Wednesday, January 20, 2010
Aflac in Utah
For those planning to get pregnant and use maternity insurance, you may want to sign up now. On February 15th you will no longer be able to sign up for AFLAC hospitalization insurance in Utah. Please contact supplementalinsurance@live.com if you would like to sign up. Thanks!
Monday, January 11, 2010
Doctor's Notes
I have a copy of the doctor's notes from my fourth delivery. I always love my doctor's notes to see what they have to say about me, but this one is so funny I thought I would post it on this blog.
Date of Service: 03/06/2009
HISTORY OF PRESENT ILLNESS: This a 26 year old patient of Dr. ____ who precipitously delivered a 35 week infant in her car on the way to the hospital. The patient's pregnancy has been significant for her preterm labor in the past. She received progesterone shots up until 32 weeks after which she reported that due to side effects that she was unable to tolerate them any further. She was admitted last weekend to the hospital with preterm contractions and was given a dose of steroids apparently at some point during her pregnancy. She has been experiencing contractions for the last 3 days and reports that they got stronger this evening. She got in the car with her husband to drive to the hospital for further evaluation when she delivered in the car. I received a call from the emergency room physician who reported that the patient was being transferred to labor and delivery, but the baby was fully delivered and appeared vigorous upon arrival to the emergency room.
DELIVERING PHYSICIAN: None.
ESTIMATED BLOOD LOSS: Unknown, although the patient has very little bleeding at this point in time.
FINDINGS: A viable male infant weighing 5 pounds 15, that is 2694 g. Apgars are unknown and unassigned by the nursery as they were not present at the time of the delivery.
LABOR AND DELIVERY: As mentioned above, the patient precipitously delivered in the car on the way to the hospital. She reports that her water broke just prior to arrival and she immediately delivered without complication. The cord was clamped and cut by the nurse from labor and delivery where the placenta was delivered by one of the nurses. The uterine fundus was immediately firm after this. I arrived and evaluated the patient. Her fundus was firm. She had very little bleeding. At that time, perineal exam revealed no obvious lacerations that required repair. There were some very superficial lacerations that did not require any suturing. The patient remained in the room in good condition, and the infant is currently in the newborn nursery being evaluated.
Date of Service: 03/06/2009
HISTORY OF PRESENT ILLNESS: This a 26 year old patient of Dr. ____ who precipitously delivered a 35 week infant in her car on the way to the hospital. The patient's pregnancy has been significant for her preterm labor in the past. She received progesterone shots up until 32 weeks after which she reported that due to side effects that she was unable to tolerate them any further. She was admitted last weekend to the hospital with preterm contractions and was given a dose of steroids apparently at some point during her pregnancy. She has been experiencing contractions for the last 3 days and reports that they got stronger this evening. She got in the car with her husband to drive to the hospital for further evaluation when she delivered in the car. I received a call from the emergency room physician who reported that the patient was being transferred to labor and delivery, but the baby was fully delivered and appeared vigorous upon arrival to the emergency room.
DELIVERING PHYSICIAN: None.
ESTIMATED BLOOD LOSS: Unknown, although the patient has very little bleeding at this point in time.
FINDINGS: A viable male infant weighing 5 pounds 15, that is 2694 g. Apgars are unknown and unassigned by the nursery as they were not present at the time of the delivery.
LABOR AND DELIVERY: As mentioned above, the patient precipitously delivered in the car on the way to the hospital. She reports that her water broke just prior to arrival and she immediately delivered without complication. The cord was clamped and cut by the nurse from labor and delivery where the placenta was delivered by one of the nurses. The uterine fundus was immediately firm after this. I arrived and evaluated the patient. Her fundus was firm. She had very little bleeding. At that time, perineal exam revealed no obvious lacerations that required repair. There were some very superficial lacerations that did not require any suturing. The patient remained in the room in good condition, and the infant is currently in the newborn nursery being evaluated.
Disclaimer
I am not a medical doctor, nor am I YOUR medical doctor. I am a mother of four who hungers for knowledge regarding pregnancy and childbirth for whatever reason, I don't know. I created this blog for people who were constantly asking me questions about these topics so they would have a place to return and read about these topics. Please consult your doctor before you do anything regarding your or your baby's bodies. Thanks!
17-AlphaHydroxyProgesterone Caproate
Sometimes called 17P or p17 or progesterone shots. Used to be called Delalutin. It's the new thing. It's all the rage. It's one of the best proven techniques to stop preterm labor in women pregnant with singletons these days. And the strange thing is, a lot of doctors aren't doing it yet. It's kind of a new thing, well a new, old thing. That's right, my mother-in-law took it when she was pregnant, but they stopped using it, like so many drugs, when there were a few lawsuits against it.
