Steroid Shots-Proactive or Reactive? (+our story, loss mentioned)

[hopefulfather]

Hey everyone.

So, first, a condensed version of our story. My wife and I lost a pregnancy with our son Joseph at 16+6 back in 2010 due to unexplained PPROM. After a year or so of unexplained infertility, and some failed Clomid cycles, she got pregnant with injectibles + IUI with twins in November. Due to our PPROM history, she was being monitored for possible incompetent cervix.

Everything was pretty good up until our week 18 u/s where it showed that her cervix had almost completed opened internally (at the 16 week u/s it was over 3 cm). Our doctors didn't really seem to have a plan, and through a different online forum I found Dr. George Davis who was only about an hour from our hospital, and got in touch with him. He thought my wife might be a candidate for a rescue TVCIC and our doctors didn't have a better plan so we headed down to south Jersey to see him on Thursday, 3/1.

We were scheduled to have the TVCIC on the morning of 3/2, but by the time they got us up to pre-op, my wife had gone into full blown labor. A quick ultrasound before the procedure revealed that Baby A's sac was pretty much completely prolapsed. Dr. Davis at first just said we could either let things take their course or do a D&C, but we pushed him to try a Delayed Interval Delivery (so he would deliver Baby A and then try to keep Baby B in there by placing the TVCIC and administering drugs and whatnot to try and stop labor), even though the odds of success are very low.

Well, 3 weeks later, between his amazing work and some good fortune, my wife is now closing in on 22 weeks pregnant with Baby B. Unfortunately, we did have to say goodbye to Baby A on March 2nd, a boy who we named Thomas.

We're now getting very close to viability, and the topic of the day is the steroid shots. There seems to be 2 different perspectives from doctors on these. Some doctors believe you should just give them proactively as early as you can and they help push maturation ahead by about 2 weeks overall. Other doctors believe that their effect is really 48 hours to 1 week, and after about 1 week their positive effect wears off, so giving them really early with no indication of pre-term labor is a bad idea. And everyone agrees giving them more than once is not recommended, so you really only get 1 chance at making this decision to do them proactively around viability, or reactively when pre-term labor is seen (of course with the downside that if labor progresses very fast, you might not be able to complete the steroid regimen before you have to give birth).

Our doctors are willing to give them as soon as 22+5, and we're currently scheduled to get them on 22+6/23. However, we recently spoke with Dr. Davis for some follow-up questions, and he said that he actually would NOT administer the steroid shots unless there was some indication of possible pre-term labor. My wife has been basically completely stable, pregnancy-wise, since the day after she delivered Thomas and they got labor completely stopped--she's pretty much had no contractions, no bleeding, no foul discharge, nothing like that. So given that, he says we should get the prescription for the shots filled and keep them handy, but not to actually have our doctors do the injections unless there is some kind of indication that pre-term labor could be coming.

I'd love to get some more opinions on this from folks who've been in a similar spot, and well, I'm sure a lot of IC "veterans" have been in this spot.

Thanks!

[SC-Sherb]

hopefulfather, welcome. First off, I'm very sorry about the loss of your first pregnancy and then the loss of Thomas (Baby A). Gentle hugs to you and your wife both. You have been through alot in a short time.

Now, congrats on the continuing pregnancy with Baby B. Has your wife been checked yet to see what her cervix currently is at or do they just not want to disrupt things and it's the stitch that is holding Baby B in? There is an invasive test that they can do to see if you are going into labour anytime soon. For the life of me, I can't seem to recall the name of it right now but I'm sure someone will know it. It's not 100% accurate and it won't tell you when you are going into labour but I think it can tell you you will not be going into labour in the next week or whatever.

I would probably go with your Dr. Davis recommendations and get them filled and keep close by but wait as long as you possibly can. Many many positive thoughts and prayers to you, your wife and your little one and I hope that Baby B keeps baking for a couple more months!

[hopefulfather]

We had a 20 week level 2 u/s (where we also found out Baby B is another boy). They just did abdominal u/s cause they don't want to do anything vaginal unless they really need to, but they were able to visualize the cervix pretty well. It looked like she was funneled to the stitch but did have like 1.7-2cm closed tight below the stitch since the TVCIC is so high. Dr. Davis said that sounded pretty good to him. We have another ultrasound scheduled for next Tuesday (22 LMP/22+4 measurement) and then a full measurement scan at 24 weeks. But all of those are planned to just be abdominal u/s to avoid any possible contamination or disturbance with a transvaginal u/s.

The test you're thinking about is fetal fibronectic testing (fFN) but our doctors said the false positive rate is very high for women who have a cerclage so they didn't think it was worth doing. I've also read that the swabbing from the test can disturb the cervix and cause contractions, so for now we're not thinking that we would push for fFN testing.

[SC-Sherb]

Congrats on the boy! Yes, that is the name of the test. Totally understandable in this situation to not do it. I'm also assuming that your wife is on strict bedrest? There are quite a few ladies here that were funneled to the stitch and still held those babies in for quite a while doing bedrest. Still positive thoughts to you all!

[hopefulfather]

No, she's not on strict bedrest. She's basically on modified "take it easy" bedrest. So most days she goes downstairs and then spends the day on the couch, and only gets up for the bathroom and once in a while to get herself something to eat quickly. Otherwise she's sitting/laying down most of the day. We've talked to a lot of doctors about this and frankly even the level of bedrest she's doing is more than any of them have told her to do. Even Dr. D basically said she should be treated like any other "normal" pregnant person at this point. I'm certainly pushing for her to take it as easy as possible, and she's doing what she can while retaining her sanity. She tried to do the strict bedrest for the first week and ended up having that severe panic attack, so to be honest that's probably more unhealthy for her and the baby than anything else, so she's finding a middle ground that works.

[hopefulfather]

Just found a great article on the steroids in doing some research today here

The article seems to suggest that based on this recent study, the proper course is to do do 1 dosing of steroids early, and then administer a second rescue course if pre-term labor is imminent. This was found to have positive results with no significant side effects. Maybe that is the way to go. Our OB said they do typically do the rescue dose.

[SC-Sherb]

I think that sounds like a good plan and course of action. Well, I would definitely stick to what she is doing at this point. I know that alot of Dr.'s don't recommend the bedrest but I've read so many stories from ladies on here that did some form of bedrest and they feel very strongly that the bedrest helped them bring home babies.

You could also post on the bedrest support board for some advice and offers of what to do for her. I know lots of ladies posted on here, played games, watched movies. Do you have anyone that can just drop by once inawhile to chat with her? Maybe bring a dinner or two to help out?

[hopefulfather]

My parents and her Mom like to stop by and bring stuff. She tends to like to just sort of hunker down and deal with this by herself, plus she does want to keep traffic in and out of the house to a minimum until we're at viability to reduce the chances of anyone bringing any kind of illness into the house that could turn into a bigger issue.

I think we're doing a pretty good job of getting there day by day. 3 weeks post-op today, which is pretty fantastic.

[SC-Sherb]

It sounds like you guys are doing a great job so far. I hope that things continue to hold as they are. Please keep us updated.

[armywfe06]

Hopeful father just wanted to post and say I am thinking about you and your family. I think it is amazing how strong your little boy is and he is truly a fighter! I have lost a child to IC and know how hard it is to move past. I can not imagine how to grieve for one child while still having to worry and try to care for his twin. I don't know anything about the steroid shots but I will be praying for you guys and eagerly looking for updates.