incompetent cervix

Mamas on Bedrest: Your Progesterone Questions Answered!

February 2nd, 2015

Hello Mamas!

I am very pleased to present to you the interview that I had with Dr. Anthony Scisione, Maternal-Fetal Medicine Specialist.

Anthony Sciscione, D.O., serves as director of the Delaware Center for Maternal & Fetal Medicine and program director of the Christiana Care OB/GYN Residency Program. He is also Director of the Division of Maternal Fetal Medicine and the OB-Gyn Residency Program at Christiana Care Health System, the Director of the Delaware Center for Maternal & Fetal Medicine and Professor of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University. Dr. Sciscione is widely published and is a principle and co-investigator on a number of national clinical studies in Maternal-Fetal medicine as well as a reviewer for articles in maternal-fetal medicine/health and obstetrics and gynecology.

Dr. Sciscione graciously agreed review the role of progesterone in the treatment of preterm labor as well as in the treatment of incompetent cervix. He gives a great overview, shares what is currently going on in the research arena and answers questions submitted by Mamas on Bedrest.

Please enjoy this very informative podcast and share your comments, suggestions and questions about progesterone therapy in the comments section below.

 

 

 

Mamas on Bedrest: Can routine cervical measuring and treatment with progesterone as indicated reduce and/or eventually eliminate bed rest?

January 6th, 2015

Hello Mamas and Happy New Year!!!

Right before we all took a much anticipated holiday break, The Society for Maternal-Fetal Medicine (SMFM) added their voice to those of  The American Congress of Obstetricians and Gynecologists (ACOG), The American College of Nurse Midwives (ACNM), The March of Dimes, Medicaid and The Perinatal Research Branch of the Eunice Kennedy Shriver Institute to recommend that preterm birth risk screening include cervical length measurements and for those women at increased risk, treatment with progesterone injections.

Why is this important? Well, if you visit our Facebook page, you will notice that a large number of the mamas in our community are on bed rest for cervical insufficiency or incompetent cervix. Cervical insufficiency is one of the leading causes of preterm labor in the US and one of the leading causes of infant mortality (infant death). The United States ranks 55th globally in infant mortality, with 26,000 infants dying annually before their first birthdays. This is a horrendous and utterly embarrassing statistic given that the US is one of the richest countries in the world with some of the most advanced health care, yet we can’t seem to save our babies. What is worse, infant mortality in the United States for African American babies is twice that of Caucasian babies, so deaths among little black infants is disproportionately high in the US.

But despite all this doom and gloom, the upside is that all of these medical societies have looked at the data as well as at available treatments and they have all come to the same conclusion: If there is more screening for preterm labor in pregnant women-measurement of the cervix and in those women at risk, the initiation of progesterone injections-the rates of preterm labor can be reduced 40-50% in mamas having just one baby and no prior history of preterm birth. And if every pregnant woman is screened for shortened cervix and those at risk identified and started on progesterone shots, medical costs associated with preterm labor, premature birth and subsequent medical and developmental support could be reduced by $750 million annually. Given that preterm labor and prematurity currently costs the US in excess of $26.2 billion annually, this is substantial savings. All of the medical societies are also in agreement that if a woman is noted to have a shortened cervix and is less than 24 weeks gestation, she should have a cerclage (a surgical stitich placed to hold the cervix closed) placed.

Preterm labor and prematurity are major issues in Maternal and Infant health and the leading cause of infant death before one year in the United States. If by simply screening and measuring cervical length early on with ultrasound and providing treatment with progesterone and cerclage can reduce preterm labor and prematurity and save the lives of babies, then we should be adopting these recommendations.

The elephant in the room for us here is will these practices negate the need for prescribed bed rest? That subject was not addressed in these recommendations, however, many of these same professional medical societies are recommending that bed rest not be routinely prescribed due to the negative effects that is has on Mamas’ bodies. So it will be very interesting to see how these recommendations are implemented and their effect on the overall preterm labor and prematurity rates. My guess is that if rates start dropping, we my in fact see a reduction in the bed rest prescription. Now wouldn’t that be exciting???

Mamas, share this information with your health care providers and see what they have to say. If you’ve been screened for a shortened cervix and started on progesterone, let us know in the comments section below. We would love to share the journey with you (join our Facebook Community!!)! And if you are prescribed the progesterone and/or cerclage without bedrest, do let us know how you fare and when you deliver your baby.

Reference

Society for Maternal-Fetal Medicine Joins with Other Organizations to Brief Congress on Need for Medical Protocols that will Save the Lives of Infants in the US by Reducing Preterm Birth. (Press Release December 17, 2014, Washington, D.C. Society for Maternal-Fetal Medicine. www.smfm.org

Mamas on Bedrest: Pessaries as a treatment for Cervical Insufficiency

September 29th, 2014

Hello Mamas!

In today’s video blog, I am discussing the use of pessaries for the treatment of cervical insufficiency. In answering a question from Mama on Bedrest Rose from our Facebook Community, I share the background on pessaries (typically used for treatment of bladder prolapse and urinary incontinence), how some Obstetricians are using them for cervical insufficiency and what the current research says about efficacy. THIS IS IN NO WAY A RECOMMENDATION FOR YOU TO GET A PESSARY!! If you think that you may be a candidate for a pessary, you may want to share this video with and talk with your healthcare provider.

References:

Uptodate – A medical reference website.