17P shots are a thick substance that must be injected intra-muscularly. They are somewhat painful, and the injection site can become irritated and itchy.
These shots work by relaxing the uterus and preventing it from contracting. They are quite effective. I went into labor at 24 weeks with this last one, and I began taking my Nifedipine pills which make me very miserable. Within a few days my doctor had me on these shots and within a week I was scarcely having any contractions. I did have a handful of days where I had some breakthrough contractions, but they all took place the day before my next shot.
It was actually a fun process for a medically minded person like me to learn how to give myself an injection, my husband did the first few and I did the rest.
Doctors may differ on treatments with these shots. Some start at 16 weeks gestation, others will wait until preterm labor begins. And it is up to you and your doctor to decide when to discontinue treatment. Theory might be that labor will begin within 2 weeks of discontinuing treatment and the hormones are completely out of your system. But it really depends on the cause of preterm labor, and each individual's body. My personal experience was that I didn't dilate at all while on the injections, so once I discontinued, I had 5 weeks before I delivered, but I always dilate early and slowly. I also, discontinued treatment at 30-ish weeks due to the nausea I was having associated with the injections. So it kept me pregnant until 35 weeks which was amazing!
If I was the doctor giving out treatment, I would start injections at 24 weeks and end at 35 weeks. Then if it did take 2 weeks to deliver, the baby will still be term.
I want to mention that I did also receive a steroid shot for the baby's lungs at 32 weeks. At my hospital, the latest they will administer the shot is 32 weeks and it must be done at Labor and Delivery with an hour of fetal/contraction monitoring. If there is any indication prior to 32 weeks that you might deliver prematurely, I would definitely push for the steroid shots before it's too late. Any help for the baby is worth it's weight in gold!
The side effects of these progesterone shots are all those that can be associated with hormones. My body is very sensitive to hormones and thus these injections made me feel like I had returned to my first trimester. Very few people complain of that, but it was still worth prolonging my pregnancy as long as it did.
If you are experiencing or have experienced preterm labor, talk with your dr. to see if they think this is a treatment worth trying. A lot of doctors haven't tried it before and after researching they might be very interested in this treatment.
17P shots are a thick substance that must be injected intra-muscularly. They are somewhat painful, and the injection site can become irritated and itchy.
These shots work by relaxing the uterus and preventing it from contracting. They are quite effective. I went into labor at 24 weeks with this last one, and I began taking my Nifedipine pills which make me very miserable. Within a few days my doctor had me on these shots and within a week I was scarcely having any contractions. I did have a handful of days where I had some breakthrough contractions, but they all took place the day before my next shot.
It was actually a fun process for a medically minded person like me to learn how to give myself an injection, my husband did the first few and I did the rest.
Doctors may differ on treatments with these shots. Some start at 16 weeks gestation, others will wait until preterm labor begins. And it is up to you and your doctor to decide when to discontinue treatment. Theory might be that labor will begin within 2 weeks of discontinuing treatment and the hormones are completely out of your system. But it really depends on the cause of preterm labor, and each individual's body. My personal experience was that I didn't dilate at all while on the injections, so once I discontinued, I had 5 weeks before I delivered, but I always dilate early and slowly. I also, discontinued treatment at 30-ish weeks due to the nausea I was having associated with the injections. So it kept me pregnant until 35 weeks which was amazing!
If I was the doctor giving out treatment, I would start injections at 24 weeks and end at 35 weeks. Then if it did take 2 weeks to deliver, the baby will still be term.
I want to mention that I did also receive a steroid shot for the baby's lungs at 32 weeks. At my hospital, the latest they will administer the shot is 32 weeks and it must be done at Labor and Delivery with an hour of fetal/contraction monitoring. If there is any indication prior to 32 weeks that you might deliver prematurely, I would definitely push for the steroid shots before it's too late. Any help for the baby is worth it's weight in gold!
The side effects of these progesterone shots are all those that can be associated with hormones. My body is very sensitive to hormones and thus these injections made me feel like I had returned to my first trimester. Very few people complain of that, but it was still worth prolonging my pregnancy as long as it did.
If you are experiencing or have experienced preterm labor, talk with your dr. to see if they think this is a treatment worth trying. A lot of doctors haven't tried it before and after researching they might be very interested in this treatment.
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