Questions for OB/MFM followup appointment after pPROM

These questions came from many sources, including the new Kanalen site http://pprom.wordpress.com/ and our own previous experiences with the medical industry.  Our doctor laughed at my 5-page print out, but agreed I was completely thorough.  Hope it helps!  (Sorry for the formatting weirdness; it’s the best I could do.)
*I’d also like to indicate that when you start asking your doctor about the cervix, IC, vaginal cerclages, and especially TAC, he is going to freak.  Generally speaking, doctors are NOT open to diagnosing IC – particularly after “just” one loss.  Doctors simply are uneducated about IC and sure are not comfortable with a TAC.  Some doctors even bristle and are combative towards you expressing interest in cervical issues.

So, as you prepare your questions and get excited about the future – which you should be! – realise that your doctor is probably not on board with this line of thinking and don’t let him burst your bubble!  Your husband is hesitant also because of the doctor’s hesitancy.  (don’t worry, though, he will get on board)
In the meantime, come onto Abbyloopers and the Facebook groups for support!

Follow-Up Questions:

  1. What happened?
  • What role did carrying multiples play?  Did I experience uterine overdistention?
  • Does pathology reveal any vascular lesions?  If so, how do we combat?
  • How much a part did CI play?
  • What caused my CI?
  • Clotting disorder?
  • Can we be tested for:

Anticardiolipin Antibodies IgG, IgM, IgA (ACAG, ACAM)

Antiphospholipid Antibodies IgG, IgM, IgA (AAP)

Lupus Anticoagulant (CLA)

Antithrombin III Activity (ATL)

Protein C Activity (ATL)

Protein S Activity (ProS)

Factor V Leiden (F5L)

Homocysteine Level (Fasting) (Homo)

Prothrombin (PROD)

Methyl Tetra Hydro Folate Reductase (MTHFR)

Karyotype Male

Karyotype Female

Hypothyroidism?

Questions for doctor after pPROM to prepare for future pregnancy:

  1.  How much experience do you have treating post-prom patients?
  2. Do you have the necessary equipment to monitor me?
  3. How often would you monitor me?  Would you be willing to see me whenever I feel there is a problem?
  4. At what point or under what circumstances would you recommend a cerclage?
  5. What testing will you be doing throughout my pregnancy? (for infection, cervical weakness, preterm labor?)
  6. What measures will you take if my test results indicate a problem?
  7. What happened?
  8. If I experience PROM again, what treatment options will I have?
  • Are the treatment options different if I have a cerclage in?
  • Are the treatment options different if I have a TAC vs. TVC in?

9.  How can my cervix be evaluated?  What are the differences in        evaluating it pre-conception, 1st trimester, 2nd trimester, and 3rd trimester?

10.  When can I do my next embryo transfer?

PREVENTIVE:

  1. What can be done differently to have a successful TERM pregnancy next time?
    1. # embryos to transfer
    2. Cerclage – TVC or TAC? (see below for further questions)
    3. P17/17P shots
      1. Risks?
      2. Benefits?
  1. Progesterone supplements?
    • Risks?
    • Benefits?
    • Delivery method?
  1. Other supplements?
    • Collagen tablets?
  1. Bacterial Infection Cultures
    • How often?
    • How would infection be dealt with given my allergies?
    • Specifically, Group B Strep?
  1. fFN test
    • How early?
    • How often?
    • Treatment if shows sign of PTL?
  1. Lifestyle
    • Diet
    • Exercise
    • Work
    • Intercourse/Orgasm

MONITORING:

  1. What can be done differently to have a successful TERM pregnancy next time?
  • Who should do my ob care?
  • Type of sono? (ab or transvaginal)
  • What about equipment differences?
  1. Any digital exams or speculum only?
  2. Monitor AFI?
  3. Bacterial Infection Cultures

How often?

How would infection be dealt with given my allergies?

Specifically, Group B Strep

  1. FN test (fFN test)

How early?

How often?

  1. Treatment if shows sign of PTL
  2. Lifestyle

Diet

Exercise

Work

Intercourse/Orgasm

CERCLAGE Questions:

TAC vs. TVC? – What are the advantages to doing one over the other?

