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What Are The Risks Of Having 3rd Degree Calcification In 32 Weeks Of Pregnancy?
Question: Hi Dr,
My wife is 25 years old. She is now 34 weeks and 2 days pregnant. She is otherwise normal with no other systemic illness such as no DM, no HTN etc.
We had a baby boy before with c-section, the c-section was performed on 30/septmber/2014, She was 36 weeks pregnant when they did the c-section that time , it was an emergency c-section because she developed Hydronephrosis probably on both kidneys (i can't remember if it was both kidneys or not). Her pregnancy before was smooth and normal she only had constant Irritable Uterus which was relieved by ritodrine but was difficult to take it all the time because of it's side effects.
Coming back to the current pregnancy, she still has the irritable uterus and now it's even worse, her uterus is contracting all day but the cervix is normal.
When she was 30 weeks she didin't feel the baby move for a whole day almost about 12 hours, which caused us some worrisome, we went to the Emergency department and they checked the baby heart beat was normal but the doctor said she can't arouse the baby to move, she asked us to stay in hospital for further check up but we denied and decided to go back home, almost after an hour from the hospital the baby started to move but not as strong as before. and everything was ok other than the painful irritable uterus.
When she was 32 weeks again she felt the baby was moving less , sometimes from 6am until 3pm she wouldn't feel any movement of the baby. so we went to a nearby clinic, The Doctor checked her with NT for 20 minutes and said the baby heart beat is perfect and there is slight contractions of the uterus due to the irritable uterus but otherwise nothing to worry about and for some reason the baby started to move just when they rapped her with the NT belt,
then later she checked with ultrasound and she found that the Placenta was calcified on the edges with center of the placenta being normal, she said it seems like a third degree calcification of the placenta. The amniotic fluid and everthing else seemed normal .
So the doctor said to not worry much, and do the following
1.stop Calcium supplements and Vitamin D as those can make calcification even worse.
2. visit her every week so she can check if the calcification is getting worse
3.make sure my wife lies on her left every 2 hours for 45 minutes to allow more oxygen to reach to the baby. (my wife can hardly do that now because she is taking of our son all day, she does that only once a day)
Currently she is doing well, other than painful irritable uterus. she says she feels less fetal movement compared to before, she uses an app on iPhone and she told me before 30 weeks she used move 150 times a day but now it's about 30 to 50 times a day.
She now takes the following medications
1.Pregnacare
2.Iron supplement (she had low ferritin with normal HGB and Iron level so the doctor told her she should take iron supplements)
Previously she used to take . 1.Duphastone, 2.Calcium Supplements 3.Vitmin D 4.Cylogest ( was interchanged couple of times with duphastone)
She stopped all these 4 medications at the moment.
My questions.
1.What are the risks to have 3rd degree calcification from 32 weeks of pregnancy.
2.does less fetal movements compared to before means an alarming thing, or as long as there is movement we shouldn't worry? is 30 to 50 fetal movements per day considered normal
3.do we need to do more tests to check if everything is fine ?
4.a friend of my wife suggested her to take Magnesium supplements as that helps with irritable uterus for her pregnancy, should i consider getting an OTC magnesium supplement for her, and if so what dosage should i get her? or is there anything you suggest us to do about those painful irritable uterus?
5. She did c-section on 30-september-2014 for her previous pregnancy at 36 weeks, her current pregnancy due date is 4-October-2016, can she give normal birth now or do you recomenned c-seciton ?
6.Any further suggestions and advice would be appreciated
Thank you.
My wife is 25 years old. She is now 34 weeks and 2 days pregnant. She is otherwise normal with no other systemic illness such as no DM, no HTN etc.
We had a baby boy before with c-section, the c-section was performed on 30/septmber/2014, She was 36 weeks pregnant when they did the c-section that time , it was an emergency c-section because she developed Hydronephrosis probably on both kidneys (i can't remember if it was both kidneys or not). Her pregnancy before was smooth and normal she only had constant Irritable Uterus which was relieved by ritodrine but was difficult to take it all the time because of it's side effects.
Coming back to the current pregnancy, she still has the irritable uterus and now it's even worse, her uterus is contracting all day but the cervix is normal.
When she was 30 weeks she didin't feel the baby move for a whole day almost about 12 hours, which caused us some worrisome, we went to the Emergency department and they checked the baby heart beat was normal but the doctor said she can't arouse the baby to move, she asked us to stay in hospital for further check up but we denied and decided to go back home, almost after an hour from the hospital the baby started to move but not as strong as before. and everything was ok other than the painful irritable uterus.
