Makena progesterone shot

[Yogurt]

Ugh, so I am having a huge conflict.



Tl;dr: would you take a progesterone injection to possibly prevent preterm labor if it increased your chance of stillbirth from 1% to 2.2%?

THE LONG VERSION:
Background: first birth was preterm, 35 +2. No signs, just spontaneous preterm labor, almost had a car baby because what I thought were BH contractions WERE NOT.
Placenta goes to lab, it's <5%ile in size.

Now: OB who was seeing me for my losses (nice old guy, seemed to know nothing about losses, IF, anything special circumstance) perscribed me progesterone to take each month ttc on 3dpo. I felt like it was just to appease me because I was uptight, etc. I was also on a waiting list to see am RE because we had been trying 15 months amd 2 losses.

When I got pregnant with this pregnancy he said to stay on it until 37 weeks due to preterm prior birth. By this point I have met the RE and was awkwardly seeing both in the couple months prior to getting pregnant while I figured out what I was going to do. RE just met me once and told me to keep trying for 3 months and I got pregnant in that time. Regular OB was running loss bloodwork.

I leave the OB and go to just the RE for my early care. I graduate and he refers me to my current OB who he thought was a good fit for me.

****The important part
My current OB wants me on a progesterone shot instead of the vag suppositories. She said the shot helps with preterm labor. Not sure if the suppositories help less or not at all in reality (after 10 weeks ish when the placenta takes over).

I research this shot and I see it has a side effect of later term loss and stillbirth (!). WTF. of course it's a small percentage, but I am totally freaked. The study on the website sites that out of about 8500 women who took it, 192 had stillbirth. Which is only 2.2%, up from the 1% of women who typically have stillbirth.

I don't know what to do.
35 weeks wasn't that early, but kind of.
Do the suppositories help/should I stay on those.
Do the suppositories OR injections even help if my preterm birth was placenta related not cervix?

I have left a message with the nurse at my ob office with all these questions. I am just so nervous about what to do.

[Tlex]

I would accept my OB’s request to take it on the condition that the OB is specifically practiced in managing High Risk pregnancies. If that is not his typical scope, I would seek at least one second opinion from a HROB.

I recall how it felt like I was doomed to have a preterm baby the second time since my first one was and all the statistics made it seem like it was my fate. Instead I made it into early term, and both the baby and I had much better recoveries. That makes it easier for me in my today-shoes to say no, I wouldn’t take that risk. But in my past-shoes not having had the experience of things going right, I think I’d be inclined to be way more cautious about preterm labour.

I don’t know, yogurt. I do know that I’m still high risk for preterm and neither subsequent pregnancy has been treated with progesterone shots to prevent preterm labour. But that’s just my anecdotal case and my preterm labour was not caused by the same issue as yours.

[sammysam]

Lurking....

I have no anecdotal evidence or experience with this...but I am going to say to go with your gut. If you're not comfortable with it then don't do it. I would talk to your OB about the possible side effects vs the possibility of another pre term labour and then decide what you want to do. Make sure whatever it is, that it is your decision.

[Yogurt]

Thanks guys.
I'm feeling like I do not want to do it. Of course it's like if something bad happens either way I'll have regrets for not making the other choice. But I am so on the fence I am leaning towards not injecting myself with hormones. My mom had a 30 weeker (her first) and then 3 other kids went term. Now, I also know to be on high alert for early contractions amd maybe something can be done at their onset. And 35 weeks wasn't ideal, but it also wasn't 30 weeks or something really early that I want to double my chance of stillbirth.
Ugh, pregnancy. Such high stakes choices, it's so stressful.
Thank you.

[sammysam]

Yogurt I'd honestly do the same. I don't think I'd take the increased risk. Whatever feels right for you is what you should do!

[magnolia]

My first DD was born at 31 weeks, most likely due to a car accident that caused a placenta abruption. My second pregnancy my doctor wanted to do the shots more for peace of mind that we were doing all that we could to keep baby cooking. I delivered at 39 weeks and 3 days.

