11 Weeks, 1 Day

Maternal Fetal Medicine

I met with Dr. B. today for what was a very informative meeting. I really like his manner of speaking. He has a very difficult job, one that I would not want, but am sure glad we are blessed with people like him on this planet.

We discussed a relatively new type of therapy for preterm labor. It's called 17-P. When he started talking about the injection, I became excited and hopeful. There were studies showing a decrease in preterm labor and delivery with 17-P injection therapy. But I knew there would be the other side of the coin. I listened carefully and then learned that the FDA has yet to approve 17-P. This blurb from Wikipedia explains and sums up the risks involved.

The application of 17OHP has been shown to be useful to delay premature labor in pregnancy.

The use of 17-hydroxyprogesterone caproate in pregnancy to prevent preterm birth is not recommended without further study according to two authorities.

A 2006 Cochrane Review concluded "...important maternal and infant outcomes have been poorly reported to date... information regarding the potential harms of progesterone therapy to prevent preterm birth is limited" There was a similar conclusion from a review by Marc Keirse. Three clinical studies of 250mg/week of i.m. 17-hydroxyprogesterone caproate have all shown a trend for an increase in pregnancy loss due to miscarriage compared to placebo.

A meta-analysis by Keirse showed a trend for an increase in miscarriage with 17-hydroxyprogesterone caproate compared to placebo.

There has also been a study in rhesus monkeys where all rhesus fetuses exposed to 1 and 10 times the human dose equivalent of 17-hydroxyprogesterone caproate died in utero. Currently (2006), 17-hydroxyprogesterone caproate is a category D progestin according to the FDA (evidence of fetal harm). There is speculation that the castor oil in the 17-hydroxyprogesterone caproate formulation may not be beneficial for pregnancy.

So, while it's wonderful to know we're on the brink of helping prevent preterm labor and delivery, I am not ready at this time to deal with the risks of 17-P.

We discussed his opinion of my chances of another preterm delivery and he put me at 16-23% based on my history and medical records. This is good news because I truly thought the chances were much, much higher.

We discussed stress management, both physically and mentally. This is something we've been working on at home for the last few months. One small example of something we can control is having Jason take the dirty laundry downstairs. That saves me strain of carrying the HUGE, OVERFLOWING basket...also, Jack is taking the bus to school now which cuts out a lot of carrying and lifting...although I do still carry him on the bus and into his seat. We talked about lifting properly and not bearing down or straining when lifting...rather, use my legs. I am sure I could even ask Jack's physical therapist on some ways to help ease the strain while lifting and carrying our ever growing little man! As for the mental stress I am taking it as easy as possible. Stress is NOT good for the baby. In fact, stress hormones are directly related to premature labor! I am trying really hard to relax.

I go back in 4 weeks' time which by then I will be 15 weeks pregnant! We will do the quad screening (genetics) at this time and also an ultrasound.

We will start measuring my cervix and tracking any changes at 18 weeks. I believe he mentioned this would be done weekly for several weeks.

We discussed the need for a repeat c-section due to the fact that Jack was taken via a classical incision which an up and down cut on the uterus. This is less stable and can lead to uterine rupture if the pregnancy goes all the way to 40 weeks. This could be fatal for me and the baby. So we'll do a fetal lung maturity test beginning at 37 weeks and as soon as the lungs are ready we'll schedule the section.

I really feel I am getting good care. It helps to ease my mind and I am doing a good job of enjoying being pregnant! We are very excited and happy. And YES as soon as they can tell I WILL know what we're having!!!!