Steroid shots, preemptive

PaniaO · November 2015

Regarding steroid shots in cases of/in case of PTL... I'm wondering what others think about them, know about them, have experienced, etc.

Backstory: I had contractions two days four weeks ago (with extreme exercise and mild dehydration--neither part of my reality anymore). They found my cervix was funneling... And when it got too far, I had a cerclage placed (at 23 weeks). Now, as I'm 26 weeks in, my perinatologist is suggesting I consider preemptive steroid shots 'just in case'--even though he thinks I'll go full-term. I guess they've had a few unfortunate cases recently so they're swinging toward being preventive/cautious. But I'm hesitant... Thinking it over... Open to others ideas if you please! TIA!

(Edited for punctuation.)

PaniaO · November 2015

Just to update... I'm 90% committed to do them Monday. Perinatologist says risks are 'negligible to zero.' Still wondering about others' experiences, though...

breezypip · November 2015

I got them at 28 weeks because my cervix had gotten so short. It was a "just in case" since of course they don't know if I'll actually deliver early or not. I haven't yet and I'm at 34 weeks.

I asked a lot of questions and my doctors assured me that as long as you do the normal course consisting of 2 shots it does no harm to the baby at all, and will help them immensely if born early. They can do one more "rescue" shot If necessary later should you have preterm labor after the two weeks. After that I was told additional shots could begin to effect their growth in a negative way. What they try to get right is timing -- the shots are most effective in the two week span after you get them. So my doctors tried to wait until they thought my likelihood of delivering early was high enough.

For me it turned out to be unnecessary because after 34 weeks my hospital doesn't give steroid shots because the baby's lungs are developed enough on their own. But it sure did give me some peace of mind in the in between weeks.

And the shots themselves weren't bad. One nurse gave me one that was completely painless, and the next day another nurse gave me one that stung quite a bit. So, get a good nurse :-)

PaniaO · November 2015

Thank you so much for sharing your experience! I really appreciate it.

DH and I are really hemming and hawing over this. I'm not having signs of PTL and I'd only be 26.5 weeks when I get the shots, so it's still pretty early in terms of getting us through 34 weeks with only two 'shots' at it. I feel like I do trust my doctor's opinion, but... also feel like he's pretty open about his advice being reactive in response to recent cases he's seen. A month ago or a month from now might have prompted a different opinion. I just don't think steroids can possibly be totally safe for a fetus... And then there's the question of timing. Tough decision!

peppercorn16 · November 2015

Just curious, would it be possible for you to request a fetal fibronectin test prior to making your decision? The results usually come back in the same day and will give you a positive or negative on whether your body seems to be preparing for labor within two weeks. A negative result is extremely accurate and could prevent you from getting the shots too early and not delivering within that window. If you get a positive result it isnt as accurate but it can suggest that your body is doing some sort of labor preparations and the shots might be a good idea. I took this approach with my doctor-- they thought it was the best way to decide how to proceed. Good luck and let us know how it goes!!

PaniaO · November 2015

peppercorn16 said:
Just curious, would it be possible for you to request a fetal fibronectin test prior to making your decision? The results usually come back in the same day and will give you a positive or negative on whether your body seems to be preparing for labor within two weeks. A negative result is extremely accurate and could prevent you from getting the shots too early and not delivering within that window. If you get a positive result it isnt as accurate but it can suggest that your body is doing some sort of labor preparations and the shots might be a good idea. I took this approach with my doctor-- they thought it was the best way to decide how to proceed. Good luck and let us know how it goes!!

