Stopping P17 shots early? (kinda long)

elizabethnseanny · January 2013

I just wanted thoughts on this...

Background is I've had two pregnancies with preterm labor at 29 weeks, resulting in 35 and 37 weekers. Treatment was tributiline and bed rest and then bedrest only. My history is lots of contractions by 25 weeks or so, and dilation. This time I opted for the offered treatment of P17 injections at 18 weeks, primarily because bedrest was not an option with my job. At 25 weeks I was checked because of contractions, no dilation. We decided to do restricted activity and no more checks. The shots themselves, which are to help relax the uterus, haven't seemed to decrease my contractions any. I just try not to walk around much, no sex or exercise.

All this background because I just found out my office has been charging me every week for this injection, on top of the fact that I bring it in. I guess it is not covered under my global maternity copay. Plus I hate Thursdays, all because I have to mentally prepare myself for the injection, I really hate needles and it causes significant soreness the next three days. So...I'm thinking about tossing the last 3 doses...I've already paid for the vial, but at least I wouldn't have the visit or the extra payment to worry about. They just don't seem to be helping anyway.I would never increase my risk of a preterm delivery on purpose. I just feel it is the amount of activity that controls my contractions and dilation, not this drug.

Thanks for reading!

caden1206 · January 2013

I think you need to talk to your physician about your concerns and possibly seek a second opinion before stopping them. This is coming from someone that declined the 17p shots all together. I didnt come to that decision lightly and confered with my OB and my MFM. The reasons I declined the 17p are only specific to my case with MD's approval and also my personal preference. Good luck and prayers you come to a conclusion that is best for you.

elizabethnseanny · January 2013

Thank you for your kind words. Although everyone's treatment is specific to their case, I'm sure sometimes it applies to others care as well. Sharing your reasons would help me, it's why we post on public boards, but that is entirely up to you to share.

I also wanted to decline them from the beginning, and was not made to feel like I needed my OB's "approval" but based on my research I couldn't find a reason not to (besides cost and anxiety) in order to prevent delivering so early. At this point in my pregnancy that risk is not so high, and the circumstances are different.

caden1206 · January 2013

First, I never wanted to take the medication because the follow-up studies are not really done. I know that all the follow up studies that are available say that babies of mothers that took the medication are not experiencing any side effects. I personally would like to wait and give it more time for follow up studies when those involved in the study are a little older. Second, my MFM told me the original study was terminated early and standard of care with 17p shots was basically derived from one study that wasn't even finished. I am not the scientist here, but I kind of wanted more info and security that it really works because of my first reason above. Third, they think I have an incompetent cervix and these shots won't help me if that is truly the case. I did get a preventative cerclage. And last I asked if I did go into PTL would we be using this medication to help me out. Both doctors said no. From what it sounds like from both doctors they support the use of the medication, but with what they presume my condition is the cerclage is the best thing for me. I pray every day that I did not make the wrong decision.

I am currently only 16 days in this pregnancy from when I had my son at 25 weeks 5 days. Leading up to his birth I had a lot of painless contractions for weeks. With this pregnancy I have not had any of that. Sometimes I get scared that I am experiencing contractions, but have recently just determined my baby is shifting. I think that this pregnancy is already very different from the last one. I don't know whether to contribute that to luck or the cerclage.

It sounds like you only have five more shots. I know they are a pain and hopefully you don't experience too many issues if you continue them. Good luck.

futuremrssmith7 · January 2013

IMHO, If you only have a few shots left, I would continue them. I just started mine today and while we had conflict with coverage. I feel much better knowing that I am doing all I can to help prevent a pre-term delivery with this one. We're not sure how well it will work as I did not start having contractions until after I had already dilated to 3-4cm at 32 weeks - so we are having close monitoring along with the injections.

