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Old 08-13-2006, 02:18 PM   #1
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Question Preterm Labor????

I'm 23 weeks with twins and when I woke up yesterday, I felt as though the babies were lower and some pelvic pressure (no pain). I eventually went to the hospital and it turned out that I was having some contractions. They kept me in the hospital overnight. My cervix was 45% effaced. They let me go. I never even felt the contractions.

My question is, what does being 45% effaced mean? is it bad to be like that at 23 weeks? the doctor didn't say it was a problem.

Also, now I'm paranoid and think that I have pelvic pressure but am not sure. Has this happened to anyone? what kind pelivc pressure means preterm labor?? it could just be my stomach is bigger and heavier

Any advice would be appreciated!

 
Old 08-13-2006, 03:21 PM   #2
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Re: Preterm Labor????

Effaced means thinning out. So your cervix is 45% thinned out getting ready for birth. I don't know what it means in terms of pre-termed labor or exactly when your cervix is suppose to efface. Did the doctor say that you were dialated at all?

 
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Old 08-13-2006, 03:33 PM   #3
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Re: Preterm Labor????

Hi Nancy,

Bless your heart! How scary!!

When your cervix effaces, that means it is thinning and your body is getting ready for the babies to be born. 45% means the cervix is almost 1/2 way ready. This should not happen for about 13 to 17 more weeks if you're 23 weeks. Were you told to stay in bed and not to lift anything heavier than a sandwich? No sex? Was your doctor called? What did your doctor say? I am not a doctor, but am astonished that you were sent home.

You need another 4 weeks mimimum (11 weeks is better) for your twins to have a healthy life if born and even at that stage, the babies might benefit from your having 2 BetaMethazone shots to mature their little lungs. I was given this medicine in 2 shots, given 24 hours apart, before my younger son was born at about 27 weeks. Because of that medicine, he never had any respiratory distress and never needed a breathing tube.

Since you have questions, do call your doctor tomorrow and find out just what you need to do or not do to give your babies the best chance at life.

Wishing you well - Barbara

Last edited by BarbaraH; 08-13-2006 at 03:34 PM.

 
Old 08-14-2006, 01:53 PM   #4
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Re: Preterm Labor????

My doctor was the one at the emergency room. I wasn't dialated at all and my cervix was way high/posterior. He said the exam was not concerning to him. I saw him again today for a normal visit and told him nothing really has changed since then.

I still seem to feel tightening of the uterus but it is very mild. It doesn't seem like I should rush to the hospital everyday due to this mild tightening, otherwise, I might live there. I'm not sure that this is even a contraction. It happens periodically, except it does stop when I lay on my side (either that or I just can't feel the tightening when I'm on my side).

Does anyone know what I should do about this very mild tightening???? it's really no different than when they released me from the hospital.

 
Old 08-14-2006, 02:33 PM   #5
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Re: Preterm Labor????

Hi there, I know this is scary for you, and I don't want to scare you even more...and I'm SURE your doctor would have taken action if he thought there was a problem, however...

I know two seperate people who have gone into early labor due to incompetent cervix. One was at 22 weeks with twins - who didn't make it and one was at 28 weeks with a singleton who did just fine.

The one with the twins was having spotting and contractions and kept going in and kept getting sent home. She really feels like if the condition had been diagnosed that the babies might have been carried to point where they could have made it.

I am not a doctor...so I don't know the signs and symptoms of incompetent cervix, but I would call him and at least ask him what his thoughts are, so maybe he can put your mind at ease.

-Diana

 
Old 08-14-2006, 05:15 PM   #6
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Re: Preterm Labor????

I don't think I have an answer for the question here.

However, I am in a similar situation where I had contractions at week 23 and was put on Ibuprofen 600mg for 7 days. I am 25 weeks. The cramping contractions have stopped.

But I still have those tightenings that Nancy mentions, I am hardly even able to make out if these are contractions. It is more pronounced when I am at home and lying/resting. However, when at work I fail to notice. How serioulsy should one take these tightenings of the uterus? Is this normal BH okay if they are not more than 4 per hour? Sometimes they are painless and may go unnoticed even if they are more than 4 an hour. This is my concern.

however, my doctor wants to check the length of my cervix weekly if possible and also the amniotic fluid around the baby as I am taking Ibuprofen (Ibuprofen seems to have an adverse impact on the fluid if taken excessively).

This really unsettling and doctors haven't given me a convincing reply so far. If anyone could share their experience it would be great.

Good luck!

 
Old 08-15-2006, 12:04 PM   #7
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Re: Preterm Labor????

What are the signs of incompetent cervix? I had an internal exam at around 20 weeks and my cervix was thick. Does that mean that the effacing is unrelated to an incompetent cervix?

Any advice would be so helpful as I am worried and don't know what to do..

 
Old 08-15-2006, 11:21 PM   #8
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Re: Preterm Labor????

