cerclage failed - need your opinion

Dear Divya
I am so sorry about your loss. Also I may not have the answers to all ur questions because I am no doctor or have a failed cerclage. But I also lost my baby at 24 weeks this August due to IC and I understand what u r going thru. But here is an attempt to answer a couple of questions


2)Doctor noticed infection when he removed the stich and also the placenta was infected. Do you think the infection caused my cervix to open or is it the leakage of mucos for 3 days which caused the infection.
If it is the infection which caused the cerclage to fail what can I do next time to prevent it?

Yes infection can trigger labour and cause a lot of damage. My problem also started with candida infection which the doctor feels could be a reason for the opening up of the cervix. Also once the mucous plug is out the placenta is very susceptible to infection.

In future u need to be very very careful of hygiene even tho the infection is more due to the changing pH rather than just hygiene. Use a medicated wash recommended by doctor. And also hygiene wipes that are easily available in the US every time you go to the loo even if it is like 12-15 times.

3)I fell had doctor seen me on the same day I called him, I would probably have not lost this pregnancy. What do you think?

I agree. However once the stitches start funneling there isn't much a doctor can do.


4)I live in US. My parents want me to come to India for next pregnancy. They say something is wrong with the treatment over here and India is better place especially for pregnancy cases. But I am really hesistant about going to another doctor as this doctor has personally experienced my case. Any suggestions about this.

I agree with u. I think u shud stay in the US. Though they have a valid point that the health service in India is more prompt, still the doctors in the US have more technical knowhow than here. Also in all probability u may just have a premature baby next time
(My doctor's target for me next time is just to take me to 28 weeks with a cerclage beyond which he feels if I go its my luck) so neo natal care is definitely much better in the US.

Besides this I think u cud also speak with ur doctor about getting a TAC (trans abdominal cerclage) put in before u get pregnant. This is a surgical procedure which has almost 90% success rate. They stitch ur cerclage up completely (perhaps even place a stent) so that there are no chances of funneling again. The only drawback is that u cannot have a normal delivery ever thereafter but that hardly matters as long as u can hold ur baby in ur arms. With a TAC most ladies go up to full term (38 weeks) without any bed rest.

And since u r in the US its even better because u have the two best experts in TAC there. One in Chicago and one in New Jersey. They are Dr Arthur Haney and Dr Davis. U can mail them if u want and they will give u your answers soon. Their ids are askdrdavis at the rate aol dot com and babies dot bsd dot uchicago dot edu.

The procedure is already covered by ur insurance but If you do not have health insurance here, the cost is about $ 23,000 US dollars with Haney. For 2010, the total medical cost, assuming one day in the hospital, is about $3,700 US with Dr Davis . If you need a second day in the hospital, it is about $5100. The prices will go up a little after the first of the year, but I do not know by how much.

I was contemplating flying down to the US myself for the procedure but my doctor said maybe I am not such a great candidate for TAC yet. So pls dont even think of coming to India for ur delivery.

All the best and do keep us updated.

God bless.

 

Dear, dear Divya,

Let us say, we are running an obstacle race with a lovely pot of gold at the winning post. Every hurdle is a burden and needs to be crossed, cleared. However, once it is crossed, it is done with, and you are closer to your gold and happiness.

Every lady aspiring to deliver a baby through a series of obstacles, is also on the same course. It is most unfortunate that you went through two miscarriages, and a cerclage that did not hold. However, these are now over. Your gynaes now have a better understanding of your body, and how it works during a pregnancy, and what needs to be done in future.

I am no doctor, I am just a laywoman, who conceived with help after 13 years of marriage, conceived twins, both growing well, lost one, then had an encerclage and delivered the other baby through C section. Believe me, before the happy ending, I went from one obstacle to another, they seemed to be endless. But with each new hurdle, I told myself that this is meant to be, once this is crossed, it is done with. Possibly, that attitude, be it faith, or a fool hardy sense of confidence, may have helped.

To answer your questions with the little I know:

1)Maybe, next time, your doctor will tell you to sleep with feet elevated, and also be off your feet 100% of the time. This time, you did what you were asked to do, so what went wrong is not your fault. And next time, your gynae will also take a more careful approach. I was also on bed rest with feet elevated. And staying in a place with no house help, it was insidious. Your hands and feet itch to get going. But it is only for about 40 weeks in a whole lifetime of activity, so just enjoy being on your back.

