Threatened Preterm labor 34 Weeks

I had a bit of a preterm labor scare this week... thank goodness everything is okay right now but I thought I would post a blog about it this week, after all I am sharing my experiences and if I can help one additional person who might be going through the same thing it's worth it to me to write about it.  For the most part I've had a VERY easy pregnancy, I've actually quite enjoyed being pregnant as a first time mom I love documenting everything about it, hence why I started the blog. 

This post will contain information and research for:
Inhibin A Hormone
Early Labor Contractions
Tracking Contractions with Bloomlife 
Steroid Betamethasone
Nitrofurantoin (Antibiotics)
Probiotics
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WARNING: This post may contain "TMI" so please read on your discretion... Click "Read More" in the Bottom Right Corner. 

To give you a bit of background on my pregnancy, I am 34 weeks and was diagnosed with high levels of "Inhibin A" found in my second trimester test. "Inhibin A" is a hormone that could cause distribution in blood flow from placenta to the baby, it is also a soft marker for down syndrome but in my first trimester blood screening ruled out down syndrome with 99.9% accuracy with a third party prenatal testing company called Counsyl. The possible clinical applications for the measurement of Inhibin A in early pregnancy could be in predicting miscarriage, Down's syndrome, preeclampsia, and fetal growth restriction in the first and/or second trimester before the onset of the clinical symptoms (Muttukrishna, 2004). So because of this high level of Inhibin A, I am now having additional Fetal and Genetics screenings such as a 36 week growth ultrasound scan, doppler flow studies to measure the amniotic fluid, and more antenatal testing than if it was a regular pregnancy. Since all the scans and tests have come back normal I was never nervous or anxious about the Inhibin A. There hasn't been too many scholarly studies I have found about it and it doesn't concern me since everything is moving along as intended.

On Monday July 9, 2018 (34 Weeks + 1 Day), around 10am, I started to get some small menstrual like cramping, I went to bed the evening prior with a terrible headache too which still lingered in the morning but then went away. I have been monitoring my contractions since Week 32 through a device called Bloomlife, and I have noticed that my Braxton Hicks contractions were getting somewhat more frequent in the middle of the night. Although they were not painful, and everything I researched stated that Braxton Hicks Contractions are completely normal. The menstrual like cramping was constant, it didn't come and go, and from a pain scale of 1 -10, I would say it was a constant 3. I have been anti Tylenol during this pregnancy as I only take pain medication if it's something that is really bothering me. So after a few hours I went to the bathroom of course, since I drink a lot of fluids in the day and noticed my urine was tinted brown also like the color of Iced Tea. It wasn't painful to go to the bathroom, and wasn't sure what to think of it, but worried it might be a UTI. On top of everything else I also was concerned because I haven't felt the baby move in a while. So I called the midwife hotline to check in to see if I should pop into the hospital for a visit. She advised me to come to UCSD Labor and Delivery to get checked out. 

When I arrived, the nurses strapped me to the monitors to check on the fetal heart rate and contractions, took my temp and blood pressure and everything came out normal. The baby wasn't in distress so that gave me a lot of relief. I was hooked up to the monitors for a while and the midwife wanted to check my cervix to check to see if there was any dilation as my contractions kept getting stronger and more intense, I was now feeling on a pain scale of 5-6 and I was getting uncomfortable. The cervix check was no joke, it was painful and very uncomfortable, felt almost like burning sensation and my cervix was high up so it took the midwife a bit to check. She stated that my cervix was closed but my cervix was shortened a bit (80% effaced) which could be due to the contractions happening. I stayed on the monitors and drank fluids for another 2 hours and she checked the cervix again to make sure I wasn't dilated and going into preterm labor (again, not fun). Thankfully for the second check I wasn't dilated!!! I was extremely happy and my stress levels went down, as I had already called my husband to get ready to bring all my hospital bag items and breast pump. So I gave my husband a list of items to do and told him to stand by to come to the hospital if I was going into preterm labor.

So THANKFULLY, because my cervix didn't change and it was still closed I was able to go home! After going to the bathroom a few more times and walking around actually helped the contractions quite a bit. I felt because I was laying on my back in the hospital bed that it made the contractions more uncomfortable and more intense as I do not lay on my back rarely at all. 

The midwife highly recommended that before she discharged me and sent me home that I receive a steroid shot called betamethasone (Celestone). She said the shot would help develop the baby's lungs and organs faster if I were to go into preterm labor. This steriod shot is usually administered before 34 weeks but since I was right on the cusp she said she would highly advise that I take it in case I go into labor that week for the baby to have a higher survival rate. This was a series of 2 shots total and I would need to come back within 24 hours. 

