PTL contractions (not IC or PROM) & subsequent full term pregnancy?

[Chrisa]

I lost my first and only baby because of idiopathic PTL at 20w4d. I’d been having BH contractions since week 15 without any cervical change, but on the day I went to the hospital they intensified, and I also had some non-distinct, constant uterine pain (not only during contractions) that built up gradually. I am certain that my dr.'s practice did everything they could to help me; they tried Terbutaline, Procardia, progesterone suppositories, and I was on bed rest with IV the whole hospital stay, but the contractions didn't stop. My son was born on the 4th day of hospitalization. He was a normal,  perfect little boy, very strong, and well-developed for his age – 400g, 27.5cm – which makes me believe he would have had a great chance of surviving if PTL started at least 3 weeks later.

At my 2nd trimester U/S, everything looked perfect, including my cervix. Blood tests, placenta analysis, emergency amnio and my son's autopsy came back "normal", and ruled out infection.

I already saw a MFM dr, who confirmed everything I knew from my OB, but no specific information as to my chances for a longer/ full-term pregnancy. After contractions began, my cervical length stayed at 2.5 cm for two days, so IC is unlikely; my water broke 10 minutes before my son was born.  Most stories and articles I read are about PROM and IC, but I haven't found much information about PTL that started with contractions in the absence of PROM or IC.

So if you, or other women you know have had irritable uterus/ contractions PTL, and had longer subsequent pregnancies, please share some stories of hope.  I’m especially interested to know:

• If yes, was it "naturally" (for lack of a better word) longer/ full-term, or due to treatment & bed rest?

• Any subsequent full-term twin pregnancies (or at least further along that the previous preemie)?

Thanks all.

[anjelika]

Sorry for the loss of your son...

I went into pre-term labor twice with my daughter after having an irritable uterus since 24 weeks.  The first time (33 weeks), they stopped contractions the first time with fluids and subsequent bed rest.  The second time (36 weeks), they used terbutaline.  I then stayed on bed rest and delivered at 39 weeks by planned induction due to IUGR. 

I wish you the best on your journey...

[APToddlerMama]

I am really sorry for your loss :(. 

I don't really have any answers to your questions, but am thinking you may want a second opinion on the whole IC thing.  I am sitting hospitalized right now after going into preterm labor at 29 weeks.  My son was born at 35 weeks.  With both pregnancies, I started contracting a lot really early on.  By 20 weeks, I was having more than 10 contractions an hour for several hours every day.  My current OB is fantastic, one of the best in the area, etc. and thinks that I probably have a combination of irritable uterus along with a somewhat incompetent cervix.  My cervix hung in there just fine through the contractions for nine weeks, and then suddenly shortened very quickly.  A cervical length of 2.5 at 20 weeks is really pretty short and a big predictor of preterm labor.  You may want to talk with another high risk OB about the possibility of cerclage.  P17 shots are another option as well.

Best of luck to you. 

[Chrisa]

Thank you for responding and sharing your stories.

Anjelika, it's great that your second pregnancy was longer, that gives me hope!

APToddlerMamma, I got a second opinion from an MFM, he said the same thing as my regular OB. They consider IC cases where dilation and shortening precede labor. In my case, the cervix had gone down from 4cm to 2.5 after at least a day's worth of pelvic pain and contractions (but hadn't been dilated or shortened before). Both agreed that cerclage was not for me, as labor would just cause my cervix to tear. With a next pregnancy, they would put me on P17 (if a singleton) and give me tocolytics if/ when contractions start. Wish you the best with the current pregnancy, hang in there!