Mommy's Angel
Mommy to Angelboy 10/22/9
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Well, today's Dr.'s appointment didn't go as planned. ((sigh))
After ALOT of waiting, I found out that my origional perinatologist wasn't there when she was supposed to be. Instead, I got one of the OB's from my prior pregnancy (which I wasn't all to happy to have).
I spent much of the time answering questionnaire forms and some were just OUT THERE pertaining to content matter. After that I waited some more which led to a nice long conversation with the very nice midwife there. She DID irritate me a little with a comment about getting past the issues with the hospital in order to have a clean slate this time. I shared with her that with the many areas of negligence, it's hard to move past this issue if you cannot trust the medical staff that are supposed to care for you.
She also mentioned letting go of what happened with my last pregnancy which I agree with myself. I let her know that this too is another issue that will be difficult to just move past because there's the first trimester milestone to pass and then the most important for me is the 22wk milestone.
We moved past that and said our goodbyes and FINALLY the Dr. came in. ((keep in mind my appointment was 1045pm and we left at 230pm))
ABOUT THE CERCLAGE ISSUE:
I told him I had some concerns from my last consult with my origional Dr. that I needed to have answers to. First was a simple one of finding out which compound pharmacy for the 17P injection I'll be taking later on. The next being that I wasn't at all comfortable with a "wait and see" attitude for a cerclage for what I believe to be a classic case of Incompetant Cervix.
Looking at the records, he said that what was written was that I had contractions at the hospital at 22wks and was found to be 3cm dialated BUT two days before, the sonogram showed 4.7 cm's. According to him, this is basically signs of preterm labor and NOT the signs of cervical insufficiency which is why they are prescribing 17p injections to quiet the uterine muscle.
They are also keeping an eye on bacterial vaginosis and prescribing antibiotics as needed.
I told him I felt I needed a cerclage between 13 or 14 weeks and he actually said the risk was HIGHER for any kind of a cerclage but a prophylactic cerclage came with it's risks and said that if early prophylactic cerclages came with little risk, then all Dr.'s would be using "preventative cerclages". He said there were no specific studies that proved preventative cerclages worked. Risks he mentioned for preventative cerclage is the proximity to the bladder and rectum and risk of puncturing either with the needle because there's LESS room than when the cerclage would be done between wks 16 & 20. Risk of infection...he said there's NO PROOF of reduction of infection or miscarriage with preventative prophylactic cerclage. He also mentions that with a preventative cerclage I could STILL go into labor preterm and have ALOT more pain as the sutures strain and possibly tear.
He kept saying "You've GOTTA have RESPECT for cerclages, for they have their RISKS".
In addition to preventative or prophylactic cerclages he mentioned two other times of cerclaging. One was emergent cerclages done between 16 and 20 wks in which he would measure the cervix every two weeks and are done when the cervix is less than 2cm's THIS is the type that he performs and teaches residents to do.
The other type is a Rescue Cerclage which is done by some when the cervix is nearly gone altogether and close to ripening. He says he Doesn't perform Rescue Cerclages and mentioned there is BETTER outcome with bedrest and 17p injections in this situation.
He said that he would NOT perform the cerclage surgery on someone HE didn't think needed it.
Can anybody think of studies done in opposition of what he was saying? In proof against I guess I would ask, because he said all the studies backed HIM up.
My husband wants to do more research on this, does anyone have websites with concrete information for him to research??
Also, since this Dr. says he's POSITIVE that what I have is PTL because there wouldn't have been ANY contractions even that one night and we STILL would have been dialated. There would have been steady decrease in length of cervix. I'm wondering if there are any links to some concrete research that will help me understand PTL and if what I really had was that OR the IC which I STILL think I had.
Any feedback would greatly be appreciated by you all. I'm at a frustrating point. We're going for the second opinion two hours away at a reputable hospital BUT, What if this group says the same thing?!
I left the building feeling that if I have the stupid cerclage early, my baby would surely die from complications....YET, If I make the decision to "Wait and see" at 16 to 20 weeks like he says, I could surely have ANOTHER second trimester loss. Either way, I feel as though I'm choosing a path to my babies death sentence and am SO AFRAID to get attatched for fear I'll lose this one too.
I'm not really understanding this, if it were THAT bad why are there so many of you with early cerclages?? Why is he saying that it's actually RARE to see prophylactic cerclages?!
