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Followup To
Question -
I am 28 years old. I have had 3 miscarriages over the last 10 years, all early in pregnancy and I just lost a baby at 28 weeks on July 18, 2005. I started bleeding at 20 weeks. Emergency Cerclage was performed. Water broke. Went to KY to have experimental Cervical Plugging in hopes that it would retard the leak. Carried Baby to 27w5d. She lived 3 days before she died. She was delivered Via Emergency C-Section. I want to know what the statistics are in regard to my chances of having another premature birth and how soon I could possibly try to conceive again.
Answer -
I don't know if any investigation was done as to the cause of your bleeding at 20 weeks or the reason for your premature rupture of membranes. You may have had a subclinical infection causing the rupture of membranes , or you may have had an incompetent cervical os. Rarely does an emergency cerclage prevent the delivery. Perhaps, next time you should have an elective cerclage at around 16-18 weeks gestation (once the baby is found to be viable). Once the reason for the premature birth is found, we can give you a better indication of your chances of another preterm birth. Once your cervix and uterus are back to normal, you can,again, conceive. There is no specific waiting period. It sounds like you are a good candidate for elective cerclage.
Follow Up Question:
They know that it was not due to infection that I went into Preterm labor. They said my cervix was dilating. I had been having painless contractions throughout the day for several days prior to the bleeding. So, they don't know if contractions caused the cervix to dilate or if the cervix dilating caused the contractions. It's a "which came first" question. Would a cerclage prevent either problem from occuring? Also, I forgot to mention that they tested me for Protein S deficency while I was pregnant and found that I am indeed deficient. Have you heard about heparin injections during pregnancy for women with this disorder? Also, have you heard about the recent research regarding Progesterone injections to prevent preterm labor. What do you think about it?
Answer It is becoming evident that you probably do have an incompetent cervical os and would benefit from a cerclage in early pregnancy (16-18 weeks) before the cervix could dilate "silently". In an incompetent cervix, the cervix starts to dilate without the patient being aware of any contractions. A cerclage in these types of cases helps keep the cervix closed until 38 weeks gestation, when the stitch is removed and you are allowed to go into labor. I have not previously used progesterone supplementation in my practice. However, current literature has shown that progeterone may be helpful in preventing early miscarriage or preterm labor and I am considering starting its use in my practice. Heparin use in pregnancy has been used in antiphospholipid syndrome and anticardiolipin antibody patients, but is still controversial. It does not prevent the cervix from dilating if you have an incompetent os.