When she was 32 weeks again she felt the baby was moving less , sometimes from 6am until 3pm she wouldn't feel any movement of the baby. so we went to a nearby clinic, The Doctor checked her with NT for 20 minutes and said the baby heart beat is perfect and there is slight contractions of the uterus due to the irritable uterus but otherwise nothing to worry about and for some reason the baby started to move just when they rapped her with the NT belt,
then later she checked with ultrasound and she found that the Placenta was calcified on the edges with center of the placenta being normal, she said it seems like a third degree calcification of the placenta. The amniotic fluid and everthing else seemed normal .
So the doctor said to not worry much, and do the following
1.stop Calcium supplements and Vitamin D as those can make calcification even worse.
2. visit her every week so she can check if the calcification is getting worse
3.make sure my wife lies on her left every 2 hours for 45 minutes to allow more oxygen to reach to the baby. (my wife can hardly do that now because she is taking of our son all day, she does that only once a day)
Currently she is doing well, other than painful irritable uterus. she says she feels less fetal movement compared to before, she uses an app on iPhone and she told me before 30 weeks she used move 150 times a day but now it's about 30 to 50 times a day.
She now takes the following medications
1.Pregnacare
2.Iron supplement (she had low ferritin with normal HGB and Iron level so the doctor told her she should take iron supplements)
Previously she used to take . 1.Duphastone, 2.Calcium Supplements 3.Vitmin D 4.Cylogest ( was interchanged couple of times with duphastone)
She stopped all these 4 medications at the moment.
My questions.
1.What are the risks to have 3rd degree calcification from 32 weeks of pregnancy.
2.does less fetal movements compared to before means an alarming thing, or as long as there is movement we shouldn't worry? is 30 to 50 fetal movements per day considered normal
3.do we need to do more tests to check if everything is fine ?
4.a friend of my wife suggested her to take Magnesium supplements as that helps with irritable uterus for her pregnancy, should i consider getting an OTC magnesium supplement for her, and if so what dosage should i get her? or is there anything you suggest us to do about those painful irritable uterus?
5. She did c-section on 30-september-2014 for her previous pregnancy at 36 weeks, her current pregnancy due date is 4-October-2016, can she give normal birth now or do you recomenned c-seciton ?
6.Any further suggestions and advice would be appreciated
Thank you.
Brief Answer:
Please provide the following information...
Detailed Answer:
Thank you for the question and I am sorry about any delay. I would like the following information in order to provide you with the best answer:
1. How was the due date determined - did she have an early ultrasound and how many weeks was she at that time?
2. Are there any medication complications such as diabetes?
3. When was the LAST ultrasound exactly and was there any concern about growth or fluid at that time?
Dr. Tim
Please provide the following information...
Detailed Answer:
Thank you for the question and I am sorry about any delay. I would like the following information in order to provide you with the best answer:
1. How was the due date determined - did she have an early ultrasound and how many weeks was she at that time?
2. Are there any medication complications such as diabetes?
3. When was the LAST ultrasound exactly and was there any concern about growth or fluid at that time?
Dr. Tim
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Doctor, thanks for quick response.
1. The due date was determined based on my wifes last period and the ultrasound scan, when we first visited the Doctor, my wife was 6 weeks pregnant, The doctor enquired about my wifes last period and after checking the ultrasound she said that the due date is on 4/10/2016.
My wife last period was on 27/12/2015.
2. There are no complications from any medications, she has no other illness such as Diabetes,hypertension,chronic liver disease ,pancreatitis etc. she didn't take any medications for any other illness as well.
3. The last scan was done on 18/08/2016 that's about 5 days ago. The Doctor said everything seemed normal, the amniotic fluid is normal, the baby heartbeat is normal, the head and abdomen were same with the pregnancy weeks which was 33 weeks, however the femur length showed 2 weeks behind (it showed 30 weeks when my wife was 33 weeks that time.). The baby weight was 1,830 kg..
Thank you.
1. The due date was determined based on my wifes last period and the ultrasound scan, when we first visited the Doctor, my wife was 6 weeks pregnant, The doctor enquired about my wifes last period and after checking the ultrasound she said that the due date is on 4/10/2016.
My wife last period was on 27/12/2015.
2. There are no complications from any medications, she has no other illness such as Diabetes,hypertension,chronic liver disease ,pancreatitis etc. she didn't take any medications for any other illness as well.
