Questions Before Trying to Conceive Again

I am 36 years old and in one year, have lost 2 babies. My first child was a Trisomy, and my second son died at 22 weeks (2 weeks ago). My amnio came back fine with my second child, and I was just about to let my guard down and I started spotting. I was seen by my doctor 1 week after the onset of spotting. At that time I was 2-3cm dilated with possible ROM (+ nitra, - ferning) Also, after being put on a monitor, I was contracting every 2-3 minutes, painlessly.

The doctors felt that my primary problem was an incompetent cervix as well as Strep B. I was send to surgery and a cerclage was successfully put in my bag intact. I was also started on the dreaded Mag Sulfate. After going into Pulmonary Edema the Mag was stopped 2 days later. The following day my bag ruptured. I delivered my son that afternoon. I was told by the nurses originally, that sometimes, even at 22 weeks with ROM they can keep you on bedrest and try to save the baby. My assumption is that because of the Strep B infection, I was not a candidate for that.

My questions are:
At term, what would the mortality rate be for the infant if given antibiotic therapy during labor?

If I was to have a cerclage put in at 14 weeks, what are my chances of carrying full term. Would strep B affect these chances? Would you recommend bedrest after so many weeks gestation?

How does my age affect my future outcomes?

If it were you, would you get a high risk OB doctor? I do like my OB a lot personally. He's good at referring me to other doctors, etc.


I realize these questions might not all be answerable. I guess I feel the need to thoroughly research these issues before ever making the decision to get pregnant again. The pain is indescribable. I don't think I can go through this kind of pain again. My hope is with all the information I have I can make a more informed decision.

Question:
ABOUT THE EXPERT

Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I truly feel for your loss; not many people realize what such grief is like or the impact on the woman and her family. I can understand your need to get all the facts (as we know them).

The problem with group B beta strep is that there is no one uniform protocol. Some advocate universal screening of all women; some believe only those at risk should be screened. Some believe in antibiotic treatment during pregnancy and others feel labor is the best time to treat. Some of the problem involves the type of risk (high risk sexual behavior versus previous history or history of preterm labor etc.). Also there is the matter of how heavily colonized a woman is and which of the cultures was positive (urine vs vaginal).

If we treat all women, we run the risk of extensive administration of broad spectrum antibiotics which has the potential to encourage emergence of drug-resistant strains of bacteria.

About 65 - 75% of exposed newborns become colonized with the bacteria but only 1/50 to 1/100 born to women with the bacteria actually develop disease. The mortality rate is about 50%.

Treatment of colonized mothers in labor can prevent up to 86% of early onset beta strep infection.

Most studies demonstrate that cerclage results in a viable baby about 80-90% of the time. When you have an additional risk factor for preterm labor or preterm rupture of membranes, such as beta strep infection, some studies show no benefit to the cerclage, while others find some benefit but with increased need for hospitalization.

In most centers, women colonized with beta strep would be treated at the time of the cerclage and again in labor. This would reduce the risk of surgical spread of the infection.

Gabbe (1996) says that after cerclage,clients should decrease their physical activity and have periods of bed rest during the day. Sex is prohibited. The status of the cervix is followed with weekly or biweekly exams. If there is progressive cervical shortening, activity can be further decreased.

Your age affects all aspects of the pregnancy. Statistically, you are at higher risk for preterm labor, hypertension, trisomy - probably everything. But this does not mean that you should not attempt another pregnancy. If it were me, I would see a perinatologist a few times early on in a subsequent pregnancy and then do regular care with your OB doctor if things are progressing smoothly.

The CDC has a web site which you may find helpful.

There is also a beta strep support group which you may already know about. The address is:

Group B-strep Association
P.O. Box 16515
Chapel Hill, NC
(919) 932-5344

I do hope all goes well for you if you decide to get pregnant again. Hope this helps.

Regards,
Peg

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