wish it was just that easy.... Everyone else seems to get what I need.



 
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Old Dec 12th, 2010, 01:55 AM   557
Vaudha
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I feel very sad about baby Grayson. Ive been reading the blog and can not imagine how painful can it be. heychickie is very brave.



 
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Old Dec 12th, 2010, 08:21 AM   558
lizziedripping
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Chickie - I cannot believe I have only just seen the post about baby Grayson. I am absolutely gutted hun, there are no words that can express how sorry I am, and heartbroken that he fought so hard, but in the end it all got too much for him.

You just don't deserve this pain my love Please take time to heal, and know that your little lamb is now at peace xxxxxxxx



 
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Old Dec 12th, 2010, 08:24 AM   559
lizziedripping
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Sherri - my shirodkar used mercilen tape, which is tough "typewriter -like" ribbon. My vaginal walls were sectioned away from my cervix, and the stitch is sewn through it, my bladder and the walls. It took me several weeks to recover from the op, and I was left feeling physically ill - much more so than from my c-section. I didn't care tho so long as it worked, and it did.

Will post again when kiddies tucked away



 
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Old Dec 12th, 2010, 15:55 PM   560
MikaylasMummy
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sheri..lol would if i could hun but had just enough to last til the day before i was meant to stop (34weeks) and at that stage i was happy to finish a day early as i knew i was pretty safe!my doc prescribed it straight away for me here(australia) as a precautionary.its so strange and scary how so many doctors have different views on your care!glad i had just the one fantastic doc!he said the progesterone supposetries were beginning to be recognised as doing the same job as a stitch and was confident they would help and they did..at the hospital at 20weeks they were very sceptical my pregnancy would make it and treated me like i was losing my baby and gave me the sad faced speach that they were sorry bla bla!how wrong they were!!
oh and i had lots of vaginal scans to check my cervix length and they really dont go in very far at all infact it is inserted JUST into the opening of the vagina and thats all they need to do so maybe that wont push the bacteria in far enough to cause a problem and u can still keep an eye on how ur cervix is?x



 
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