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Re: preterm labor view from an OBGYN who has been through itFrom: annette lee (aleeoc@rocketmail.com)Wed Feb 16 06:27:23 2000
After all this discussion of treatment and overtreatment of preterm labor, I have to add my 2 cents. I had 3 pregnancies, one as a resident, on as a fellow and one as an RE in practice. No risk factors, but contractions started at 20 weeks in each. In each case my OB (3 different ones in NY, OR and NJ)worried, asked me to stay off my feet (ha,ha)and finally consulted a perinatologist who after documentation of cervical shortening (15-20 mm length) and regular contractions did the following: Baby #1 -PTL dx'd at 32 weeks MgSO4 x 3 days,TRH, Dexamethasone, Cefezox at 32 weeks. Contratctions never stopped, NSVD 36 6/7wks. Baby #2 - Oral terbutaline starting at 29 weeks, cervix stayed 2 cm dilated, contraction never stopped, NSVD at 37 0/7 weeks, Baby #3 - Subcutaneous terbutaline pump starting at 24 weeks, converted to oral procardia at 26 weeks, NSVD at 37 0/7 weeks. In each case, not as an OBGYN, but as a gravida, I had a feeling that is hard to put into words, that these contractions were not labor in each case at exactly 36-37 weeks, although the contractions were the same frequency, they were more intense and delivery followed within a few hours. Bottem line is that from someone who has been on both sides as the patient and as the doc, I think that we "overtreat" a lot of "preterm labor". I can certainly understand that especially when treating a collegue, you don't want to miss it, but I believe in many cases a multip can tell what feels real and what does not. In all 3 cases, I guess it could be considered a tocolysis success story, but I think that the outcome would have been the same without any treatment at all, which is what we plan for the next pregnancy. Talk to your friends online with Yahoo! Messenger.
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