Intro questions about IC and p17

Amber&Reva

I normally post in LGBT parenting but am hoping you all can answer some questions I have. I recently PPROMed at 18w3d and delivered at 19w.  The delivering midwife was so sure that I didn't have an IC but when I met with the MFM she said basically the other reasons for PPROM were so rare so I must have an IC and would be treated accordingly next pregnancy.  That said I may look for a new MFM for a second opinion.  I have some questions.

What have you noticed to be side effects of p17 shots on both mother and baby?

Did your doctors recommend putting in a preventative cervical stich early on or not until changes where noticed in your cervix?

Did anyone PPROM and have recommendations other then p17 shots and a cervical stich?

What are the chances of being put on bed rest related to IC and getting a cervical stich?

Thank you in advance for any insight you can give me.  I am so confused try to do research online but am not finding any useful links.  I am constantly bouncing ideas off my dp but she knows just what the MFM told us and is so convinced that the chances of the same thing happening twice is so slim.

ajsweeton

I had PPROM at 22w5d with twins. This pregnancy I just had a cerclage placed at 14w preventatively. They monitored my cervix biweekly from 14-28w. There were no changes so I had no bedrest. I'm now almost 34w and still have had no BR. I haven't done the p17 shot either.

Wally3

Hi. I delivered ds1 at 34w due to pprom. I had p17 shots with ds2. No side effects except for itchy sore bum. I was put on modified bed rest with ds2 from 32 - 36w due to contractions. No significant change to my cervix. Was induced at 39w due to high af. Ds2 was healthy.

Mrs_D_in_KY

I have no advice on the IC or cerclage. But I have been on p17 shots since week 20 and I am currently 28 weeks. I get them weekly and no side effects except for a sore bum the first few days. Sometimes the injection site is itchy. Using a heating pad usually helps take the soreness away.

I get them more to keep my irritable uterus calm so I don't start dilating too early.

Amber&Reva

Thank you for your responses.  Do any of you know if there is a way to diagnose IC that isn't just noticing changes in your cervix once you are already pregnant?

ThereBeDragons

PPRoM due to combined IC and PTL @ 17weeks last pregnancy. This pregnancy I wasn't gotten in for a cerclage/ptl/high risk evaluation until 17 weeks due to insurance snafu- had the docs been choosing I would have been evaluated before 16weeks. Anyway, at 17weeks this pregnancy, my cervix was measuring 1.4cm (1.0 3 days later when my cerclage was placed) so I was given a variety of options. 

Due to the short cervical measurement, I was offered a choice between cerclage or suppository for progesterone. Due to the history of ptl, I was also given the option for p17. My MFM recommended p17 and left the decision on the cerclage up to me. OB recommended cerclage so I went with cerclage and p17. 

P17 side effects: none for baby. Mild sleepiness for me. They can leave a sore spot, but it's really nothing worth fussing over. 

Cerclage: I am an excellent candidate for an early preventative cerclage. Due to insurance snafu, I was not evaluated for one until I had already funneled significantly. Mine was not considered a rescue cerclage as I had not begun to dilate, but it was also less effective than an early preventative stitch placed while the cervix is still measuring long. Because of the late placement, I have been on bedrest for 10weeks and will stay on bedrest until at least 36weeks. I

 highly recommend getting an early placement if your doctor is agreeable- most women with an early placement have some restrictions (no heavy lifting, maybe pelvic rest) but don't need flat out bed rest unless thier stitch begins to fail. Coming from someone looking at 3 months of being bed bound- I wish I had had the option for an earlier cerclage- bed rest sucks.

That said, I was unwilling to take a chance with this baby and do nothing. She is our last chance. When the MFM strongly suggested that a cerclage might only delay the inevitable (birth before viability or a fragile micro preemie) I didn't find that to be a reasonable reason to skip the stitch. I wanted to give this child the best chance possible to survive. And so far we have beaten all of the odds. First she made it to viability in February, then we made it to March and better chance of survival without complications, and on Monday we will have made it to April... And now the MFM and OB are feeling confident that I can make it to 36+weeks and maybe take baby home without a nicu stay. There are great success stories- I hope to be one of them!

MinaE01

I'm sorry for your recent loss. I delivered DS at 32w3d due to PTL and PPROM. They do not believe that it was due to IC, but this pregnancy, my cervix has been monitored closely. That's the only way to diagnose IC - to monitor and catch it early. My cervix has held strong up until this past week when it was discovered that I dilated to a 1. At this point (33w), it is not indicative of IC.

I am on the p17 shots (only 3 more to go!). They make my butt sore and itchy for several days, but that's about it.

I recommend you have a pre-conception consultation with your MFM (or chose a new one) to share your concerns and work out a plan for when you do get pregnant. This should help ease your mind.

sexyntexy

I was diagnosed with IC at 30 weeks w/ DS1. I was too far along for a cerclage and was put on BR until 36.5 weeks and I went to 39 weeks.

With DS2 they noticed I had a short cervix at my NT scan (13w) so I got a
Preventative cerclage at 14w. I didn't get any p17 shots nor BR. I have taken it VERY easy this pregnancy. I'm currently 36w3d and get my cerclage removed on Thursday.

Amber&Reva

Thank you everyone for all the information.   It is a lot to take in between a loss and then being told I most likely had an IC from the MFM and subsequent pregnancies would be treated as if I do.  It is confusing just because the midwife said there was no way I have IC yet the MFM said other reasons for PPROM were so rare that I must have an IC and then treating  me for something I may not have is overwhelming.  Not to mention that I read somewhere that getting a cervical stich can increase chances of infection which is the other reason people PPROM who don't have IC. 

I do plan to sit down with another MFM prior to trying again just to see if he would suggest the same approach that the MFM I already met with suggested.

ThereBeDragons

Trust the MFM over a midwife. I know both have the absolute best intentions for you, but the MFM only handles high risk cases and a midwife may see one or two high risk cases a year. I'm not saying you need to replace your midwife or anything, just give the MFM credit for advice that is specific to his speciality.

The earlier a cerclage is placed, the less risk of infection there is. 

The odds of introducing an infection when the cervix is not funneled and closed tight are actually minimal- less of a risk than engaging in sex actually- unless you routinely scrub down your partner with antiseptic before hand. The real risk comes when you've funneled down or have an open cervix and the natural barrier of the mucus plug is severely compromised. That's when the doc will put you on pelvic rest (nothing goes in the vagina) and start talking about infection risks.

In a random aside- my MFM did not recommend my cerclage initially. He felt the risk of trapping an already present infection in (I showed signs of amniotic "sludge" which can be, but is not always, a sign of infection in the fluid) were high enough to compromise my own safety for minimal advantage for the baby. I was willing to take that risk and my OB felt it was a good gamble too. Today, at my 32 week appointment, instead of talking about how difficult a future pregnancy might be, my MFM recommended a cerclage at 12 weeks, more p17, and strongly suggested that with those two interventions (no bed rest!) I could expect to carry a future baby to full term. 

Risks are evaluated at the time of placement. The earlier you have the intervention- the less risk you face.

Amber&Reva

Next time I go in I'll ask if there is any disadvantage to getting a cerclage put in before any changes start to happen in my cervix even if there is a chance that IC isn't the issue.  It just seems like cervical changes can happen so quickly that even with close monitoring something can be missed.  I would rather do everything I can to keep my future little one inside of me as long as possible.