3. The last scan was done on 18/08/2016 that's about 5 days ago. The Doctor said everything seemed normal, the amniotic fluid is normal, the baby heartbeat is normal, the head and abdomen were same with the pregnancy weeks which was 33 weeks, however the femur length showed 2 weeks behind (it showed 30 weeks when my wife was 33 weeks that time.). The baby weight was 1,830 kg..
Thank you.
Brief Answer:
Multiple answers to question are detailed below...
Detailed Answer:
Thank you for the followup information. Here are my answers to your questions:
1. What are the risks to have 3rd degree calcification from 32 weeks of pregnancy?
Calcification seen on ultrasound is a nonspecific finding. It is common in a mature placenta but can certainly be seen at 34-35 weeks of pregnancy. The risk of doing anything about this (such as early delivery) is outweighed by the risk of delivering a 34 week fetus. Given her complaint of regular contractions and a subjective sense of less fetal movement (and in the setting of any concern regarding the placenta) I would probably bring her in for monitoring weekly and repeat the growth in about 3-4 weeks.
2. Does less fetal movements compared to before means an alarming thing, or as long as there is movement we shouldn't worry? is 30 to 50 fetal movements per day considered normal?
Anything counts when it comes to movements - big or small. They change later in pregnancy and might be sensed as 'less' movement. I tell patients that, in any two hour window, you should be able to feel the baby move. 10 movements in two hours would be considered 'normal'.
3. Do we need to do more tests to check if everything is fine ?
As I stated above, it is important to monitor her for regular contraction activity and signs of labor. If she is laboring, this is a stress on the old C-section incision.
4. A friend of my wife suggested her to take Magnesium supplements as that helps with irritable uterus for her pregnancy, should i consider getting an OTC magnesium supplement for her, and if so what dosage should i get her? or is there anything you suggest us to do about those painful irritable uterus?
Magnesium supplementation is harmless and a typical dose might be 1gm per day. Consider that in patients in whom we are trying to prevent preterm labor, we are giving this in doses exceeding 1gm per hour!
5. She did C-section on 30-september-2014 for her previous pregnancy at 36 weeks, her current pregnancy due date is 4-October-2016, can she give normal birth now or do you recommend C-section?
I honestly do not have enough information to say whether she is a good candidate for a trial of labor vs. a repeat C-section.
Dr. Tim
Multiple answers to question are detailed below...
Detailed Answer:
Thank you for the followup information. Here are my answers to your questions:
1. What are the risks to have 3rd degree calcification from 32 weeks of pregnancy?
Calcification seen on ultrasound is a nonspecific finding. It is common in a mature placenta but can certainly be seen at 34-35 weeks of pregnancy. The risk of doing anything about this (such as early delivery) is outweighed by the risk of delivering a 34 week fetus. Given her complaint of regular contractions and a subjective sense of less fetal movement (and in the setting of any concern regarding the placenta) I would probably bring her in for monitoring weekly and repeat the growth in about 3-4 weeks.
2. Does less fetal movements compared to before means an alarming thing, or as long as there is movement we shouldn't worry? is 30 to 50 fetal movements per day considered normal?
Anything counts when it comes to movements - big or small. They change later in pregnancy and might be sensed as 'less' movement. I tell patients that, in any two hour window, you should be able to feel the baby move. 10 movements in two hours would be considered 'normal'.
3. Do we need to do more tests to check if everything is fine ?
As I stated above, it is important to monitor her for regular contraction activity and signs of labor. If she is laboring, this is a stress on the old C-section incision.
4. A friend of my wife suggested her to take Magnesium supplements as that helps with irritable uterus for her pregnancy, should i consider getting an OTC magnesium supplement for her, and if so what dosage should i get her? or is there anything you suggest us to do about those painful irritable uterus?
Magnesium supplementation is harmless and a typical dose might be 1gm per day. Consider that in patients in whom we are trying to prevent preterm labor, we are giving this in doses exceeding 1gm per hour!
5. She did C-section on 30-september-2014 for her previous pregnancy at 36 weeks, her current pregnancy due date is 4-October-2016, can she give normal birth now or do you recommend C-section?
I honestly do not have enough information to say whether she is a good candidate for a trial of labor vs. a repeat C-section.
Dr. Tim
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
Hi Doctor, thanks you for the well detailed answers.
1.you said "I would probably bring her in for monitoring weekly and repeat the growth in about 3-4 weeks." what do you mean by repeat growth? do you mean repeat baby growth? doesn't that include in the normal monitoring or is there special ultrasound for it?
2.you said , "10 movements in two hours would be considered 'normal'" .
