Yesterday was our two week postpartum appointment. Sort of the post-game analysis, what went wrong, what we’d do in the future, and we hope you’re not just sitting at home bawling your eyes out kind of thing. (We’re not, don’t worry.) It went… more or less as well as we could have reasonably expected.
We both really wanted to be told, hey, this is what happened, and here’s how we’re going to stop it from happening again. Case closed. We knew that was extremely unlikely. In something like 60-75% of cases of preterm labor, a cause is never identified for certain. But we do have some answers, and the answers we do have are better than expected.
There are essentially four possible known causes of preterm labor: placental abruption, infection, incompetent cervix, and simply “spontaneous preterm labor” (which is really not a cause but a catchall for “we have no fucking clue,” I think).
My clotting disorder puts me at high-risk for placental abruption, but this was the one cause they have been able to basically rule out (as much as anything can be ruled out in these cases). This is good because it means my blood thinners were doing their job and I won’t require additional anticoagulation in the future. This is bad because it means I definitely now have two high-risk conditions rather than one that caused a terrible outcome.
They think it is unlikely that I have incompetent cervix, or at the very least think it is unlikely that this was the triggering/primary issue in my case. This is very good news, as IC is the worst-case scenario for me. There are no proven treatments that actually help with this, and the two treatments that they use that “may help” (extended bedrest and cerclage, literally sewing your cervix shut) are scary options for someone with a clotting problem who is on blood thinners during pregnancy.
That leaves basically just infection and “unknown reasons.” According to the pathology report, my placenta showed evidence of “severe acute chorioamnionitis,” a fancy way of saying it was seriously but recently infected. Infection is our best-case as it means there is no reason to think this is likely to reoccur, so this is potentially promising (and tragic). The issue here is the “recently.” Because they believe my water broke 2 days prior to delivery, there is no way to know if the infection triggered labor or if I got the infection at the hospital after my water broke. I am tempted to believe it was the former because I want to believe it was the former and also because I was on 5 days of IV antibiotics at the hospital. By the time my water broke, I’d been on penicillin for more than 48 hours and that was followed with amoxicillin and erythromycin. It seems crazy that I could have developed a severe placental infection in that time, but I guess it’s possible. We will never know for sure.
What does all this mean for the future? I am actually pretty pleased with our OB’s plan all things considered. In our next pregnancy, I would get weekly p17 shots from weeks 16-36 – these are more or less the only preterm labor tool that has been clinically proven over and over to actually reduce preterm birth, extend the number of weeks a woman carries even if she doesn’t go to 37 weeks (which seems frankly greedy to us at this point, we’d take 32 in a hot second), and even improve NICU outcomes in preterm births. They would then have me come in every week I’m pregnant, and the second it looks like my cervix is shortening or doing anything untoward, I’d be put on bedrest, but not until then. I’m pretty thrilled that they don’t want to just prescribe blanket extended bedrest and would only want to put me on it as needed (though I imagine around the 22-28 week mark you’ll have a hard time convincing me I should be moving around anyway). I also think getting checked out weekly will be really helpful for my anxiety, so I’m glad that they want to do that.
Next stop is follow-up with the high-risk doctors, hopefully they share the opinion of the regular OB.