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Old 01-13-2012, 01:37 PM   #1
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fibronectin positive cervix thin

HI All,
Just a bit of knowledge needed... Im 34 weeks n 6 days ago my fibronectin test came back positive, i have had bad pains but not regular like my first child (10 years ago) i went to hospital at 33 weeks n was told his head is right down n my cervix was really thin, i was 1 cm dialated but this is normal as iv had a child plus i had leap surgery couple of years ago.... The thing is im wondering if any of u have had the same thing happen n go into labour so i no where my heads at!! my pains aint regular but r pretty strong wen i get them n they can last hours... All advice would b helpful...... Thanks xxxxx
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Old 01-13-2012, 02:33 PM   #2
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Re: fibronectin positive cervix thin

First of all, I want to encourage you to call your doctor's office and talk to a nurse. They will be your best resource since they know your medical history and can directly address your questions or concerns. If they cannot answer your questions then you should talk to your doctor.

Did they discuss a plan for you? Are you on bed rest? Has your doctor been monitoring your cervical length to watch for changes?

I certainly think that taking it easy would be in your best interest. Obviously you are at risk for preterm delivery if your test came back positive. Drink lots of water and get off your feet when you are feeling contractions.

I started having episodes of contractions at 19 weeks with my daughter. I went to the ER at least 3 times because I was having too many in a certain amount of time. My uterus was very active but, thankfully, my cervix did not change until some time after 34 weeks. I was treated with 17P shots (but they start those much ealier in pregnancy) and Terbutaline (which is no longer used in pregnancy). I had my last appointment with the Perinatologist at 34 weeks and that last fetal fibronectin test came back negative. I went into full on labor at 36 weeks exactly and my daughter was born at that time.
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Old 01-13-2012, 02:45 PM   #3
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Re: fibronectin positive cervix thin

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Originally Posted by Kayla1981 View Post
First of all, I want to encourage you to call your doctor's office and talk to a nurse. They will be your best resource since they know your medical history and can directly address your questions or concerns. If they cannot answer your questions then you should talk to your doctor.

Did they discuss a plan for you? Are you on bed rest? Has your doctor been monitoring your cervical length to watch for changes?

I certainly think that taking it easy would be in your best interest. Obviously you are at risk for preterm delivery if your test came back positive. Drink lots of water and get off your feet when you are feeling contractions.

I started having episodes of contractions at 19 weeks with my daughter. I went to the ER at least 3 times because I was having too many in a certain amount of time. My uterus was very active but, thankfully, my cervix did not change until some time after 34 weeks. I was treated with 17P shots (but they start those much ealier in pregnancy) and Terbutaline (which is no longer used in pregnancy). I had my last appointment with the Perinatologist at 34 weeks and that last fetal fibronectin test came back negative. I went into full on labor at 36 weeks exactly and my daughter was born at that time.


You need to be seen and evaluated by your care-provider, IMHO.

I had pre-term labor starting at 18 weeks. Started dilating & effacing at 23 weeks & was hospitalized. Positive FFN at that time. I was put on 17P (progesterone) shots every week and Nifedipine Q6hr, which was later switched to terbutaline Q4hr, by my midwife (I'm so curious why you mentioned, kayla, that they don't use this anymore... Are there risks or side effects that would be contraindicated during pregnancy? I really want to know. because I very well may have to do this routine again with another pregnancy. I remember finding some info that sounded negative at the time but my midwife and the OB she was with brushed me off... ) I was on strict bed rest with only potty breaks. They threatened to keep me hospitalized till delivery but I'm a nurse and I promised to behave so the Perinatologist let me go home.

My cervix continued to thin and dilate over the next few weeks (I was checked every week) and my water broke @ 36 weeks, putting me in full blown labor instantly. LO was born 4 hours and 22 minutes later.

Best wishes, OP, for a safe and healthy pregnancy & hopefully term baby.
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Old 01-13-2012, 02:59 PM   #4
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Re: fibronectin positive cervix thin

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Originally Posted by colin-mylilguy View Post


You need to be seen and evaluated by your care-provider, IMHO.

I had pre-term labor starting at 18 weeks. Started dilating & effacing at 23 weeks & was hospitalized. Positive FFT at that time. I was put on 17P (progesterone) shots every week and Nifedipine Q6hr, which was later switched to terbutaline Q4hr, by my midwife (I'm so curious why you mentioned, kayla, that they don't use this anymore... Are there risks or side effects that would be contraindicated during pregnancy? I really want to know. because I very well may have to do this routine again with another pregnancy. I remember finding some info that sounded negative at the time but my midwife and the OB she was with brushed me off... ) I was on strict bed rest with only potty breaks. They threatened to keep me hospitalized till delivery but I'm a nurse and I promised to behave so the Perinatologist let me go home.