I just asked my wife how many times did the baby move since she woke up.
She told me from 5:30am (when she woke up) until now 9:30am the baby moved 6 times, 3 movements in the morning just when she woke up and 3 movements when she tried to lie on her left for 25 minutes when it was about 9am.
so about 4 hours the baby only moved 6 times, isn't that abnormal? some days she has a total of 25 movements and on other days 40 to 50. But before 32 weeks she was getting more than 150 times of movements .
I will get an over the counter magnesium supplement, I'm thinking about Additiva Magnesium 300mg once daily as per my wifes friend dosage. is that ok?
1.you said "I would probably bring her in for monitoring weekly and repeat the growth in about 3-4 weeks." what do you mean by repeat growth? do you mean repeat baby growth? doesn't that include in the normal monitoring or is there special ultrasound for it?
2.you said , "10 movements in two hours would be considered 'normal'" .
I just asked my wife how many times did the baby move since she woke up.
She told me from 5:30am (when she woke up) until now 9:30am the baby moved 6 times, 3 movements in the morning just when she woke up and 3 movements when she tried to lie on her left for 25 minutes when it was about 9am.
so about 4 hours the baby only moved 6 times, isn't that abnormal? some days she has a total of 25 movements and on other days 40 to 50. But before 32 weeks she was getting more than 150 times of movements .
I will get an over the counter magnesium supplement, I'm thinking about Additiva Magnesium 300mg once daily as per my wifes friend dosage. is that ok?
Brief Answer:
Magnesium dose is okay
Detailed Answer:
Thank you for the follow up. Here are clarifications per your questions:
1. In someone with a prior C-section and in whom there has been a noticeable change in fetal movement for unexplained reasons, AND in whom there is regular contraction activity that is unexplained, I would bring them in weekly to evaluate the pregnancy. Every week this would involve placing her on the NST to monitor contraction activity and see how the baby tolerates this. The NST is a short term test of fetal well being. It can be done weekly, but ultrasounds for growth can only be done monthly (due to the error in ultrasound measurements). So, I think of the weekly testing as the thing you do to get you to the other test, measure of fetal growth and fluid, that would be done monthly.
2. Basically, a fetus can 'sleep' for up to an hour with no movement. So, in any two hour window, a fetus should show some movement. There is no protocol that is better than another. I tell patients to watch for '10 movements in two hours' because it is easy to remember. She should talk specifically with her doctor about what they want in terms of self-monitoring. Also, if a patient notices a trend over time of taking longer to get to 10 movements then they are also evaluated similar to what is described in #1 above
3. Yes, that dose of magnesium is harmless
So, I understand your concerns and that your wife is miserable. She needs to make it at least another 3 weeks, so in that time period, given that her own sense of fetal movement has become more unreliable, there needs to be some new form of fetal monitoring.
Dr. Tim
Magnesium dose is okay
Detailed Answer:
Thank you for the follow up. Here are clarifications per your questions:
1. In someone with a prior C-section and in whom there has been a noticeable change in fetal movement for unexplained reasons, AND in whom there is regular contraction activity that is unexplained, I would bring them in weekly to evaluate the pregnancy. Every week this would involve placing her on the NST to monitor contraction activity and see how the baby tolerates this. The NST is a short term test of fetal well being. It can be done weekly, but ultrasounds for growth can only be done monthly (due to the error in ultrasound measurements). So, I think of the weekly testing as the thing you do to get you to the other test, measure of fetal growth and fluid, that would be done monthly.
2. Basically, a fetus can 'sleep' for up to an hour with no movement. So, in any two hour window, a fetus should show some movement. There is no protocol that is better than another. I tell patients to watch for '10 movements in two hours' because it is easy to remember. She should talk specifically with her doctor about what they want in terms of self-monitoring. Also, if a patient notices a trend over time of taking longer to get to 10 movements then they are also evaluated similar to what is described in #1 above
3. Yes, that dose of magnesium is harmless
So, I understand your concerns and that your wife is miserable. She needs to make it at least another 3 weeks, so in that time period, given that her own sense of fetal movement has become more unreliable, there needs to be some new form of fetal monitoring.
Dr. Tim
Above answer was peer-reviewed by :
Dr. Prasad
thanks for the well-detailed answer doctor.
Last questions before i close discussion.
