Something in my vagina...

[APToddlerMama]

I've been hospitalized for preterm labor.  I'm still contracting despite meds and bedrest and my cervix is paper thin, some dilation, head is very low, etc., which has been going on for weeks now.  My doctor and I agreed there would be no more cervical checks whatsoever several weeks ago because he does not want to risk setting off labor.  He did say if something "changed" he may need to look.  So, I have been sitting here for three days now not saying anything about the changes I've been feeling because I don't want a cervical exam.  But...basically it feels like something is sitting in my vagina.  Low.  Like I suspect I would feel something if I put my finger in maybe two inches.  I did some reading and it sounds like that sensation can come from a bulging bag or from a prolapsed cord (which is an emergency for baby).  I am worried that if it is a bulging bag, a cervical check could rupture the membranes.  Also worried that if it is a prolapsed cord that if I don't have it checked, something bad could happen. 

So, wise MDC mamas, what would you do?  Would I be having other signs of prolapsed cord and how likely is it that it could have prolapsed given my water has not broken?  TIA

x-posted in my DDC

[Just1More]

I'd let them check.  Or I'd check myself.  I just wouldn't want to mess around.  You are, at best, 34 weeks, right?  Have you had steroid shots for the baby's lungs? 

That said, if your water is still intact, is it even possible for the cord to prolapse? 

Anyway, either way, if you are contracting, and dilating, and you are feeling something...it could be possible that the baby may be coming soon.  You really shouldn't wait to be checked out. 

[WaitingForKiddos]

I would wash my hands and labia/mons/peri. and then very, very slowly and gently insert one finger. Gently. IME, a self exam like that is way more gentle than any internal a dr/mw has done. I think just because when it's your own body you have more of a sense of the pressure being applied.

No PLT stuff here but what I've found is that when I'm pregnant the extra blood flow sometimes makes it feel like there's something in my vagina. I have experienced a cord prolapse and ya, it left like that....like a nagging sensation that there was something there. However, my water had broken and was I was in labor when that happened.

Edited by WaitingForKiddos - 10/20/11 at 6:14pm

[katelove]

If your membranes are intact then you don't have a prolapsed cord. You can have a presenting cord, which is when the cord is in front of the baby's head but, by definition, it isn't prolapsed.

If you did have a prolapsed cord then the baby's heart beat would be affected but that would only be obvious if/when someone actually checked the heartbeat. Other than that, the only signs are a sensation of something in the vagina or a cord visible on inspection or a cord felt during an examination.

If you were my client then I would probably suggest a very gentle speculum examination. That way I could have a look without too much poking around. If you told me you thought the "thing" was only a couple of inches in then I would put the speculum in about an inch and then have a look. If I couldn't see anything then I would gradually advance it until I could see something.

[APToddlerMama]

Thank you everyone!  For now I have been hanging tight waiting because I think it might have to do with losing more of the mucous plug which I noticed shortly after posting this. 
 

Originally Posted by Just1More 

I'd let them check.  Or I'd check myself.  I just wouldn't want to mess around.  You are, at best, 34 weeks, right?  Have you had steroid shots for the baby's lungs? 

That said, if your water is still intact, is it even possible for the cord to prolapse? 

Anyway, either way, if you are contracting, and dilating, and you are feeling something...it could be possible that the baby may be coming soon.  You really shouldn't wait to be checked out. 

33 weeks and have had the steroids.  I am contracting, am dilated (and I'm sure continuing), but since I'm already in the hospital on bedrest and on meds to stop PTL there isn't a lot to do if it is the bag bulging.  My major fear is the whole cord prolapse thing because I've gotten conflicting info on if it is possible with intact membranes.
 

Originally Posted by WaitingForKiddos 

I would wash my hands and labia/mons/peri. and then very, very slowly and gently insert one finger. Gently. IME, a self exam like that is way more gentle than any internal a dr/mw has done. I think just because when it's your own body you have more of a sense of the pressure being applied.No PLT stuff here but what I've found is that when I'm pregnant the extra blood flow sometimes makes it feel like there's something in my vagina. I have experienced a cord prolapse and ya, it left like that....like a nagging sensation that there was something there. However, my water had broken and was I was in labor when that happened.

