When to deliver w/ history of classical c-section

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hols537
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Re: When to deliver w/ history of classical c-section

Postby hols537 » Tue May 31, 2011 07:20 am

Yes, they had been checking my cervix regularly and I was having cervical length ultrasounds. The signs that had me head into L&D were contractions and I had just started dilating and was 1cm, so it was the very earliest signs of labor that prompted delivery.

I did not have an amnio or a fetal fibronectin at that point (I had one earlier in the pregnancy because I had been having issues with contractions and had been taking 17P and terbutaline to prevent PTL anyways). My case may have been different because of the contractions I'd been having?
Holly
DS 1 - 2/26/07 (32 weeks, Severe PE, IUGR, Oligo)
DS 2 - 9/13/08 (38 weeks, Folgard, Lovenox, 17P, No PE)

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riehlism
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Re: When to deliver w/ history of classical c-section

Postby riehlism » Mon May 30, 2011 07:31 pm

I'll be 18 weeks on Wednesday and I just asked my doctor about this. He said he will schedule an amnio at 36 weeks, hoping for a 37-week delivery. I had a classical C-Section last June. It looks like my doctor has the same plans as your Dr. H.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

rebecca2
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Re: When to deliver w/ history of classical c-section

Postby rebecca2 » Mon May 30, 2011 02:49 pm

I get the sense this is not typical, but I was scheduled for a repeat c/s at 39 weeks with my second despite having a classic c/s with my first. At the first signs of labor at 38 weeks (on the nose), they delivered. I had no complications but they did give medications to stop/slow the labor while we waited for bloodwork and the heparin to clear my system because they did not want contractions intensifying.
Hols537, how did your OB monitor you during those last couple of weeks of pregnancy? Did they do frequent cervical checks early on to help predict whether you were close to labor? Did they do that swab test to get an idea if labor was likely? (I don't remember the name of it, but the one they use in late 2nd/early 3rd trimester if they suspect someone might go into preterm labor? I think a negative result gives some reassurance that labor is unlikely for at least 2 weeks. It might not even be valid this late in pregnancy.) Also, what were your first signs of labor at 38 weeks that led to delivery? Was it actual contractions, or other less noticeable symptoms? Sorry for so many questions. I would love to make it to 38 weeks especially if there is some way to know if I'm getting close to labor.

Alexis, do you know if your friends OB did any special monitoring for labor with your friend?
Becky
Mom to...
baby girl Addison 3/11/09-3/11/09 (severe preeclampsia 26w5d)
baby boy Aden 5/25/10 (35w6d low amniotic fluid)
baby boy #2 due 7/4/11

rebecca2
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Re: When to deliver w/ history of classical c-section

Postby rebecca2 » Mon May 30, 2011 02:33 pm

Thanks ladies.

Angie, the hospitals around here have the same policy requiring amnios prior to 37 weeks, or at least they did last year. However, I think the classical c-section alone is technically enough for the hospital to consider it medically necessary. Now there is a BIG push in our area (& I think nationwide) to avoid elective deliveries prior to 39 weeks, so I'm not really sure if the hospital has changed its official policy or if they are just encouraging doctors/patients to wait until 39 weeks. My understanding is the push to wait until 39 weeks has more to do with brain development and overall health. Apparently the newer research suggests that there is a lot more brain development occurring during the last couple of weeks of pregnancy than previously thought.

Miamibunnie, your doctors sound like mine. FWIW, with my son there was talk about 35 weeks too, but as we got closer to 35 weeks they kept pushing it back further. I'm excited to see you're approaching 30 weeks! I hope you have several more healthy weeks of pregnancy to go!
Becky
Mom to...
baby girl Addison 3/11/09-3/11/09 (severe preeclampsia 26w5d)
baby boy Aden 5/25/10 (35w6d low amniotic fluid)
baby boy #2 due 7/4/11

alexis
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Re: When to deliver w/ history of classical c-section

Postby alexis » Mon May 30, 2011 11:54 am

I did not have a classical, but a friend of mine delivered by classical CS at 24+5 because of severe PE. Her 2nd and 3rd pregnancies were PE free, and her OB had her deliver at 37-38 weeks.

There was a study showing more problems in early term babies (37-39 weeks). I would definitely try to push past 37 if everything was fine and I was showing no signs of dilation or labor. I don't know that I would go past 38.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

hols537
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Re: When to deliver w/ history of classical c-section

Postby hols537 » Mon May 30, 2011 11:41 am

I get the sense this is not typical, but I was scheduled for a repeat c/s at 39 weeks with my second despite having a classic c/s with my first. At the first signs of labor at 38 weeks (on the nose), they delivered. I had no complications but they did give medications to stop/slow the labor while we waited for bloodwork and the heparin to clear my system because they did not want contractions intensifying.
Holly
DS 1 - 2/26/07 (32 weeks, Severe PE, IUGR, Oligo)
DS 2 - 9/13/08 (38 weeks, Folgard, Lovenox, 17P, No PE)

angieb
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Re: When to deliver w/ history of classical c-section

Postby angieb » Mon May 30, 2011 11:26 am

I think most hospitals now require an amnio before 37 weeks if there's no other medical indication for delivery yet. Not sure how strict that is and if most MFM's can get around it.