If you do decide to stop the injections - you must be able to live with that decision. Chances are that everything will be fine - however, if something were to go awry, I would feel absolutely guilty knowing that I could have done more to prevent PTL. You mention that bedrest is not an option for you with your job - you must factor this in as well. From what I've seen most women go into labor anywhere from 1-5 weeks after stopping injections - you could end up on bedrest or with pre-term delivery and a nicu stay for LO. As PP mentioned, I would discuss the issue with your doctor to make sure you are fully prepared to make the decision to stop or continue injections. Good luck.

fbf2006 · January 2013

I personally wouldn't stop it. You only have 5 left, right?

htaylor516 · January 2013

I wouldn't stop taking the shot either without dialogue with your doctor first. I started taking the shots at 18 weeks. My first shot was done in the office where they taught my husband how to administer it so he can do it at home. It's not quite as gentle as when the nurse did it, but it is definitely more convenient. Maybe that's an option for you, or perhaps you have a friend or neighbor that's a nurse who could do it for you so you don't have to go to the office?

mommatotwo2 · January 2013

I wouldn't just stop them without talking to the OB, if only to make sure that you won't push yourself into pre-term labor with your body being used to such a high amount of progesterone and then abruptly stopping it. I could be way off base, I'm no doctor, but I'd want to double check.

A google search says that a 30 weeker has a 95% chance of survival. That's pretty good odds, so I can see why you feel more safe at this point and the pain and cost of the shots does not sound like a nice thing to deal with, so I truly see where you are coming from.

I was also asked by my OB to consider the progesterone shots and ultimately declined.My last pregnancy resulted in the birth of my DD at 35 weeks due to PPROM. I consulted with my OB and MFM. I did some research. The research I found stated that progesterone will not help stop a future pre-term birth when PPROM was the reason for the first pre-term birth. I went to my next appointment with article in hand (which was from the American Academy of Obstetrics and Gynecology) and the OB I saw that day (I'm rotating now, practice protocol) opened my chart to review before we began the appointment and before I talked about the shots or the research she said "I see here they asked you to consider the P17 shots..but it looks like your previous birth was due to PPROM, P17 won't help with that, I don't feel you need them". I just nodded in agreement and told her that was the conclusion I'd come to as well and showed her the article.

elizabethnseanny · January 2013

That's great that one of the doctors were as up to date as you were. I was offered the suppositories instead and had to remind the doctor that those are for history of shortening cervix. I kept up the shots because they figured out how to bill them correctly, but also because at my check I have not dilated yet, so that is progress from my last pregnancies, where I was dilated by 29 weeks.

I know the risks decrease for each week, but I wouldn't stop them if I felt it increased my risks of delivery anytime before 36 weeks. My experience with 35-37 weekers includes 1-3 weeks of nicu time. My issue was all of the continued contractions- no apparent improvement of my previous situation. Now that I know I'm not dilating, I will just deal with them and continue to lie down to get them to stop.

As for bedrest, now that I am in the tail end, if I was to go into PTL, I could stay off my feet for a few weeks now to reach full term, that wasn't a good option back at 24 weeks when I had my first issues.

Thanks for all of your feedback!

elizabethnseanny · January 2013

caden1206:
First, I never wanted to take the medication because the follow-up studies are not really done. I know that all the follow up studies that are available say that babies of mothers that took the medication are not experiencing any side effects. I personally would like to wait and give it more time for follow up studies when those involved in the study are a little older. Second, my MFM told me the original study was terminated early and standard of care with 17p shots was basically derived from one study that wasn't even finished. I am not the scientist here, but I kind of wanted more info and security that it really works because of my first reason above. Third, they think I have an incompetent cervix and these shots won't help me if that is truly the case. I did get a preventative cerclage. And last I asked if I did go into PTL would we be using this medication to help me out. Both doctors said no. From what it sounds like from both doctors they support the use of the medication, but with what they presume my condition is the cerclage is the best thing for me. I pray every day that I did not make the wrong decision.
I am currently only 16 days in this pregnancy from when I had my son at 25 weeks 5 days. Leading up to his birth I had a lot of painless contractions for weeks. With this pregnancy I have not had any of that. Sometimes I get scared that I am experiencing contractions, but have recently just determined my baby is shifting. I think that this pregnancy is already very different from the last one. I don't know whether to contribute that to luck or the cerclage.
It sounds like you only have five more shots. I know they are a pain and hopefully you don't experience too many issues if you continue them. Good luck.

Thank you for sharing your story, I appreciate the insight. I had the same scares in the beginning, and realized him moving was a bit uncomfortable. It sounds like you made the right decision, and I hope your contractions continue to stay away!

BeesMomma00 · January 2013

Can you request a prescription of Progesterone Suppositories instead? My first pregnancy, I had the shots. This pregnancy (only 2 years later) MFM is telling me that they have more success with progesterone suppositories (at least in my case for Incompetent cervix and irritable uterus).

Just a thought, perhaps worthy of a discussion.

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