reasurance needed - early contractions and fetal fiber nectin testing? also procardia XL?

[ismommy]

Hi
I am hoping you all can chime in with advice, knowledge and reasurance. I am 24 weeks pregnany with baby X and started having contractions last week. My OB recommended take it easy(no lifting, limited walking etc.)They have started getting harder and now my OB is talking about medicating.I want to avoid this if at all possible. I was on terbutaline with bella and it was horrible. My midwife(who I can't see this time but is a close personal friend) said to ask about fetal fiber nectin testing. I guess it can indicate up to two weeks of not having preterm labor. Does anyone have any experience with this? Thanks so much for any help and advice.
ETA name of the drug is: Procardia XL 30mm Has anyone been on this?
I am having the FFN test done tomorrow so please keep your fingers crossed that it shows no preterm labor. Thanks so much for all your input so far. I am hoping some of our docs and OBS will chime in
Helene
mommy to Isabella
baby x EDD 1/11/05

[nathansmom]

No advice as this is the first time I've had contractions before labor. However I am scheduled for the test you've mentioned for Monday evening. I can report back then with details.

[ismommy]

Norah,
Did you OB give you any percentages on how good this test is? I am not even sure if my OB does it but I am hoping he does. Any info you have would be great. Do they have you on any meds? Thanks so much
Helene
mommy to Isabella
baby x EDD 1/11/05

[jk3]

I'm so sorry you are going through this. I had this test at 26, 28, and 30 weeks. They all came back negative + it was a huge relief.

I was hospitalized at 26 weeks for regular contractions, put on Magnesium Sulfate + fluids. The mag. sulf. was fine but the drugs have some pretty major side effects. I was on Terbutaline for a few days but just couldn't cope with it. Since I was not dilating + the ffn tests came back negative I didn't have to continue with the meds. Sometimes dehydration can exacerbate the situation so drink LOTS of water. I revisited the hospital a couple of times + iv fluids did the trick those times. Then I was on modified bedrest from 26-24 weeks + delivered 36 weeks 1 day. Please feel free to pm or email me.

=) Jenn

Jenn
DS 6/03

http://lilypie.com/baby2/030603/2/5/1/-5/.png

[lizajane]

i started contracting at 20 weeks. my OB told me that it wasn't contracting, it was cramping. whatever. this is my second child and i had tons of braxton hicks with my first. this isn't cramping. she told me to 1)take it easy (ha! i have an 18 month old!) and 2) drink lots of water.

i hope it isn't anything serious!!! keep us posted.

[rrosen]

I don't have advice but, I really wanted to send you a hug. I know you must be feeling anxious right now. I hope you get the answers you need. Try to take it easy and rest as much as possible, a tall order for a mama, I know.

Take care,

[mommd]

There is good info on this test from the March of Dimes:

http://www.marchofdimes.com/professionals/681_1149.asp

It is more reliable if the fetal fibronectin test is negative, meaning that you won't go into labor for at least 2 weeks. If it is positive, it doesn't always mean you will go into labor. Hope everything is OK!

ETA: Some percentages, another website says this

"If a fetal fibronectin result is positive in the patient population, they have a one in six chance of delivering within the next two weeks. In patients that are asymptomatic and high risk for preterm birth, such as those with multiple gestations, a previous preterm birth, uterine anomaly, or a first pregnancy, patients have been tested before between 22 and 34 weeks of gestation with a fetal fibronectin sample collected at two week intervals. In patients with the above risk factors, one out of three will deliver at less than 37 weeks of gestation."

From http://www.lvpa.com/articles/fibronectin.htm

[NEVE and TRISTAN]

Helene the second Steve walks in the door I am passing TRistan to him and calling you!!!! I wish I had some insight on the Procardia but we have two mommies here atleast in the field of OB and I hope they see this too...
I am glad that you shared with the boards this is a great support system and we all want to be there for you!!!!

BIg hugs to you honey and we'll speak in a few minutes!!!!

Neve and Tristan born Feb 25, 2003
* EDD 3/19/05 IT'S A GIRL
* Adopting siblings in Ukraine 1/05

http://home.nc.rr.com/ourbabytristan

[amp]

Helene - I have no info for you on this. I just wanted to let you know that I will be sending non-labor vibes your way. Hugs to you!