Oooh... I am assuming everything went okay for you?  How long did you have that sensation?  I would gently check myself, but I don't think I'd know the difference between a bag and a cord or a cervix.  I am realllllllllly a big baby about things like that too.
 

Originally Posted by katelove 

If your membranes are intact then you don't have a prolapsed cord. You can have a presenting cord, which is when the cord is in front of the baby's head but, by definition, it isn't prolapsed.

If you did have a prolapsed cord then the baby's heart beat would be affected but that would only be obvious if/when someone actually checked the heartbeat. Other than that, the only signs are a sensation of something in the vagina or a cord visible on inspection or a cord felt during an examination.

If you were my client then I would probably suggest a very gentle speculum examination. That way I could have a look without too much poking around. If you told me you thought the "thing" was only a couple of inches in then I would put the speculum in about an inch and then have a look. If I couldn't see anything then I would gradually advance it until I could see something.

So, is a presenting cord dangerous?  Would the cord and bag be bulging together?  The baby's head has been fully engaged for weeks already.  Does this make it less likely or impossible that the cord could have slipped under the head? 

Would an NST or just listening with a doppler rule prolapse out?  TIA
 

[AbbieB]

If your baby is fully engaged, chances of a prolapse are very slim. That's good news!

I would imagine that you have been monitoring the baby in some way? Listening to heart tones or ultrasounds? If not, it might make you feel better to have someone check.

[katelove]

Originally Posted by APToddlerMama 

So, is a presenting cord dangerous?  Would the cord and bag be bulging together?  The baby's head has been fully engaged for weeks already.  Does this make it less likely or impossible that the cord could have slipped under the head? 

Would an NST or just listening with a doppler rule prolapse out?  TIA 

A presenting cord is a potential problem on it's own if the following part (head or bottom) puts too much pressure on it but it is less of an issue than a prolapse because the amniotic fluid tends to help cushion the cord. If the cord was in front of the baby's head when it engaged then it may still be there but, if it wasn't then it's almost impossible for it to slip down past an engaged head. I would think that if there was any cord compression happening then you would already know. I assume you're having 4 hourly foetal heart checks while you're in hospital?

Either an NST or doppler auscultation of the baby's heart beat have the potential to suggest cord compression if it is occurring but neither can provide a definitive diagnosis and neither could suggest or rule out a presenting cord without compression.

Transvaginal ultrasound can sometimes detect it but is not super reliable and may be more of a risk in your case. It is something you could discuss with your HCP though.

Unfortunately the only way to definitively diagnose cord prolapse is direct examination after the membranes have ruptured. The examiner would then hold the presenting part off the cord until the baby was born, usually by c/s unless birth is imminent. 

Presenting cord is very rare though, 0.2-05% of births, so with a head-well-down baby you have a good chance of it all being fine.

[RosieL]

Can you have the same conversation with your doctor as you presented here? Tell him what you feel, and your fear that it's it's the bag, you really don't want a check, but if it's the cord, you really want a check, and carefully weigh the options with Doc?

[APToddlerMama]

Quote:

Originally Posted by AbbieB 

If your baby is fully engaged, chances of a prolapse are very slim. That's good news!

I would imagine that you have been monitoring the baby in some way? Listening to heart tones or ultrasounds? If not, it might make you feel better to have someone check.

Yes, both.  Thank you :)

Originally Posted by katelove 

A presenting cord is a potential problem on it's own if the following part (head or bottom) puts too much pressure on it but it is less of an issue than a prolapse because the amniotic fluid tends to help cushion the cord. If the cord was in front of the baby's head when it engaged then it may still be there but, if it wasn't then it's almost impossible for it to slip down past an engaged head. I would think that if there was any cord compression happening then you would already know. I assume you're having 4 hourly foetal heart checks while you're in hospital?

Either an NST or doppler auscultation of the baby's heart beat have the potential to suggest cord compression if it is occurring but neither can provide a definitive diagnosis and neither could suggest or rule out a presenting cord without compression.

