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July 18, 2007

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C

The googler was me. My niece was born and passed away July 3rd. She was a 23 weeker. I took my sister-in-law to her follow-up appointment today. The doctors initially thought she had a placental abruption, but we found out today she had an incompetent cervix, hence my search. So, what's worse to have if you think you want to try again to have a baby - a previous placental abruption, or an incompetent cervix? Our hearts are broken, so we're trying to arm ourselves with as much education as possible.

Monica

I don't want you to think I was making fun of you. My comment about the search was that both suck. I'm no doctor, but I'll try to answer your question as best as I can. Both can be deadly to the baby. I think incompetent cervix happens mainly before viability. I have a woman in my support group who lost two babies (both exactly at 17 weeks to IC). However, some women find success with cerclages. My friend had a cerclage with her second pregnancy, but the doctor did not perform it correctly, nor was it the most... how can I put this, "tight" of the different types of cerclages. If you google cerclages, you will see that there are different methods for trying to keep the cervix from opening. Some can be done with minimal invasion (without an incision). My friend may try again, she's still figuring it out, but if she does, she's found a new perinatologist who will do the move "invasive" cerclage, commonly known as an "abdominal cerclage". So, the recap, I think the main fear with IC is that it usually happens before viability or during the second trimester when the baby may not ready to be out on its own. Now for placental abruption... those can happen at anytime and are deadly in that the infant loses it's supply of oxygen and nutrients. There are some indications of this such as bleeding and pain, but not always. Many times (and with a complete abruption) you do not have enough warning to get the baby out. There are cases of "partial" placental abruptions that do not result in death of the baby, but result in monitoring as "high risk" and possibly inducing if the baby is mature enough. I hope I helped, but remember, I'm no doctor. Please ask your sister-in-law to ask MANY questions. Also, tell her not hesitate to switch doctors if she doesn't feel supported (I did). Get as much info. on both, especially IC (including the differnt types of cerclages and this doctor's experience performing them) if you believe that is the cause. I'm sorry she lost her baby and I wish her strength in her grieving.

THnaks,

Monica

Monica

crap, I forgot to add something important... the risk for recurrence is higher with an IC and less with a placental abruption... that is unless the abruption had something to do with where the placenta attached (like the lining of the uterus was scarred)

Sara

In case C returns:
I'm so sorry to hear about your loss. I'm glad your sister has a supportive family.

I lost my son at 25 weeks, and the doctors disagree about whether my premature dilation was the result of an IC or pre-term labor caused by progesterone deficiency. I presently have a cerclage in and am getting progesterone shots, and although we don't know yet if it's "successful" it's been more than a month and I'm doing well. I described my experience with the procedure on my blog. I put a link on the right to the post where I describe it. If the doctors know in advance your sister's at risk for an IC, and put in an elective cerclage early on, chances of success are 90% or better. I'd be happy to answer any questions at any time your sister's ready to ask them.

Monica - I'm glad you had a good day yesterday. I totally understand your feelings about caring less about yourself than the baby right now.

basilbean

First of all about the placental abruption/incompetent cervix "which is worse" conversation (which I believe your blog came up Monica because in the links you give info about each site--mine mentions IC and Nate Nate Rollerskate's mentions PA). IC can be very treatable. This is generally true the further into the pregnancy that it presented. Since it looks like this one occured on the "cusp" of viability (like mine did) that might indicate a more positive outlook. Losses at 17 weeks like the woman from your support group often indicate a much weaker cervix, usually with thinning as well as dialating. I recommend going to a perinatologist for a consult. This doctor will look at all of the records and be best able to give information about the plan of action for a future pregnancy. My doctor told me that I have a 90% chance of carrying to term with a cerclage. I will warn that there are some doctors out there who are operating from the latest research that indicates that cerclages might not really be all they were once thought to be (as my OB put it, a cerclage is no longer a "forgone conclusion"). Doctors from this school of thought take a "wait and see" approach and monitor the pregnancy very closely with lots of TV ultrasounds and modified activity. I would not have gone down that road. After a loss there is no way I would ever advocate a "wait and see" attitude with the life of a child. Anyway, C I wish you and your sister all the best and I am so sorry for your loss.

Monica, about the irregular heartbeat. What you have described is something that I have experienced. I went to a cardiologist when I was in my early 20s and he did an EKG and all of that and determined that it was due to stress (hmm...an anxiety-related symptom, really?). It seems like since heart "flutters" are common in pregnancy anyway that this is something caused by your anxiety and that it will pass at some point after Critter is born. Perhaps it will take a while, though, as I'm sure hormones and emotions will add to it even after Critter is on the outside. I recommend deep breathing and visualization exercises.

Monica

basilbean,

You are right about the search, that is why it pulled up my blog. I've also heard the success rate for cerclages is about 90%. The new perinatologist my friend from my support group met with is very confident that he can get her to term or near term. He's going to do the abdominal cerclage and he doesn't think her failed cerclage was tight enough. He says his success rate with cerclages is about 98%, so now she just has to get up the nerve to try again. She looked into the "carrier" option but it was very expensive. I'm not sure if she will try again or not, but she has my support whatever she chooses.

Jenny

Hey Monica,

This has absolutely nothing to do with your post...just wanted to leave you a comment to say thank you so much for the flowers,the macaroni grill gift card and the sweet card. I really do appreciate your friendship. It's good to know you have someone you can count on who has your back...Really, though, there is not anything we need right now. It nice to know you are there, though.

Hope you have a great day!
Jen

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