One thing I forgot to mention which I remembered when i saw my wife complaining about today is that , since 2 weeks (that is from 32 weeks) my wife has sudden upper left abdominal pain that radiates to the back sometimes, she explains the pain as sudden shooting pain on her upper left abdomen. When she told the Doctor she suspected pancreatitis or gallstones but the test came back negative for both these diseases. The doctor didn't know what's going on, the uterus ultrasound was normal other than the calcification in the placenta as i mentioned above.
1.What do you suggest regarding this pain? what would you suspect? pre-eclampsia? or something related to the pregnancy?
2.Is there any specific treatment for her Irritable Uterus?
3.My wife currently takes IRON supplements can she take it together with Magnesium supplements or is there drug interaction?
Thank you in advance for all the detailed answers, very happy to have discussed with you ..
Last questions before i close discussion.
One thing I forgot to mention which I remembered when i saw my wife complaining about today is that , since 2 weeks (that is from 32 weeks) my wife has sudden upper left abdominal pain that radiates to the back sometimes, she explains the pain as sudden shooting pain on her upper left abdomen. When she told the Doctor she suspected pancreatitis or gallstones but the test came back negative for both these diseases. The doctor didn't know what's going on, the uterus ultrasound was normal other than the calcification in the placenta as i mentioned above.
1.What do you suggest regarding this pain? what would you suspect? pre-eclampsia? or something related to the pregnancy?
2.Is there any specific treatment for her Irritable Uterus?
3.My wife currently takes IRON supplements can she take it together with Magnesium supplements or is there drug interaction?
Thank you in advance for all the detailed answers, very happy to have discussed with you ..
Brief Answer:
Pregnancy related discomfort and constipation / gas pain...
Detailed Answer:
First of all, lets review pain related to gallstones or pancreas and also my thoughts on your other questions:
1. Pancreas - midline pain stabbing straight through to the back
2. Gallbladder - RIGHT upper quadrant pain, worse after a high fat meal
3. No, this does not sound like preeclampsia
4. Yes, I think that the pain and discomfort is related to the pregnancy.
5. No, there really is no treatment for her irritable uterus, unfortunately
6. The IRON supplements cause constipation and this might be part of the problem
In a patient who is pregnant with left upper quadrant or left sided pain, the most likely explanation is related to gas pain. The only thing on that side of any significance is the large intestine. Most pregnant women have some version of constipation. This is often made worse by iron supplements.
Just a reminder - my impressions of your wife's situation and answers to questions are just hypothetical answers to any similar situation. I don't want you to construe my answer as medical advice because it is not. While it sounds like this is all normal, you need to keep her doctor involved as well as they may want her seen more often or perform other evaluations.
It has been a pleasure to help!
Dr. Tim
Pregnancy related discomfort and constipation / gas pain...
Detailed Answer:
First of all, lets review pain related to gallstones or pancreas and also my thoughts on your other questions:
1. Pancreas - midline pain stabbing straight through to the back
2. Gallbladder - RIGHT upper quadrant pain, worse after a high fat meal
3. No, this does not sound like preeclampsia
4. Yes, I think that the pain and discomfort is related to the pregnancy.
5. No, there really is no treatment for her irritable uterus, unfortunately
6. The IRON supplements cause constipation and this might be part of the problem
In a patient who is pregnant with left upper quadrant or left sided pain, the most likely explanation is related to gas pain. The only thing on that side of any significance is the large intestine. Most pregnant women have some version of constipation. This is often made worse by iron supplements.
Just a reminder - my impressions of your wife's situation and answers to questions are just hypothetical answers to any similar situation. I don't want you to construe my answer as medical advice because it is not. While it sounds like this is all normal, you need to keep her doctor involved as well as they may want her seen more often or perform other evaluations.
It has been a pleasure to help!
Dr. Tim
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
thank you Doctor.
Appreciate the time you took to answer deliberately to all my questions.
I'm aware and understand your consultation here is based on hypothetical answer and thorough evaluation of her situation is required by a physician who can see her and order the required tests directly. However valuable discussion and suggestions allows me to further know my wife current situation also so that i can talked to our doctor regarding the points you mentioned so that she can also consider it.
We went to the Doctor today for the 1 week follow up and everything seem normal and the baby added about 350grams since last week (she was 1800gram now 2150grams) , the calcification didn't get worse , the amniotic fluid and fetal heartbeat were normal. fetal growth was also at normal range.
She gave her injection called Primolut 250mg at the hospital and cyclogest for 1 week. she said this is good to help with my wife contractions and so that we can keep her until above 36 weeks.
My questions.
1.What do you think about the Doctors treatment plan?
