How to tell the difference between preterm labor & normal stuff?

[klocke]

So I'm super on edge about pelvic pressure (guess that's what you'd call it) I've been feeling for about two weeks now. I'm nearly 26 weeks and I know that pelvic pressure is normal in a twin pregnancy but how do you know when it is a sign of preterm labor? It is a tingling sensation in my cervix and at times I do have a pushing sensation but like I said it has been going on now for almost 2 weeks. It is almost always in the evening. I have a dr. appointment with a perinatal dr next Tuesday and really don't want to have drag everyone to the hospital or anything crazy if it is a normal thing. I've had 3 normal full term vaginal births of babies between 8 - 9 lbs but I guess everything I keep reading has me so worried about preterm labor. Thoughts?

Oh for what it is worth I tried to do a self cervical check and my cervix is still way to high for me to even reach to tell if it is dilating or anything funky.

[daisie31]

are you contracting? I had preterm labor with both my pg starting at 28 wks. I contracted on and off with my son but contracted almost continually with my twins. None of my contractions were painful, they just made my uterus feel very tight. I had pelvic pressure too but it started at 18 wks and lasted about a month or so. If in doubt, always get checked, go to l&d. The first time I was in preterm labor, I didn't even know it, just thought it was normal. Thank God I happened to mention it at my appt and got checked. My second pg, I didn't care how bothersome I was...I went in whenever I felt something odd. You know what feels normal and what doesn't. I hope it's nothing and most likely isn't. My baby A was wedge in my pelvis for the entire second half of my pg thanks to baby B who was taking up way more than her share of space so that is what was causing my pressure.

Dena

[klocke]

I have occasional BHs but nothing that I would consider odd since it is my forth pregnancy. BHs aren't regular or painful. I'm definitely going to have them measure my cervix on Tuesday. I hate having to have a vaginal exam done but with this strange sensation I need to have some reassurance that it is OK.

[~bookcase~]

My 5th/6th were born at 32 weeks and I would want regular follow up in your position as steroids etc can help. I had weird feelings from 27 weeks and thought at that point that i felt like i was in the last month with my singletons. I went 5 more weeks but it was so sudden at the end. It was sad and scary.

Best wishes mama. Try to rest, eat lots and drink plenty.

[dividedsky]

i had mine @ 32 weeks also, so i say get checked for sure!! it's worth the hassle. you can absolutely be contracting without knowing it. better safe than sorry @ 26wks. i wouldn't freak out, but definitely get it checked out mama!

[Intertwined]

Also have them run a urine culture for possible UTI and also maybe do a swab for BV (both of which can in fact be there mostly without symptoms). I sometimes get the odd urge to 'bear down' when I've got a UTI during pregnancy. And I had BV without many symptoms for years and only realized it when I was pregnant with my twins. It was good to get rid of that as it can be a culprit of PROM!

[annekh23]

I wouldn't mess around with those symptoms with twins. I wouldn't even mess with them with singletons, I've known a handful of people have a couple of term pregnancies, then pop a baby out significantly early, then go back to term pregnancies. I don't have a lot of confidence in prevention methods and I've seen several bits of evidence suggesting that measures that have a small degree of sucess in singleton pregnancies may actually make them worse in multiple pregnancies, but even if you can't change the outcome, it's still better to have warning, to give steroids and get yourself to an appropriate level of NICU and given there are things that in some circumstances can change the outcome, you need to at least get the info.

I was supposed to be on terbutaline and strict bedrest, I was 29 weeks (with a singleton), 1cm dilated and about 1cm long and soft and contracting, though with a negative ffn test. I used the first few days of bedrest to dig around and decide that I wasn't going to take the terbutaline and I'd take things easy, but not strictly bedrest. I wasn't going to ignore contractions that came in a regular pattern, or were particularly painful, but there was still some risk balancing to do. I did want to get another ffn 2 wks and possibly 4wks later, but we had a mess up with our midwives back up ob being on holiday, so we got past the point of a negative ffn being such a good indicator and for other reasons that if my body said out rather than in that the OB wasn't going to advise attempting to stop it, which did spare me a few hours on a mag drip, but also having to deal with contractions whilst having to lie on my left side because otherwise my BP shot up!

[DoubleLove]

Be certain to get your cervix checked! Measuring with a transvaginal ultrasound with be your best indicator if your contractions are doing anything.

I had regular contractions every 7-10 minutes apart every single evening and into the night from 20 weeks on. They weren't painful, but they weren't comfortable either. The discomfort was more mid to upper uterus, but not much down in the cervical area. My doctor checked my cervix and it wasn't doing anything, plus with all those contractions for like 10 weeks my cervical length on ultrasound went from 52mm to only 34mm, with no dilation. That is a normal expected change according to the perinatologist, but of no concern he said. Apparently it was normal for my body, and can be normal with multiples, but everyone is different of course. But my membranes did rupture at 31 weeks, likely do to polyhydramnios (too much amniotic fluid), birthing 3 days later.

Luckily I'm already an OB nurse and I could assess a lot on my own, but I'm certain that if I had gone in to the hospital for a labor check, I would have been given a shot of terbutaline every time I went in. Just so you know the standard course for trying to hault preterm labor (which if it really is real labor, the literature says it cannot be technically stopped for long) generally includes the following: electronic fetal monitoring, a terbutaline shot, IV hydration, a sterile speculum exam checking fetal fibronectin (FFN, if before 32-34 weeks), then a manual cervical exam, a urine culture, possibly a urine drug screen, and IV or oral Nifedapine. If the FFN is positive or if you are making cervical change, the steriod shot is given. The terbutaline shot can be repeated. Terbutaline makes you feel horrible! Sometimes a magnesium sulfate drip is started, but the literature isn't supporting that practice anymore, unless BP is rising to critical levels.

I wish you a calm uterus for 10 more weeks! Rest, stay calm, stay well hydrated, lay on your side always, and no sex!