2)Infection can cause early labour, I saw it with a young lady in my clinic.Again, infection can be caused through lack of personal hygiene. And more often, the body can auto trigger infection, and accidental moves on our part can cause infection. Again, this will guide your doctor to advice you better next time.

3)I fell had doctor seen me on the same day I called him, I would probably have not lost this pregnancy. What do you think?

I would say, don't think on these lines. However, had you been in India, there is a strong probability that you could have seen a doctor on the same day. Whether that would have prevented the miscarriage or not, is something that we can only speculate on. So, don't fret over that.

4)I live in US. My parents want me to come to India for next pregnancy. They say something is wrong with the treatment over here and India is better place especially for pregnancy cases. But I am really hesistant about going to another doctor as this doctor has personally experienced my case. Any suggestions about this.

I started treatment in Europe, and then totally frustrated by the delays, lack of physical and moral support, I shifted to India and had good results. I will not say that pre natal, post natal or even neo natal care is better abroad. You can get excellent medical care in India, just choose the right doctor. Other advantages like lower costs, faster treatment regimens, instant attention, availability of family support, external domestic help etc adds to success rate indirectly.

I understand that you do not want to change doctors. But with a comprehensive case file, and with your input, I guess a new competent doctor will be just as effective. Even in clinics, the same doctor will not see you always. Once conception occurs, the fertlity consultant might see you only towards the end. The pregnancy will be dealt with by good gynaecologists, high risk intensivists etc.

Divya, you hang in there. You are closer to conceiving and delivering a bonny baby, now that one more hurdle is caused. Happy Pongal, have a great year ahead, one that sees all your desires fulfilled.God bless.

 

i would think you can raise your legs by putting pillows underneath. also, divya, you may have already done this but have you spoken with your doctor about your questions? i think we get so worried about being cordial that we aren't pushy enough with our doctors. i'm speaking from personal experience but i've now decided, i will not leave until every question i have is answered and i keep a notebook about my questions so i can have them handy!

best of luck to you!

 

Dear Divya,

While in hospital, they will raise the lower part of the bed with a pulley mechanism. Hospitals have special beds for that. In India, Godrejj manufactures these health beds. The elevation will be decided by the doctor. And can be anything from 3 inch to 1foot.You will not feel the incline, and will have no discomfort.

At home, we got two identical blocks of wood, 3 inches high, and placed it under the legs of the cot. Some use bricks, but these will give way suddenly. Best is wooden blocks. Legs are totally free, in any case.

Just one addendum. I personally found the bedrest very irritating, though I was allowed to walk to the bathroom, have my own bath, sit for meals and prayer. Later I found that I was the mildest case. I found women who cheerfully underwent bedrest, with one foot elevation, no movement for 37 weeks, bed pan etc. After seeing that, my attitude changed and it helped all round.

The conditions of bed rest are decided by the doctor. Why I keep repeating this is, in some cases, the pregnant lady might develop constipation. This will happen with almost 99.99% of pregnant women, only because all other internal organs apart from the uterus become flaccid. So, there will be a natural tendency to force. In some cases of bed rest after cerclage, even that forcing will not be allowed.

I am writing these extreme details just to tell you that even after such bedrest, the women deliver peacefully and have healthy babies. So, all will be well with you.

Pls check out this post also.

Raising with pillows is not allowed. We checked with the doctor.

Goodluck, lots and loads of it forever.

 

yikes, my apologies - i wasn't trying to misguide

 

Divya,

I went to a clinic in my home town, Trivandrum. Now they have gone all international, with couples from Gulf, America and Maldives streaming in. The doctor there is considered to have a lucky touch.

Yes, best is to sleep on one side, preferably the left. This improves circulation to the foetus. Sleeping on the back should be avoided, get your husband or mom to keep checking at night, if you have a tendency (like I do), to go back to sleeping on back. And to state the very obvious, sleeping on your stomach is NO-NO.

Goodluck, each day takes you closer to your baby.