That's a really good idea! I've asked them before about the ffn test (before it was time to consider steroids) and they said they 'don't do that test anymore,' that it's 'mostly academic,' and some other dismissive statements (something like it's old-school practice). But it's worth asking and I will now do so! I would imagine it's not something they would never do--just that it's not standard policy anymore... Thank you for the suggestion @peppercorn16 !!

peppercorn16 · November 2015

@PaniaO, I am nosy/curious if you have gotten the shots yet or not! I am now finding myself in almost the same situation after 2 months of bed rest. My cervix went from 1.4 to .5 in 2 weeks after it had been stable for almost 4 weeks following its initial shortening. They are going to do the FFN on me next Thursday and we will discuss steroid shots after that if needed, but the waiting feels like FOREVER! I will be 30 weeks 4 days when they do the FFN, so even if I had to get them right away I would be close to making it through that 34 week window, but still not quite there. Hoping for a negative result so I can go another week or two, but trying to prepare for anything!

PaniaO · November 2015

@peppercorn16 Soooo much back-and-forth with my perinatologist! Long story short: not taking them (yet).

Long story long: So I'm 27 weeks today and saw the doctor yesterday after having emailed back and forth about my hemming-and-hawing all week... and I'd finally decided to do the shots Thursday and today because he had me all worried about the chance that I might suddenly give birth with too little warning. But when I saw him that morning, he goes, 'Sorry about all the emails. You probably just shouldn't do the shots. You could go either way, but it sounds like you don't really want to, so you probably just shouldn't do them.' I was so confused but relieved also. He really was on the fence, I guess? He was no longer officially recommending them, so I decided to hold off. I've been feeling pretty good and my cerclage is holding just fine, so I was willing to take the risk, I guess. He had convinced me it would be good because they'd have some benefit to get me to 30-31 weeks... But I honestly feel like I'll make it anyway.

***BUT, if I didn't have a cerclage, and I were still well under 34 weeks, I would definitely get them! With mine at over 2.5 cm long, and stable with the stitch, I'm less concerned about sudden onset of labor or my water breaking.

PaniaO · November 2015

Oh AND btw... I forgot about the fFN test. My perinatologist reiterated that they don't do the fFN at our clinic because they make clinical judgments with measurements/exams, but that they'd refer me to one nearby if I wanted it done anyway. He said they have a higher rate of false positives for women in my population (can't remember if it's short cervix or cerclage, but yeah...). So I decided against that drama. I might get the steroids if I have any contractions or extra discharge or anything though.

peppercorn16 · November 2015

I am glad you guys were able to come to a conclusion that you are comfortable with, and it sounds like you have a good plan in place! My doc definitely stressed the risk of a false positive (I am on progesterone suppositories) so I totally get them not wanting to put too much weight in the test if you're at an increased chance of a false positive. Mine have been negative so far but I do have a feeling that this one next week will be positive. I probably will go ahead with the shots if I get a positive, unless I have gained some cervical length (cervix measurement is the day before OB appt, so I will know by then). They probably wouldn't get me in for them until I had passed 31 weeks anyway since my appt is at the end of the week and my "upgrade day" is Sunday. So I wouldn't be too far off! Thank you for sharing your experience, I appreciate it!

PaniaO · November 2015

Wow, you're so close and that's awesome that the fFN has been negative even with the false-positive tendency! Sounds like you're in great shape. The thing that sketches me out about relying on cervical length is that it can change so much so quickly. Mine went from stable at 2.75 to 3+ in a couple of days and then over one weekend (literally between Friday and Monday morning) went all the way down to 8mm, which is super scary. Anyway, I'm sending positive thoughts out there for you!

flowerintherain · November 2015

So your doctor told you that they're really only effective for a few weeks after receiving them?
I just got them yesterday and today at 25 weeks. It was my second time in l&d for contractions. And this time I was dehydrated and had a fever that was spiking baby's heart rate. My cervix is now measuring 2.5cm at 25 weeks from 3.1cm at 19 weeks. So between that and the contractions my doctor told me to get the shots. I tried to ask questions, but my doctor seems to not be experienced with complicated pregnancies and really had no answers. I asked if he thought I needed them because he expected me to go into labor within the next couple of weeks. He said no, that it was a precautionary measure and has no side effects. But he did not mention them only having a two week life span. I don't think I'm going to deliver that soon. And I also read something about it causing a film on the brain....anybody know anything about this?? Now, I'm almost wishing I would've been able to look more into it before just listening to my doctor and getting them now. Best of luck to you lady's also. Hopefully we all make it to term and have happy, healthy babies