TVC Questions:

Do you place TVCs?  (Which type? McDonald, Shrodikar, TVCIC)

What is your TVC success rate for TERM deliveries?

What is your TVC rate for pre-term deliveries?   How many of those babies survived to take-home age?

Can you explain your TVC failures?

What are the risks of TVC to me?
What are the risks of TVC to baby?

  • Does it restrict fetal growth?
  • Does it make infection more likely?  (Wicking up bacteria?)

How can a TVC successfully prevent funneling?
Don’t 40% of TVCs result in preterm babies?

  • How can we prevent this?

How can we know that it won’t rip?

  •  What do we do to prevent it from ripping?

How “delicate” is the stitch?

  • Can I tie my shoes?  Can I slam on the brakes in the car?  Can I reach for a high shelf?

What is the likelihood of bedrest?  (% for ME, not for women in general)

  • How plausible is bedrest for future pregnancies with infants and toddlers needing care?
  • How would I combat DVT on bedrest?

What are the risks of putting in a TVC?
What are the risks of holding a TVC?

  • If it rips, will there be further damage to my cervix?
    • How would this impact me?
    • How would this impact future pregnancies?

What are the risks of taking out a TVC?
Is there a limit to the number of pregnancies I can have with a TVC? (like, can I only have so many TVCs placed?)
What is recovery time for a TVC?

  • How long until I could be back at work?
  • What specific restrictions would I have with a TVC?
  • What happens if I go into labor with a TVC? At term?  At preterm?

Specifics for ME:

  • How long is my cervix?
  • How long WAS my cervix immediately after my pPROM (before delivery)?
  • Which cervical length do we assume?
  • Where precisely would the cerclage be placed?  (which mm?)

What are the long-term effects of having a TVC?

  • Future pregnancies
  • My own health
  • Periods
  • Conception
  • Contraceptives
    • Studies of any associated higher risks or increased incidents of other disease/conditions?

TAC Questions

Do YOU place TACs?  Why  or why not? What is your personal success rate?   Can you explain your TAC placement failures?  Which method do you use to place them (open traditional, lap, DaVinci Robot)?  Why do you use that method?

Am I a candidate for TAC?  Who is?
What are the risks of TAC to me?
What are the risks of TAC to baby?

  • Does it restrict fetal growth?
  • Does it make infection LESS likely?

Does TAC successfully prevent funneling?
What is the success rate of the TAC for TERM pregnancies?
How can we know that it won’t rip?

  • What do we do to prevent it from ripping?

What is the likelihood of bedrest?  (% for ME, not for women in general)
What are the risks of putting in a TAC?
What are the risks of holding a TAC?

  •  If it rips, will there be further damage to my cervix or other parts?
  • How would this impact me?
  • How would this impact future pregnancies?

Is there a limit to the number of pregnancies I can have with a TAC?

  • Limit on the # of pregnancies?
  • How many pregnancies does my uterus have left?

What is recovery time for a TAC?
How long until I could be back at work?
What specific restrictions would I have with a TAC?
What happens if I go into labor with a TAC?

  • Preterm
  • Term

Where precisely would the cerclage be placed?
Who can do the TAC?

  • Should I see Dr. Haney or Dr. Davis or Dr. Sumners? (for outside of the U.S., fill in one of the expert docs mentioned on the abbyloopers yahoo group website, for ex: Mr. F at Liverpool in England)

WHEN should the TAC be placed?

  • Pros/cons for PREconception
  • Pros/cons for POSTconception

How is fetal demise handled after 12 weeks?
What are the long-term effects of having a TAC?

  • Future pregnancies
  • My own health
  • Periods
  • Conception
  • Contraceptives
    • Studies of any associated higher risks or increased incidents of other disease/conditions?
    •  What if I needed a hysterectomy?
    •  Could various cancers still be detected?
    •  Can I still conceive naturally?
    •  Can I still do embryo transfers?
    •  Can I still have further egg retrievals?
    •  Could I do an IUI?

MISC Questions:

Will insurance cover a TAC?
Is there any other information I should know?

One response to “Questions for OB/MFM followup appointment after pPROM

  1. I wish I had come up with half those questions! Very thorough and things I will keep in mind.

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