[icunurse]

FFN has been shown to be pretty accurate, so it would never hurt to be able to keep a closer eye on or treat preterm labor if it should come back that you are at high likelihood to have preterm labor. My friend had one done, as she was high risk, it came back negative and she did go full term. I used to work in a neonatal ICU (but it's been a while)....if you should start going into preterm labor, you can be given doses of steroids to help the baby's lungs mature faster. But they have to be spaced apart a certain amount of time and it's more than one dose. Maybe ask your doc about the possibility of receiving them (ie. what they do, how they are given, side effects, etc.) Also, does the OB want you on Procardia for your blood pressure or what is it being prescribed for? Just get some rest, take it easy, and let us know how the test goes. Fingers crossed for you.
Traci
~Connor's Mom~
http://lilypie.com/baby1/050204/1/0/1/-6/.png (http://lilypie.com)

[lukkykatt]

Helene,

No real experience here. I did have contractions starting at 32 weeks with DS#2, but I never had to be medicated.

Just wanted to send hugs, and wish you well! Let us know how your test turns out.

[chrissyhowie]

The fetal fibronectin (fFN) test is probably the best test out there right now to help predict preterm delivery. As others have mentioned, its strength lies in its excellent negative predictive value. In other words, >99% of women with symptoms of or at high risk for preterm delivery stayed pregnant for at least two more weeks. The best thing about a negative result is that it can allow you to avoid unneeded intervention or taking unnecessary medications. If the test returns with a positive result, while it is better than anything else out there right now (digital exam, risk scoring, non-stress tests with contraction monitoring), it still is not great at predicting exactly who will deliver preterm.

As for the Procardia XL (generic name nifedipine), this class of medication has been shown to be effective in prolonging pregnancy for at least 48 hours. It is also the only medication that has shown improved outcomes for preterm babies. In addition, it is usually better tolerated than medications like terbutaline. These days, it is and should be considered first line therapy. (But I am really hoping your fFN test will come back negative so you don't have to be on any meds :) ).

There will be many people here thinking good thoughts for you and your baby!

HTH,

[egoldber]

Helene, many hugs to you!!! Please let us know if we can do anything for you!

[NEVE and TRISTAN]

I spoke with Helene tonight and said "I hope Chrissy your post!!!!!!!!!!" :)...you are the GREATEST!!!!!!

Neve and Tristan born Feb 25, 2003
* EDD 3/19/05 IT'S A GIRL
* Adopting siblings in Ukraine 1/05

http://home.nc.rr.com/ourbabytristan

[ktdid74]

Hi Helene- I was on Procardia(nifedipine) with both pregnancies. I wasn't on the XL, just the 20mg every 4-6 hours. I started off with Brethine (terbutaline) then went to mag. After my fFN came back negative, I was allowed to just continue on the nifedipine until 36 weeks. I delivered at 36wks with #1 and 40wks with #2. I contracted continuously from 22 weeks on with both pregnancies (but I have a uterine defect that makes me more likely to contract).
The nifedipine made me feel very flushed and hot. I could watch my feet turn red and continue on up my legs. I occasionally felt palpitations and my feet swelled.
Good luck and here's to a negative fFN! Take care and hang in there!

[lrucci]

Helene,

Sorry, I have no advice for you but I just wanted to let you know that I'm thinking about you and sending big hugs your way. Please let me know if there is anything I can do for you.

Lisa
Mom to Kyleigh 7/19/03

[ismommy]

Thanks so much for all the replies.
I have a couple more questions - Chrissy if the Procardia only holds off labor 48 hours why would I be on it for weeks?
Katie so even though you had a negative FFN they kept you on the meds. Were you also on bedrest? Is the procardia as bad as terbutaline - I had to take that every 4 hours with bella and I have never felt so sick in my life.
Thanks so much for answering and I will post my results as soon as I get them.
Helene
mommy to Isabella
baby x EDD 1/11/05

[zuzu]

No advice from me either, but wanted to send along big hugs and wish you well!
Take it easy (easier said than done, I know) and keep us posted.

