PPROM/Sm Abruption.. what are your docs doing?

niknak1128

Good Morning All.I've posted a couple of times here before but most frequently post on PGAL.  I'm 3 weeks away from my loss point with my last pregnancy and I'm starting to get really nervous and anxious. My previous loss was at 19wks 1 day due to PPROM and small abruption. We still don't know why.

I have had a hysteroscopy which came back totally normal. I had a recurrent loss panel to check for clotting disorders and infection and vascular.. immunological..thrombophilia.. we've checked everything.. as far as I know.  We did not test for MTHFR.  There were no cervical changes that we know of but I only had an u/s at 6wks and again at 19 weeks the day I delivered. 

I'm with MFM now. I'm seen every 2 weeks. My cervix has been measuring 3.9-4.52cm so far. My fluid has looked good. I had a small SCH that seems to be resolved at this point.  (They never actually told me it was a SCH, they said 'area of bleeding' but that's waht it looked like to me).  I get u/s every 2 weeks. I am starting Makena injections at my next appt. at 17 weeks for 20 weeks.  I'm on baby aspirin (just in case), B6/B12/extra folic (because we never tested for MTHFR), and prenatal vitamin. We've talked about cerclage but so far no cervical change.

I am terrifired that my water is just going to break! The logical part of my brain says that I just have to try to keep calm because there's nothing else I can do but I just wondered what others' experiences were. 

hopefuldad

Your course of care is pretty standard for your history, from what I've read/seen.

The only thing I might suggest is that you request to move to weekly cervical length checks via transvaginal ultrasound until week 24 or so. Weeks 16-24 is basically the primary IC danger zone, and waiting 2 weeks can sometimes be too long. For my wife, we had a week 16 scan where she was over 3cm and closed, and then at week 18 she was under 1cm and funneled. If we had had a week 17 scan, we might have been able to catch it sooner. It's probably more monitoring than you really need, but it'll give you peace of mind too.

niknak1128

Thanks! I think I will suggest that.  My last check was 05/24 and they did do transvaginal and measured two ways. First, it measured at 4.52cm and second it measured at 3.9cm. But my next appt. isn't until week 17 on 06/04.  I'm not see at all this week.  And after that my next appt. isn't until 06/18.  I think I'm going to ask to be seen the week of 06/11 which would be weekly and honestly they told me they were going to do that since I"m inching closer to the 19week point when my loss occurred and they didn't.

I haven't been diagnosed with IC but we don't really know. My MFM suspects that my cervix changed and wasn't caught before but we don't know for sure. All I know is that I am terrified and nervous pretty much every day.

hopefuldad

Your story sounds a bit like my wife's--in her first pregnancy, she had unexplained PPROM around 16+6/17. She didn't have an abruption but there was a decent sized clot in her placenta when they did the labwork. Going into our current pregnancy they didn't think it was IC (they thought maybe it was a subclinical infection), but it did turn out to be IC. I wish we had known more about IC when all that happened and had been pushing for more vigilant monitoring.

I wish I could say that the nervousness and anxiety would go away soon, but I think it's just part of the game for someone who is pregnant with IC risks. For us, I guess it finally got a little easier around viability, and then even easier to handle around week 27-28. My wife also did some counseling with a psychiatrist from week 19-24, but a lot of that was due to the extra stress and anxiety from our Delayed Interval Delivery situation.

kknapik

So sorry to hear of your loss. I have to agree with PP about the weekly cervix checks. I have been going weekly since 16 weeks and even with the frequent visits, we still had quite the scare. My cervix on a Thursday morning was 2.5cm (which it had been hovering around for a while, then on Sunday evening I started having contractions (which I thought was food poisoning) every 5-7 minutes and was rushed from my local hospital by ambulance to a medical center an hour away as I was only 23 weeks. Luckily the Magnesium and Indocin stopped the contractions but they found that my cervix had shortened to 1cm in just three days. With a previous loss with an unknown cause I would definitely tell them that you want to be monitored more closely.

GL!!!

june10-06

It sounds like we have really similar stories. I had unexplained PPROM at 21 weeks and we did all the same tests you mentioned with everything coming back normal. I did have bleeding during that pg from weeks 7-12, which is what they think weakened the membrane but we don't know for sure. Now I'm 17 weeks & having weekly cervical checks & progesterone shots & baby aspirin. My doc was going to have checks every 2 weeks but changed to every week bc I had a d&c in Jan for fibroids & they dilated my cervix. It sounds like you could ask to be checked weekly which could ease your mind. It usually calms me down for a day or 2! Hang in there...I think it'll be easier after we pass our loss milestone & v-day. I can't really relax or plan for the baby right now. Good luck!

stillwaiting12

On top of my cerclage I get weekly 17P injects, daily crinone ( vaginal progesterone gel) and my MFM also gave me a script for azithromiacin antibiotics 3 days per month. He said the hope with the antibiotic is it would ward off any inflammation or unknown infections that could cause unnoticed contractions. Best of luck to you. I'm coming up on my last loss milestone in 2 days and it's extremely nerve wracking.