"Cervical incompetence is basically a cervix that is too weak to stay closed during a pregnancy. Therefore resulting in a preterm birth and possibly the loss of the baby, because of the shortened gestational length. It is believed that cervical incompetence is the cause of 20 - 25 % of all second trimester losses. This incompetence generally shows up in the early part of the second trimester, but possibly as late as the early third trimester.
It is generally categorized as premature opening of the cervix without labor or contractions. Diagnosis can be made either manually or with ultrasonography. The use of ultrasonography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm."

I am not a doctor, but I would say PLEASE, PLEASE, PLEASE talk to your doctor about this! Just call him and put "incompetent cervix" on his radar. The worst that can happen is the he can reassure you that this is not what is happening! ANd that is great! It seems like the fact that your cervix is still closed is a good thing, but if you are effacing already, I would be so concerned!!!

If the diagnosis can be made they can do what is called a circlage, where they stitch your cervix closed and you have the baby by C-Section. My friend who lost the twins at 22 weeks has had three more children, and because they know she has incompetent cervix, she went in each time at 14 weeks to get a circlage, and she has had three healthy babies by C-Section.

But if they had been able to diagnose it maybe her twins could have made it at least a few more weeks. But I think she had never even heard of it before, and she just trusted that her docotrs were doing the right thing by sending her home (even though she had the gut feeling that they weren't). She is still trying to heal from the loss of her twins.

PLEASE CALL YOUR DOCTOR and talk to him about this specific condition!

-Diana

 
Old 08-16-2006, 05:58 AM   #9
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Re: Preterm Labor????

I agree -- talk to your doctor about having a cerclage done. If the cervix effaces much more, it won't be possible anymore, and then you'll probably be on bed rest. Some doctors will only do a cerclage once a woman has already lost a baby due to incompetent cervix, but some are willing ot do one just in case when the cervix begins to ripen early.

And having a cerclage done doesn't mean you have to deliver by C-section. Depending on other risks, the doctor can easily remove the stitches holding the cervix closed at 37 weeks, and then see if you dilate normally.

 
Old 08-16-2006, 11:24 AM   #10
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Re: Preterm Labor????

Thanks so much for the advice.

I did ask about the effacing and he told me that he wasn't concerned about the exam at all b/c my cervix was so high. He never mentioned incompetent cervix. The nurse said it wasn't unusal to have effacing like mine with twins. My doctor told me that bed rest wouldn't do anything but that I should not overdue things and get rest.

I have an ultrasound next week. Would that show if I had an incompetent cervix or more effacing????

 
Old 08-16-2006, 08:42 PM   #11
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Re: Preterm Labor????

Hi!

Like Barbara said, your cervix is what seems quickly, preparing for birth. Please try to convince your doctor to tell you more about this situation. Being pregnant is a wonderful thing, and to carry your babies as long as you can (considering most twins are born pre-mature) would be wonderful. Do whatever it takes, bed rest, hospitalization, specialist, to keep these babies inside! They're not ready for the world yet, and if your body is, sacrifice all that you have for them. You'll thank yourself, (and they'll thank you) later!

Good luck to you and your babies!

Abigail

 
Old 08-17-2006, 05:52 AM   #12
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Re: Preterm Labor????

It's not quite accurate to say that most twins are born premature. When they say that full-term for twins is two weeks or so earlier than for singletons, it's not just because twins tend to be born that much earlier, but rather because twins who stay in the womb until 40 weeks suffer the same problems that singletons who stay in the womb to 42 weeks suffer -- increased rates of stillbirth, decreased heart rate, deterioration of the placenta, etc. So if twins are born at 37 weeks, that's not just "okay," it's actually much better than if they were born at 40 weeks.

 
Old 08-17-2006, 06:44 AM   #13
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Re: Preterm Labor????

They will probably do a transvaginal u/s in addition to the abdominal one so that they can measure your cervical length. Because that part of your anatomy is so far down into your pelvis it can be difficult to see on an abdominal u/s alone.

I get a transvaginal u/s every 2 weeks to have my cervix checked (due to a large fibroid that could be growing and pushing the baby out). For me this started at 18 weeks and I'm now 24w6d.

If you've never had a transvaginal u/s it's no big deal... there is a wand attached to the u/s machine. They put a large sheath on it (ok, I guess they use the term sheath instead of condom, but that's what it is) and then spread gel on it. They insert it vaginally and move it around to get the best angle. It doesn't hurt, and if you weren't in stirrups and under fluorescent lights it could even be fun -- ha! There is a "slime factor" from all the gel that you have to clean up before you get dressed, but it's no different than when you get a manual exam from the doctor.

Good luck!

 
Old 08-17-2006, 04:16 PM   #14
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Re: Preterm Labor????

my contractions seemed to have stopped....I rest in bed a lot now. I think I'll ask about incompetent cervix at my next visit. 1.5 weeks from now. I think they only do abominal u/s on me...my doctor won't be at this ultrasound.
I appreciate everyone's advice.....I'll definitely reduce my activity until my next visit.

 
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