Transvaginal ultrasound can sometimes detect it but is not super reliable and may be more of a risk in your case. It is something you could discuss with your HCP though.

Unfortunately the only way to definitively diagnose cord prolapse is direct examination after the membranes have ruptured. The examiner would then hold the presenting part off the cord until the baby was born, usually by c/s unless birth is imminent. 

Presenting cord is very rare though, 0.2-05% of births, so with a head-well-down baby you have a good chance of it all being fine.

Wonderful.  Thank you for such a detailed explanation.  I've had two ultrasounds since baby's head has engaged (checking for growth as I have history of abruption) and I think I am at a 0 or +1 station (head is really low).  Also, I have three NSTs a day and baby is always very reactive.  I think you are right and it sounds like my risks are really low.  Thank you for putting my mind at ease and explaining it so well! 

Originally Posted by RosieL 

Can you have the same conversation with your doctor as you presented here? Tell him what you feel, and your fear that it's it's the bag, you really don't want a check, but if it's the cord, you really want a check, and carefully weigh the options with Doc?

My OB doesn't do rounds on the weekends so it would be a different doctor.  I really trust him but I do not trust his partners at all.  He told me that sometimes they check things they shouldn't in terms of dilation/effacement "just because they HAVE to know."  He put a note in my chart about not touching my cervix again because the cervix is already paper thin, dilated (don't know how much now) and the head is so low.  One of the partners totally ignored everything and did an exam a couple weeks ago that made me bleed for a couple of days so I don't want to go through that.  I guess weighing the risks, I am more afraid they will start labor or rupture the membranes and then make me deliver a 33 weeker than I am of the cord being prolapsed now.  Thank you for your help :).  Great to have lots of ideas to consider. 
 

[katelove]

Happy to help. Sounds like waiting until your Dr visits on Monday is a good option unless something changes significantly before then. With the babe's head so low for so long the other possibility is that your vaginal wall is a bit oedematous and that is what is giving you the sensation of something there.

Thinking of you and hoping all is going well for you and your precious babe.

Kate

[Jaimee]

Sounds like you've gotten some very good advice. I'm so sorry you're dealing with all this!  I did want to say that I am having the same sensation you are describing and I'm 34w5d.  I don't feel it all the time, but often when I'm squatting, and sometimes even just standing, sitting, or laying.  I emailed my mw just the other week to ask b/c I seriously thought that something was in the vaginal canal.  I described it to her as a malpositioned tampon/diva cup sensation and like the baby was going to fall out.  She said the latter was perfectly normal, but the malpositioned vaginal sensation was not something she was familiar with.  She suggested an internal at our next appointment and that in the meantime my dh could try and see if he could tell if something was "out of the ordinary."  I had a good laugh at that one.  How often is dh feeling up around my cervix?  Um, never.  Anyway, some of my DDCers thought that perhaps the head is pushing down a little farther forward than the cervix and actually pushing on the vaginal canal creating that sensation.  Otherwise I'm chalking it up to third baby, weakened muscles, and engaged baby.  My mw will check me in about a couple weeks, so I guess she didn't think it was a pressing issue.  Of course, your situation is much different than mine!  Keep us updated!

[RosieL]

Originally Posted by APToddlerMama 

My OB doesn't do rounds on the weekends so it would be a different doctor.  I really trust him but I do not trust his partners at all.  He told me that sometimes they check things they shouldn't in terms of dilation/effacement "just because they HAVE to know."  He put a note in my chart about not touching my cervix again because the cervix is already paper thin, dilated (don't know how much now) and the head is so low.  One of the partners totally ignored everything and did an exam a couple weeks ago that made me bleed for a couple of days so I don't want to go through that.  I guess weighing the risks, I am more afraid they will start labor or rupture the membranes and then make me deliver a 33 weeker than I am of the cord being prolapsed now.  Thank you for your help :).  Great to have lots of ideas to consider.  