This pregnancy I’m taking them again. For me, the peace of mind knowing I will more likely have a full term baby is worth it. Obviously, you have to do what you are comfortable with. 31 weeks is way different than 35 weeks, so I understand why you are so hesitant. Also, to me, the small placenta is as much of an issue as the 35 weeks.

[Yogurt]

Oct 25, 2018 11:00:44 GMT -6 magnolia said:

My first DD was born at 31 weeks, most likely due to a car accident that caused a placenta abruption. My second pregnancy my doctor wanted to do the shots more for peace of mind that we were doing all that we could to keep baby cooking. I delivered at 39 weeks and 3 days.

This pregnancy I’m taking them again. For me, the peace of mind knowing I will more likely have a full term baby is worth it. Obviously, you have to do what you are comfortable with. 31 weeks is way different than 35 weeks, so I understand why you are so hesitant. Also, to me, the small placenta is as much of an issue as the 35 weeks.

Did you take Makena or the p17 (is that it? The generic).
I am wondering if there is a way to monitor my placenta or examine it like at the anatomy scan. I just don't even know if the Makena is an appropriate intervention if the cause of my preterm labor was placenta size not cervix related.

[magnolia]

Oct 25, 2018 13:21:40 GMT -6 Yogurt said:

Oct 25, 2018 11:00:44 GMT -6 magnolia said:

My first DD was born at 31 weeks, most likely due to a car accident that caused a placenta abruption. My second pregnancy my doctor wanted to do the shots more for peace of mind that we were doing all that we could to keep baby cooking. I delivered at 39 weeks and 3 days.

This pregnancy I’m taking them again. For me, the peace of mind knowing I will more likely have a full term baby is worth it. Obviously, you have to do what you are comfortable with. 31 weeks is way different than 35 weeks, so I understand why you are so hesitant. Also, to me, the small placenta is as much of an issue as the 35 weeks.

Did you take Makena or the p17 (is that it? The generic).
I am wondering if there is a way to monitor my placenta or examine it like at the anatomy scan. I just don't even know if the Makena is an appropriate intervention if the cause of my preterm labor was placenta size not cervix related.

I take the generic.. My biggest concern if I were you would be placenta size as well.

My knowledge is very limited, but I do know that vaginal progesterone should only help preterm labor if you have a short cervix. The progesterone shots are recommended for women who have had previous spontaneous preterm labor.

I would definitely ask about monitoring placenta size. I hope your doctor is able to answer all of you questions and you feel good about whatever decision you make.

[Eames]

I would definitely ask about monitoring placenta size as well. Plus, you know how labor feels and would go in earlier if it starts again, and I would ask if they could possibly stop it, or if the type of labor you had was happening regardless. With all your various doctors, I didn't catch- do you still see the OB that delivered your first? If so, I'd be curious to get their opinion.

Ugh I'm sorry you have to deal with these things.

[Yogurt]

Oct 25, 2018 13:52:08 GMT -6 Eames said:

I would definitely ask about monitoring placenta size as well. Plus, you know how labor feels and would go in earlier if it starts again, and I would ask if they could possibly stop it, or if the type of labor you had was happening regardless. With all your various doctors, I didn't catch- do you still see the OB that delivered your first? If so, I'd be curious to get their opinion.

Ugh I'm sorry you have to deal with these things.

Thanks those are some good points, re:labor. Yeah, I just really don't know if the shot is even the correct intervention...

No, the OB that delivered my first moved to LA, so I have new doctors.

Thank you.

[joeypotter]

Totally lurking, but had the same conversation with my doctor today. I went into labor with my first at exactly 36 weeks due to premature rupture of membranes. My OB was extremely reassuring when I brought up my concerns. He is part of a large practice and he said they have prescribed this shot to hundreds and hundreds of women and have never seen any of the side effects in real life that are mentioned on the website. He said many of the women who participated in the initial drug trials were very high risk to begin with, so it’s hard to generalize their situations to the average pregnant population anyway, but he said he has never seen anything but positive outcomes from both the generic (17-P) and the name brand Makena. He said in his experience it really does work to help most women get to term, and they would never prescribe something that they felt would cause even a small chance of harm. On a side note, I’m also being followed by a MFM specialist due to hypothyroidism and he strongly recommended the shots as well.