2.are these medications safe? I read too much progesterone during pregnancy might cause SLE to the baby in the future. it worries me that because our doctor kept on prescribing Duphaston and cyclogest interchangeably for the past 2 to 3 months.
3.cyclogest sometimes causes her to have itchiness in the vagina makes her feel like she is getting thrush, should it be stopped if symptoms of thrush or itchiness is felt while taking cyclogest?
I'm sorry doctor, this will be my last questions. I just wanted to let you know our doctors plan so you can give us your point of view as well. We are currently in the middle east, not in USA that's why I get concerned if we are receiving adequate treatment as home country.
????
Appreciate the time you took to answer deliberately to all my questions.
I'm aware and understand your consultation here is based on hypothetical answer and thorough evaluation of her situation is required by a physician who can see her and order the required tests directly. However valuable discussion and suggestions allows me to further know my wife current situation also so that i can talked to our doctor regarding the points you mentioned so that she can also consider it.
We went to the Doctor today for the 1 week follow up and everything seem normal and the baby added about 350grams since last week (she was 1800gram now 2150grams) , the calcification didn't get worse , the amniotic fluid and fetal heartbeat were normal. fetal growth was also at normal range.
She gave her injection called Primolut 250mg at the hospital and cyclogest for 1 week. she said this is good to help with my wife contractions and so that we can keep her until above 36 weeks.
My questions.
1.What do you think about the Doctors treatment plan?
2.are these medications safe? I read too much progesterone during pregnancy might cause SLE to the baby in the future. it worries me that because our doctor kept on prescribing Duphaston and cyclogest interchangeably for the past 2 to 3 months.
3.cyclogest sometimes causes her to have itchiness in the vagina makes her feel like she is getting thrush, should it be stopped if symptoms of thrush or itchiness is felt while taking cyclogest?
I'm sorry doctor, this will be my last questions. I just wanted to let you know our doctors plan so you can give us your point of view as well. We are currently in the middle east, not in USA that's why I get concerned if we are receiving adequate treatment as home country.
????
Brief Answer:
You are getting good treatment.
Detailed Answer:
Thank you for the followup and I am happy that everything is going well with the baby. That is very reassuring that there is normal interval growth and normal amniotic fluid volume present.
With regard to your questions, here are my thoughts:
1. The use of progesterone (primolut and cyclogest) is considered harmless during pregnancy, whether in the first, second or third trimester. In the USA, we use progesterone in the first trimester for patients with a history or recurrent miscarriage, and in the second and third trimesters in patients who have an increased risk of early delivery. I have noticed that the US and middle eastern countries differ quite a bit with regard to the use of this type of medication. We would not use it for the specific situation in which your wife is in, but it is completely reasonable and if it works then it is a good thing.
2. I have never heard about this connection between and SLE
3. Given that progesterone for preterm contractions is not a typical use of this medication AND the fact that she got a shot of progesterone already at the hospital AND the fact that she is miserable with the cyclogest vaginally, it would seem reasonable to stop this medication - but she should check with her doctor before doing so.
4. If we had a patient such as her, and after determining that she was NOT in labor (no cervical change) AND knowing that there is nothing concerning about the pregnancy otherwise, we might treat her with a low dose of Nifedipine to relax the uterus and decrease contractions
I hope that this helps!
Dr. Tim
You are getting good treatment.
Detailed Answer:
Thank you for the followup and I am happy that everything is going well with the baby. That is very reassuring that there is normal interval growth and normal amniotic fluid volume present.
With regard to your questions, here are my thoughts:
1. The use of progesterone (primolut and cyclogest) is considered harmless during pregnancy, whether in the first, second or third trimester. In the USA, we use progesterone in the first trimester for patients with a history or recurrent miscarriage, and in the second and third trimesters in patients who have an increased risk of early delivery. I have noticed that the US and middle eastern countries differ quite a bit with regard to the use of this type of medication. We would not use it for the specific situation in which your wife is in, but it is completely reasonable and if it works then it is a good thing.
2. I have never heard about this connection between and SLE
3. Given that progesterone for preterm contractions is not a typical use of this medication AND the fact that she got a shot of progesterone already at the hospital AND the fact that she is miserable with the cyclogest vaginally, it would seem reasonable to stop this medication - but she should check with her doctor before doing so.
4. If we had a patient such as her, and after determining that she was NOT in labor (no cervical change) AND knowing that there is nothing concerning about the pregnancy otherwise, we might treat her with a low dose of Nifedipine to relax the uterus and decrease contractions
I hope that this helps!
Dr. Tim
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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