On Tuesday July 10, 2018 (34 Weeks + 2 Days),  No more headaches, I was actually feeling quite normal and I had to go back to the hospital to get my second steroid shot that evening. I still had brown urine and I haven't gotten my results for the UTI yet. When I arrived at the hospital, they wanted to strap me back onto the monitors to check fetal heart rate and contractions. I was still contracting pretty frequently, every 6 minutes or so but the baby's heart rate was fine. They wanted to do another cervix check since I was still contracting. Cervix was still closed! The midwife confirmed that I had blood in my urine, but the bacteria results will take an extra day to see the growth factors and what specific bacteria it is. She stated that I most likely have a UTI and will need to go on antibiotics even through I didn't have any symptoms of painful urination. The bladder is pushed so close to the urethra that a bladder infection during pregnancy is very common, and if untreated could travel to my kidneys which could trigger preterm labor. She prescribed me Nitrofurantoin/Macrocrystals or Common Brand Name: Macrobid 100MG twice a day for 10 days to treat the bladder infection. The medicine can be used prior to 38 weeks of pregnancy. Of course I have been reading and researching  all about probiotics which I was taking consistently early in the pregnancy but then tapered off taking them. I am now back on track to take the probiotics 3 hours after I take my antibiotics to make sure my bacteria in my gut isn't completely killed off, and I will continue the probiotics every day even after birth. 

Information about the steroid Betamethasone from Healthline 2017:  

Steroids are usually injected into one of the mother’s large muscles (arms, legs, or buttocks). The injections are given two to four times over a two-day period, depending on which steroid is used. The most common steroid, betamethasone (Celestone), is given in two doses, 12 mg each, 12 or 24 hours apart. The medications are most effective from two to seven days after the first dose. 

What are the benefits of steroids?
Steroid treatment reduces the risk of lung problems for babies who are born early, particularly for those born between 29 and 34 weeks of pregnancy. Babies born more than 48 hours, but less than seven days, from the first dose of steroids appear to receive the greatest benefit. This steroid treatment cuts the risk of lung disease in half and reduces a premature baby’s risk of dying by up to 40 percent. All babies born at less than 28 weeks had lung problems, but the problems were milder for those who got steroids before birth. Steroids may also reduce other complications in babies. Studies have shown that some babies have fewer problems with their intestines and with bleeding in the brain when their mothers received a course of betamethasone prior to birth. If you’re admitted to a hospital in preterm labor or you have a medical problem that your doctors worry will require an early delivery, you’ll probably be offered a course of steroids. Staying pregnant for those first two days after a corticosteroid shot is the first major milestone for you and your baby (or babies).

What are the risks of taking steroids? 
Animal studies have shown that giving steroids to a pregnant female can affect the immune system, neurological development, and growth of her offspring. However, these effects have shown up only in studies where steroids were given in very high doses or early in the pregnancy. In the treatment of preterm labor, steroids are given later in pregnancy.
Human studies have not shown any significant risks associated with a single course of steroids. Older studies followed infants whose mothers were given steroids during pregnancy until the children were 12 years old. These studies showed no adverse effects from the steroids on the child’s physical growth or development. Still, more studies need to be done.

Information about Antibiotics during Pregnancy from CDC 2018
Antibacterial Medication Use During Pregnancy and Risk of Birth Defects National Birth Defects Prevention Study 2009

Bloomlife Contractions Sunday July 8 - Tuesday July 10 2018

I am so glad that I purchased the Bloomlife device so I didn't have to time and track my contractions manually. I had NO idea what Braxton Hicks Contractions felt like and I wasn't sure if they were early labor contractions or not, but I knew through the monitor stats and trends that something wasn't right. I was getting contractions every 6 minutes and they would last about a 1-2 minutes. They weren't painful but I was glad to share this data with my midwife so she knew I wasn't crazy. Now that I have been threatened with preterm labor, I am able to check my contractions to see if its the UTI is what is causing them and gives me peace of mind that I can see what is going on with my body instead of guessing. 

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REFERENCES:

Crider, K. S. (2009, November 01). Antibacterial Medication Use During Pregnancy and Risk of Birth DefectsNational Birth Defects Prevention Study. Retrieved from https://jamanetwork.com/journals/jamapediatrics/fullarticle/382406

Healthline (2017) Treatment of Preterm Labor: Steroids and Antibiotics. Retrieved from https://www.healthline.com/health/pregnancy/preterm-labor-adjunctive-therapy#corticosteroids

Morbidity and Mortality Weekly Report (MMWR). (2018, January 11). Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a4.htm

Muttukrishna, S. (2004, August). Role of inhibin in normal and high-risk pregnancy. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15319825
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