After ALOT of waiting, I found out that my origional perinatologist wasn't there when she was supposed to be. Instead, I got one of the OB's from my prior pregnancy (which I wasn't all to happy to have).
I spent much of the time answering questionnaire forms and some were just OUT THERE pertaining to content matter. After that I waited some more which led to a nice long conversation with the very nice midwife there. She DID irritate me a little with a comment about getting past the issues with the hospital in order to have a clean slate this time. I shared with her that with the many areas of negligence, it's hard to move past this issue if you cannot trust the medical staff that are supposed to care for you.
She also mentioned letting go of what happened with my last pregnancy which I agree with myself. I let her know that this too is another issue that will be difficult to just move past because there's the first trimester milestone to pass and then the most important for me is the 22wk milestone.
We moved past that and said our goodbyes and FINALLY the Dr. came in. ((keep in mind my appointment was 1045pm and we left at 230pm))
ABOUT THE CERCLAGE ISSUE:
I told him I had some concerns from my last consult with my origional Dr. that I needed to have answers to. First was a simple one of finding out which compound pharmacy for the 17P injection I'll be taking later on. The next being that I wasn't at all comfortable with a "wait and see" attitude for a cerclage for what I believe to be a classic case of Incompetant Cervix.
Looking at the records, he said that what was written was that I had contractions at the hospital at 22wks and was found to be 3cm dialated BUT two days before, the sonogram showed 4.7 cm's. According to him, this is basically signs of preterm labor and NOT the signs of cervical insufficiency which is why they are prescribing 17p injections to quiet the uterine muscle.
They are also keeping an eye on bacterial vaginosis and prescribing antibiotics as needed.
I told him I felt I needed a cerclage between 13 or 14 weeks and he actually said the risk was HIGHER for any kind of a cerclage but a prophylactic cerclage came with it's risks and said that if early prophylactic cerclages came with little risk, then all Dr.'s would be using "preventative cerclages". He said there were no specific studies that proved preventative cerclages worked. Risks he mentioned for preventative cerclage is the proximity to the bladder and rectum and risk of puncturing either with the needle because there's LESS room than when the cerclage would be done between wks 16 & 20. Risk of infection...he said there's NO PROOF of reduction of infection or miscarriage with preventative prophylactic cerclage. He also mentions that with a preventative cerclage I could STILL go into labor preterm and have ALOT more pain as the sutures strain and possibly tear.
He kept saying "You've GOTTA have RESPECT for cerclages, for they have their RISKS".
In addition to preventative or prophylactic cerclages he mentioned two other times of cerclaging. One was emergent cerclages done between 16 and 20 wks in which he would measure the cervix every two weeks and are done when the cervix is less than 2cm's THIS is the type that he performs and teaches residents to do.
The other type is a Rescue Cerclage which is done by some when the cervix is nearly gone altogether and close to ripening. He says he Doesn't perform Rescue Cerclages and mentioned there is BETTER outcome with bedrest and 17p injections in this situation.
He said that he would NOT perform the cerclage surgery on someone HE didn't think needed it.
Can anybody think of studies done in opposition of what he was saying? In proof against I guess I would ask, because he said all the studies backed HIM up.
My husband wants to do more research on this, does anyone have websites with concrete information for him to research??
Also, since this Dr. says he's POSITIVE that what I have is PTL because there wouldn't have been ANY contractions even that one night and we STILL would have been dialated. There would have been steady decrease in length of cervix. I'm wondering if there are any links to some concrete research that will help me understand PTL and if what I really had was that OR the IC which I STILL think I had.
Any feedback would greatly be appreciated by you all. I'm at a frustrating point. We're going for the second opinion two hours away at a reputable hospital BUT, What if this group says the same thing?!
I left the building feeling that if I have the stupid cerclage early, my baby would surely die from complications....YET, If I make the decision to "Wait and see" at 16 to 20 weeks like he says, I could surely have ANOTHER second trimester loss. Either way, I feel as though I'm choosing a path to my babies death sentence and am SO AFRAID to get attatched for fear I'll lose this one too.
I'm not really understanding this, if it were THAT bad why are there so many of you with early cerclages?? Why is he saying that it's actually RARE to see prophylactic cerclages?!
Unless there is some factor known only to these clinicians, I cannot understand why they would say stitching now is more risky than waiting. It is not rare to have proph stitches placed, but there are still many practitioners who are reluctant to do so unless the IC diagnosis is absolute (which it never can be). 
I'll be cheering with you when you finally pass that wk.