[Yogurt]

joeypotter thank you. That's extremely helpful.

[Tlex]

I can speak to placenta monitoring as I’ve had a ton of that, they can do very high tech ultrasounds that monitor the blood flow to the placenta closely and can give a really accurate picture of size/placental efficiency. I went weekly with D2 for placental monitoring from around 24 weeks on. The more frequently they check on it the more accurate things like measurements are, it does give a lot of peace of mind (and eventually gets boring!) and they check baby for growth very frequently with the same results. It’s not like when a mom gets her second ultrasound at 37 weeks to check baby’s positioning and they give a size guesstimate, when you’re going weekly it’s very close to accurate.

[orangehibiscus]

I don’t mean for this to sound harsh, so I apologize if it comes across that way.

When I’m trying to make medical decisions, I weigh the outcomes against either other. I’ve never had a stillborn or preterm labor, so take this with a grain of salt...If you had a baby born early, would you regret not doing the injections? If you had a stillborn, would you regret having done the progesterone shots?

Sorry I can’t give better advice. That’s a tough decision.

[magnolia]

Oct 26, 2018 16:58:04 GMT -6 orangehibiscus said:

I don’t mean for this to sound harsh, so I apologize if it comes across that way.

When I’m trying to make medical decisions, I weigh the outcomes against either other. I’ve never had a stillborn or preterm labor, so take this with a grain of salt...If you had a baby born early, would you regret not doing the injections? If you had a stillborn, would you regret having done the progesterone shots?

Sorry I can’t give better advice. That’s a tough decision.

This isn’t my thread, so I’ll be brief, but your statement is pretty insensitive to the women in this thread who are taking the shots.

Of course I don’t want a stillborn baby. But I also don’t want another 31 week preemie, a 7 week NICU stay, a $300,000 NICU bill, and potential medical issues from being preterm that could last a lifetime.

This decision is simply not at easy as your oversimplified statement above makes it seem, otherwise OP would not have needed to make a thread.

[Yogurt]

Oct 27, 2018 11:51:06 GMT -6 magnolia said:

Oct 26, 2018 16:58:04 GMT -6 orangehibiscus said:

I don’t mean for this to sound harsh, so I apologize if it comes across that way.

When I’m trying to make medical decisions, I weigh the outcomes against either other. I’ve never had a stillborn or preterm labor, so take this with a grain of salt...If you had a baby born early, would you regret not doing the injections? If you had a stillborn, would you regret having done the progesterone shots?

Sorry I can’t give better advice. That’s a tough decision.

This isn’t my thread, so I’ll be brief, but your statement is pretty insensitive to the women in this thread who are taking the shots.

Of course I don’t want a stillborn baby. But I also don’t want another 31 week preemie, a 7 week NICU stay, a $300,000 NICU bill, and potential medical issues from being preterm that could last a lifetime.

This decision is simply not at easy as your oversimplified statement above makes it seem, otherwise OP would not have needed to make a thread.

Well, and the answer is yes to both. If I take the shots and have a still birth I will regret it and if I don't and have a preemie I will regret it. That doesn't really help me get closer to a decision.

[magnolia]

Oct 27, 2018 11:56:34 GMT -6 Yogurt said:

Oct 27, 2018 11:51:06 GMT -6 magnolia said:

This isn’t my thread, so I’ll be brief, but your statement is pretty insensitive to the women in this thread who are taking the shots.

Of course I don’t want a stillborn baby. But I also don’t want another 31 week preemie, a 7 week NICU stay, a $300,000 NICU bill, and potential medical issues from being preterm that could last a lifetime.

This decision is simply not at easy as your oversimplified statement above makes it seem, otherwise OP would not have needed to make a thread.

Well, and the answer is yes to both. If I take the shots and have a still birth I will regret it and if I don't and have a preemie I will regret it. That doesn't really help me get closer to a decision.

Exactly! It’s just not that simple.

[orangehibiscus]

I am sorry! I was trying to helpful, and I was not. I apologize to Yogurt, magnolia, and anyone else that was hurt by what I said. My intentions were not to hurt anyone, and I’m so sorry that I did.