My second pregnancy, we did the amnio at 36+1, his lungs were good to go, good thing because my water broke at 1 in the morning that night and I started having contractions on the way to the hospital in the car (right after I got off the phone with my ob and told her, why no, I'm not contracting, of course.) They were only every 10 minutes or so when I first checked in and I had eaten too recently so they were going to monitor us and do the c-section around 7 am when the food had time to clear, but less than an hour in the hospital and they were every few minutes and pretty painful (they didn't mess around any longer by that point). My ob said the scar looked fantastic so i guess the stint of labor didn't stress it too much.

Whether my water broke because of the amnio that day or the baby was just ready (considering he was 7lbs4oz and had been super low for awhile), we don't know, probably a little of both. It was a bit scary though and next time, if we're so lucky again, I'll skip the amnio and deliver at 37 wks. (That was my choice this time, I wanted him out safely asap.) I had kind of dismissed the risks of the amnio- water breaking, infection-but since my water did break I won't dismiss that next time! (And the procedure went perfectly and really didn't hurt much, they expected no complications.) My MFM said I'm her first patient that has had that happen (she didn't actually do the amnio, her partner did.) Anyway, after my experience, the amnio just seems like an unnecessary extra risk now and I'll opt out of it next time.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

miamibunnie
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Re: When to deliver w/ history of classical c-section

Postby miamibunnie » Mon May 30, 2011 07:28 am

I feel the same way with my first daughter I had a c-section and my second was vaginal..which mu second past because was born at 23 wks. I tell you my dr keeps changing up when will I deliver and she is not sure if c-section or vaginal. All she says is we wil see as we get closer...I'm 1 wk away from 30 wks...and am nervous I don't like surprises. My dr would like for me to carry as further as possible. One day she will say at 35 wks then she will say 37 wks...I don't know anymore...like she said depends if I don't get sick. Also she did bring up the amniocentisis will be done to see lunh maturity at that point....
Lisette 37 Hubby 37
Lisette 36 / Luis 36
1996 25 weeker due to Eclampsia with seizures daughter alive today 15 yrs old " Julyzah Caridad"
2010 23 weeker due to severe preeclampsia my angel left us

2011/27/July we beat preeclampsia and made it to 36.5 weeks 6lbs 1oz baby girl "Kendall Lauren " pe-free just bp started acting up.
Thanks to God, my doctor, Lovenox and Lda.

rebecca2
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When to deliver w/ history of classical c-section

Postby rebecca2 » Mon May 30, 2011 00:02 am

If you had a classical c-section in a previous pregnancy, how far along will your Dr let you go this time (assuming no PE) before he delivers? I'll be 35 weeks tomorrow & so far things are going very well--BP is good & no protein. There are multiple doctors at my MFM practice and they all have different opinions on when to schedule my c-section. They all agree that at this point if I start having uterine activity, we will deliver. No one wants to risk the catastrophic event of uterine rupture if I were to go into labor. The ambiguity comes in if all continues to go well. Here is what they told me...

1. Dr H recommends an amnio between 36-37 weeks. If the results from that day indicate mature lungs, we will deliver the following day. If not, they will send the sample for further testing and will get the results the next day. The results from this test will help her decide how long we should wait to deliver.

2. Dr X said he wouldn't bother with the amnio, he would just deliver between 36 1/2 and 37 weeks. (Note: This dr is new to the practice. I only got his opinion because he was shadowing Dr H that day as part of his orientation.) He explained that there are varying opinions in cases like this and no real universally accepted *best* gestational age to deliver. Everyone is just weighing the risk of rupture against the benefit of more time for baby to mature.

3. Dr C, the one that I saw the most during my 2nd pregnancy, said I look much healthier this time and he might even consider letting me go to 38 weeks if things continued to go well. He wants to wait and see how the next couple of weeks go before he recommends anything. (Things were going well at this point in my 2nd pregnancy also, but we delivered at 35w6d because my amniotic fluid dropped from a 9 to a 2 over the weekend. My son spent just over 2 weeks in NICU, but is a perfect little 12 month old now!)

So, what is your dr recommending for you? What would you do if you were given these options? I would love to avoid NICU this time around and carry this little guy as long as possible, but the thought of a rupture is terrifying!
Becky
Mom to...
baby girl Addison 3/11/09-3/11/09 (severe preeclampsia 26w5d)
baby boy Aden 5/25/10 (35w6d low amniotic fluid)
baby boy #2 due 7/4/11


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