PREGNANCY-BIRTH Messages for January, 2000: Re: High Risk OB?

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Re: High Risk OB?

From: anonymous@obgyn.net
Wed, 26 Jan 2000 16:01:18 -0600 (CST)

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At Wed, 26 Jan 2000, Barbara wrote: >
>I recently gave birth to a premature baby at 24 weeks. He lived for 2
>1/2 days. I also have a 3 y.o. that was born at 31 weeks. After I had
>my first son, I asked the dr. about a cerclage for future pregnancies.
>They felt I didn't need it because I didn't show "classic" IC symptoms.
>I had a slight backache the night before I had him. Never felt any
>contractions until I was about 10 cm. dilated. With this pregnancy, I
>was given a choice: a) get a cerclage (5 Dr's felt I didn't need one and
>I was afraid of the risk of m/c), b) be followed up by sonos for
>cervical change and if any changes, hospital bedrest or c) do nothing.
>All consisted of bedrest at 24 weeks. I chose b. At 20 weeks, I had a
>sono done and they said my cervix looked fine, and the baby was healthy.
>Throughout the whole pregnancy, there were no problems. No bleeding,
>cramping, contractions, etc. At 24 weeks, I went to urinate and noticed
>a small line of pink when I wiped, no larger than the line on a preg.
>test. I called my doctor and went to his office. After I got hooked to
>a monitor, I felt my uterus tighten. I thought they were BH
>contractions. Those were the first contractions I'd felt throughout the
>whole preg. Upon pelvic exam, the dr. said I was dilated to around 4
>cm. and that he could see my membranes. By the time I got to the
>hosp., I was fully dilated and my water broke. I gave birth via
>emergency C-section since he was breech and transverse. At my follow-up
>visit, the dr. said they would definitely do a cerclage at 12 weeks
>since now I show classic signs of IC. They didn't think so before
>because I carried my first son to 31 weeks and he said I would've showed
>signs of IC around 18-20 weeks. I tested positive for Group B-Strep,
>but he said that wouldn't cause me to dilate the way I did. My question
>is: For my next pregnancy, should I see a high-risk dr. or can a
>"regular" ob/gyn treat me as high-risk and I can get the same care? Is
>there special training that a high-risk dr. gets that makes them
>"better" at certain cases?
>
>Thanks for your help and sorry this was so long!

You certainly will have a high-risk pregnancy, and if you have ready access to a Meternal-Fetal Medicine Specialist, that would be appropriate. However, most OBs handle this sort of thing fairly routinely. Commonly, MFMs will be used as consultants. Your regular OB will do most of the work, including the delivery as well as the cerclage, but will refer you to an MFM for special testing and ultrasounds. The most important thing will acutally be the nursery that is available at the time of any preterm delivery is such occurs. The obstetrical management is fairly straightforward (you need a cerclage, pelvic rest, and limited activity), but if the birth is premature, the nursery will spell the difference in outcome. If you make it past 34 weeks, then that will become less of an issue.

--
William D. McIntosh, MD, FACOG
Clarksville, TN

This is for educational purposes only, and is not intended to be replacement
or substitute for consultation and examination by an appropriate medical
professional.  Due to time constraints, private e-mails cannot be answered.

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