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pregnant at 40, previous 2nd trimester loss+ fibro= circlage??From: Alexandra (anonymous@obgyn.net)Sun, 15 Oct 2000 18:54:18 -0500 (CDT)
I am 40 yo and pregnant at 15 weeks. Blood tests, urine tests Ok (week 10) Nuchal transucency test with U/S on week 13 was OK, cervical length was 3.9mm, but I was told that placenta's position is too low but this might change and that there is a fibro (3.9mmx4mm) but this is not so bad??!! I am due for amnyocentesis on 26 OCT/00. However, PAST HISTORY is quite COMPLICATED. 1) 1991 : (31 yo)gave birth to a healthy baby girl. Uncomplicated pregnancy, 10 days before due date water broke, no contractions, (labor induced 12 hrs later), normal birth (in Greece). 2) 1994: conisation of cervix(lazer)after having been diagnosed with CIN II(performed in Belgium). No advice for cerclage in future pregnancy 3) 1996 : pregnant again (in Belgium), the doctor assured me on week 24 that everything was OK, cervix tight and long(diagnosed by vaginal examination-no U/S)no problem with travelling etc. While on vacation in Greece, premature rupture of the membranes week 26.5 -no contractions at all, bedrest at hospital+medication(steroids) for maturing the baby's lungs, NO antibiotics, in 48 hrs I developed severe infection (septisemic condition), operated in emergency, cesarean section, baby(boy) was born and died in 28 hrs from massive cerebral damage. Greek gynecologist urged me, to have a preventive cerclage in case of a new pregnancy. 4) 1997: 2nd cesarean to take out a 10cm diameter fibro( myoma ?)(in Belgium). I was told that in case of pregnancy baby will have to be delivered by a Cesarean section. The Belgian gynecologist who is treating me during this pregnancy and 2 other Belgian gynecologists with whom I have consulted insist that a cerclage should NOT be performed for perventive reasons. As they say, cerclages are not so frequent and necessary as in the 80's because conisations are being done during the past 10 years with lasers. The approach is more "wait and see" and if necessary react. As a precaution my current gynecologists wants to put me on medical leave so that I can rest and relax as much as possible . However, with my past medical history, I do not understand the reluctancy of the Belgian gynecologists. Shouldn't they perform a cerclage anyway considering that everything was "perfect" during my 1996 pregnancy until 26.5 weeks? And if not what are the preventive measures that need to be taken? I have read that the cervical length needs to be checked often but how often and by which means? Is it possible that dilatation due to incompetent cervix and ROM may occur without any previous warning at a stage that nothing can be done as in my previous pregnancy? In short, should I have a cerclage or not and when? Also, according to what I have read, my 1996 premature rupture of the membranes might have been due to an infection (amnionitis). As I am having an amnyocentesis next week, should they also check for infection or should they do that later and how? (amnyocentesis again or other test?). Finally, considering my history (conisation, 2nd trimester loss-PROM, 2 cesareans, fibro) how optimistic should I be about this pregnancy? (frankly, I am not at all optimistic) I have heard several versions ranging from "everything will be fine-no particular precautions" to "high risk pregnancy, very difficult, possible but cannot guarantee anything" and I really do not know what to believe. Thank you in advance for considering my case. I would appreciate an early reply as the clock is ticking especially for the cerclage
-- Alexandra Kousta
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