That makes perfect sense. Sorry you have to deal with a set of docs that you don't trust. That's my biggest fear; being risked out of a homebirth then being treated by on-call docs whom I don't trust and who don't listen. :-/ Good luck mama. I'm sending magical cervical closure and no complications thoughts. 

[APToddlerMama]

Originally Posted by katelove 

 With the babe's head so low for so long the other possibility is that your vaginal wall is a bit oedematous and that is what is giving you the sensation of something there.

All is still well.  Does that mean swollen?  Because if it does, I think that is probably exactly what is going on. 
 

Originally Posted by Jaimee 

Sounds like you've gotten some very good advice. I'm so sorry you're dealing with all this!  I did want to say that I am having the same sensation you are describing and I'm 34w5d.  I don't feel it all the time, but often when I'm squatting, and sometimes even just standing, sitting, or laying.  I emailed my mw just the other week to ask b/c I seriously thought that something was in the vaginal canal.  I described it to her as a malpositioned tampon/diva cup sensation and like the baby was going to fall out.  She said the latter was perfectly normal, but the malpositioned vaginal sensation was not something she was familiar with.  She suggested an internal at our next appointment and that in the meantime my dh could try and see if he could tell if something was "out of the ordinary."  I had a good laugh at that one.  How often is dh feeling up around my cervix?  Um, never.  Anyway, some of my DDCers thought that perhaps the head is pushing down a little farther forward than the cervix and actually pushing on the vaginal canal creating that sensation.  Otherwise I'm chalking it up to third baby, weakened muscles, and engaged baby.  My mw will check me in about a couple weeks, so I guess she didn't think it was a pressing issue.  Of course, your situation is much different than mine!  Keep us updated!

Hahaha...yeah my DH would have no clue what he was feeling.  I'm glad your MW isn't too concerned.

Originally Posted by RosieL 

That makes perfect sense. Sorry you have to deal with a set of docs that you don't trust. That's my biggest fear; being risked out of a homebirth then being treated by on-call docs whom I don't trust and who don't listen. :-/ Good luck mama. I'm sending magical cervical closure and no complications thoughts. 

I hear you!  Luckily my OB supposedly always comes to deliveries even on the weekends unless he is out of town.  I guess they just don't do rounds for routine issues on the weekends unless they are on call.  Thank you for the magical cervical closure thoughts :). 

[katelove]

Originally Posted by APToddlerMama 

All is still well.  Does that mean swollen?  Because if it does, I think that is probably exactly what is going on. 
 

Sorry, yes it does. Glad everything is still good.

[Baby_Cakes]

Originally Posted by Jaimee 
  I emailed my mw just the other week to ask b/c I seriously thought that something was in the vaginal canal.  I described it to her as a malpositioned tampon/diva cup sensation and like the baby was going to fall out.  

This is exactly the way I described the sensation I've been having which turned out to be a slight bladder prolapse.  Is that possible, OP?

[APToddlerMama]

Originally Posted by Baby_Cakes 

This is exactly the way I described the sensation I've been having which turned out to be a slight bladder prolapse.  Is that possible, OP?

ughhhh, yes.  I would not be surprised at all.  I had pelvic floor dysfunction and was in physical therapy for months with my first.  Doing way more than my fair share of peeing on myself these days too.  Does that seem like a good indication?  What do they do for it?  More PT?  How are you doing now? 

[Baby_Cakes]

Yup, it could definitely be. Im doing better. Kegels, kegels, kegels!! I didn't notice mine until about 6-7 weeks postpartum, and started intentional kegels at 8 weeks. I felt a change for the better within the week.

Sent from my SGH-T959 using Tapatalk

[katelove]

Probably not something you could do at the moment but there is some interesting talk about squatting being really good for pelvic floor strength. There is an article here http://www.pregnantpossibilities.com/2011/pelvic-floor-exercises-squatting/

[BaileyB]

Kick counts, kick counts, kick counts!!!!!!!!  KICK COUNTS!

[BaileyB]

Originally Posted by Jaimee 

How often is dh feeling up around my cervix?  Um, never. 

haha! this made me laugh! he must've felt up there once....just not with his finger right? haha. Another appendage though