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

[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--