PaniaO · November 2015

@flowerintherain Yes, my doctor said they have the best benefits in the first 1-7 days, definite benefits up to 2 weeks, ad some benefit as much as 3-4 weeks after the shots. My research told me 1-7 days, so I was super wary of risks given that tiny window of benefit. But I think my perinatologist is definitely awesome and he says up to a month... Interestingly, I'm now 7 days past my first planned shots and about 11 days after he first suggested them. No PTL yet (knock on wood!!). I was told risks were negligible to zero, so I don't know about effects on the brain. My perinatologist said there are no ill effects on growth with just one round. After two, they won't do more, as you probably know. It's just that my own brain can't accept that there really is no drawback to injecting steroids... especial if they potentially slow growth after 2 rounds. BUT, goodness gracious, I would rather have done the shots if he were born early! Such a hard decision. No sense in having regrets now, I say. You're not in an easy place, logically or emotionally, and you did the best you could with what resources, information, and support you had available to you. Baby will be better off with steroids even if he/she stays in than they would be if they came early without them. No question! Best to you!

mphillips2 · November 2015

My doctor says he is going to wait till delivery is inevitable because they work best if you deliver within 48 hours after the shots. So I am on standby for the steroid shots.

PaniaO · November 2015

Well, now that I'm at 28 weeks with no issues, my doctor told me it looks like I 'made the right decision' by not getting the shots. Of course it could have gone another way, but I really felt like we were on solid footing. My H and I are really glad we were brave enough to go without and lucky enough to not live to regret it in adverse circumstances!

Kelley421 · November 2015

Hi ladies! I received the injections at 24w. At 29 my perinatologist suggested another round of steroids, but at 30 weeks my babies were born. I had a cerclage and my cervix was shortening at 1.9cm. There were no changes over a month so I thought all was good and was staying on bedrest. At 29w6d I was not dilated at all, and then 30w went to L&D with the lightest pink spotting and had dialed to 5, with the cerclage starting to tear. I never felt contractions.
We did not have another round before birth, so that was 6 weeks between steroids and birth. Only one baby needed any assist and she is just on room air at 1 liter.
I've read so much and stories, it seems to be hit or miss with steroids and outcome, you don't know if there will be time for them or of it's too early and then you don't go into labor. My regular OB felt the steroids were enough 6 weeks ago. (Or maybe he was trying to calm me down? You can imagine what a basket case I was!)
Good luck, I hope you ladies hold on to term!

PaniaO · November 2015

Thank you for sharing your story @Kelley421... Makes me think more than twice about my seemingly stable status at the moment...

peppercorn16 · November 2015

PaniaO said:

Well, now that I'm at 28 weeks with no issues, my doctor told me it looks like I 'made the right decision' by not getting the shots. Of course it could have gone another way, but I really felt like we were on solid footing. My H and I are really glad we were brave enough to go without and lucky enough to not live to regret it in adverse circumstances!

Glad to hear things are still going well for you! Hoping you have plenty more weeks before delivery! I got to get steroid shots by surprise during a 5day hospital stay this week. I subsequently had a negative FFN, so I feel reassured from 2 angles; if the FFN is right and I don't deliver in the next two weeks, I will be right upon the 34 week mark where steroids would not be needed or given anyway, and if for some reason I did deliver in the next two weeks I have the steroids giving baby a little boost. It is a hard call on the shots, but I am thankful the decision was pretty much made for me!

PaniaO · November 2015

Wow! I'm sorry to hear you had a scare. Glad you're still baking and are in good shape to see the pregnancy through these last vulnerable weeks! Sounds like you'll be golden, with respect to what's foreseeable; sending positive vibes!

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