Melissa, mom to Sarah (5/03)

[chrissyhowie]

The 48 hour mark is an important outcome measure for studying any preterm labor intervention because it provides you time to administer steroids (to promote lung maturity) to women who will go on to deliver a preterm infant. So when looking at any new intervention for preterm labor, the first outcome to examine would be whether it was more effective than no intervention at getting women to that 48 hour point. For many women it will prolong the pregnancy longer than that, but that 48 hour window is crucial for those who will ultimately end up delivering soon after they arrive at the hospital in preterm labor to get those steroid on board.

There is a big difference in those who have preterm contractions (which many women experience) and who amongst that group will actually go on to preterm labor (when those contraction actually cause cervical dilation). Predicting who amongst the preterm contraction group will NOT go on to preterm labor is what the fFN test does best. When there is a negative fFN test, some doctors will choose not to put the patient on any medications and others will choose to continue with medications which are relatively well tolerated (such as Procardia). That will ultimately depend on the discussion had between the doctor and the patient.

And then the $64 million dollar question is how do you stop preterm labor? If I knew the answer to that, I'd be going to Stockholm to pick up my Nobel prize ;).

Good luck with everything today! I'll be thinking healthy thoughts for you!

[ktdid74]

Hi Helene- I was just checking to see if you had your test yet? Feel free to PM me if you need anything at all. I actually work as a RN in labor and delivery but was admitted as a patient while I was working! I was on modified bedrest for both pregnancies starting at 25 weeks. Obviously it was easier to behave with #1 since I didn't have a 2 year old to deal with. The bedrest didn't make me stop contracting but I contracted less with less activity.
I was kept on the meds basically to try to keep my uterus a little less irritable. I found the procardia easier to deal with but I only had brethine shots while in the hospital- never took the pills. Like I said, the part I didn't like about the procardia was the hot flashes. It is a blood pressure med so don't stand up too quick- you'll feel even more light headed.
Just keep little goals in your head- I only thought ahead to the next milestone like 28wks, then 32, then 35. Take care and keep us posted--

[ismommy]

Katie,

I had my test this morning and they said I would have results today - though I had read it can be up to 36 hours. I am hoping my OB calls soon. I am at 24 weeks and either 3 or 5 days depending on which u/s you go by. I am keeping small goals in mind. I will post as soon as my OB call.s
Helene
mommy to Isabella
baby x EDD 1/11/05

[ismommy]

Chrissy,

SO I guess I am having preterm contractions and hoping they dont say pretrerm labor? I also can see you heading to stockholm to pick u that prize one day:) Thanks so much for ansering my questions and thanks to everyone for their warm wishes and sharing stories. It is so nice to hear other moms who had this happena nd had full term babies.
Helene
mommy to Isabella
baby x EDD 1/11/05

[JenaW]

Helene

I am an OBGYN PA, but I have nothing else to add...other than some more well-wishes. Chrissy explained the test and results pretty well. I am praying that yours comes back negative.

FWIW - my fFN was positive with my son at 30 weeks.....I was induced after my due date at 41 weeks. A positive test is not at all a guarantee that you WILL have preterm labor...it probably will warrant meds and bedrest though. I continued contracting but never had any significant cervical change.

I hope you got your results today and don't have to wait until Monday. I am thinking of you.
Jera
Mom to Carter ~ 05.13.03
Cautiously pregnant with #2 ~ EDD 10.13.04

[ismommy]

Thanks Jera. No results yet and since its 9:45 Friday night I am guessing I will have to wait until Monday. This will probably drive me nuts. I keep reminding myself even with contractions baby x can and will be full term.
Helene
mommy to Isabella
baby x EDD 1/11/05

[JenaW]

Oh that stinks! I can't believe they are making you wait. Maybe someone will call tomorrow???

You are right - even with contractions this early, your baby can still go to term. I started contracting early with this pregnancy too, (can't remember exactly when they started - it was just cramping at first) and am 38 weeks and still pregnant (and STILL contracting ;) ). Just take it easy as much as you can.


Jera
Mom to Carter ~ 05.13.03
Cautiously pregnant with #2 ~ EDD 10.13.04