My cervix continued to thin and dilate over the next few weeks (I was checked every week) and my water broke @ 36 weeks, putting me in full blown labor instantly. LO was born 4 hours and 22 minutes later.

Best wishes, OP, for a safe and healthy pregnancy & hopefully term baby.
I just found this out at my first Peri appointment with this pregnancy. My Peri told me that the FDA no longer approves of the use of Terbutaline for preterm labor. I believe the concern had to do with the mother's health and not the baby's but I did not ask for details. To be honest, I didn't want to know! Especially because I took it for my first pregnancy and I didn't want to freak myself out. She told me that she did not agree with the FDA on this but that she would no longer use it because she needs to comply with their recommendations, no matter her opinion. She told me they now use another medication (told me the name, but I cannot recall) that also works to relax smooth muscles. I want to say it was a medication used for the digestive system???

Maybe if you are able to start 17P at an earlier time then it will be more effective for you the next time around. I believ it's most effective if it's started around 13-18 weeks? At least you will have the foresight this time around that your body may need that. She also told me that folic acid may help with PTL and I've read Vitamin D can as well. Of course you will get those in your prenatals so just make sure you are taking them.

Sorry to hijack!
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Old 01-13-2012, 03:15 PM   #5
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Re: fibronectin positive cervix thin

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Originally Posted by Kayla1981 View Post
I just found this out at my first Peri appointment with this pregnancy. My Peri told me that the FDA no longer approves of the use of Terbutaline for preterm labor. I believe the concern had to do with the mother's health and not the baby's but I did not ask for details. To be honest, I didn't want to know! Especially because I took it for my first pregnancy and I didn't want to freak myself out. She told me that she did not agree with the FDA on this but that she would no longer use it because she needs to comply with their recommendations, no matter her opinion. She told me they now use another medication (told me the name, but I cannot recall) that also works to relax smooth muscles. I want to say it was a medication used for the digestive system???

Maybe if you are able to start 17P at an earlier time then it will be more effective for you the next time around. I believ it's most effective if it's started around 13-18 weeks? At least you will have the foresight this time around that your body may need that. She also told me that folic acid may help with PTL and I've read Vitamin D can as well. Of course you will get those in your prenatals so just make sure you are taking them.

Sorry to hijack!
Thanks for the response! (Sorry, I started the hijack... )

The thing is, I was taking vitamin D, in addition to prenatals and folic acid because I have a congenital anomaly that makes me very prone to pre-term labor. In fact, I don't know that it is really even possible to go term for me, but maybe by some miracle? My midwife and the OB she is with knew that from the beginning. I had a full work up with ultra sounds, MRI's and the like, but I felt like they just blew it all off. Then, when I was hospitalized in another state, by another doctor, they were all "Oh! Goodness Gracious! Wow! Okay, you need to be monitored closely by a Perinatologist...yada, yada, yada..." and then I was put on this drug and that and bed rest and a belly support binder 24/7 and it was just crazy intense.... I didn't have time to research the drugs before I started them, like I would normally do. I was overwhelmed.

The MFM doctor said I should be on Nifedipine, the Midwife and OB said "no, no, no, terbutaline is best" and that Perinatologist said "neither one will help and they have side effects so you shouldn't take either" which was SO CONFUSING! I ended up doing what the Midwife (and OB) told me to do, because she was my primary care provider, but looking back... well, I don't think I would have done the same thing, if I could do it again. I just hated feeling like I wasn't in control of my body and I almost felt pressured into taking the terbutaline without ever really being told what the pros/cons were. When I asked, I was kinda told that I should just trust them because they know what they are doing... I'm not a fan of that type of patient/provider relationship.

I will say, though, that the Nifedipine made me feel sick but the terbutalin... Oh, the Terbutaline! That was some awful stuff! It made me feel like a train wreck and my heart would just pound all day. I seriously wondered if my heart would give out on that drug and every 4 hours, when I had to take the next dose, my heart would pound harder... I never want to take that drug again. I found out later that it can cause problems with the baby's heart, too and I can see the connection since my heart was pounding so hard but luckily I had stopped taking it about a week before LO came and he didn't seem to show any side effects.
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Old 01-13-2012, 04:35 PM   #6
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Re: fibronectin positive cervix thin

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Thanks for the response! (Sorry, I started the hijack... )

The thing is, I was taking vitamin D, in addition to prenatals and folic acid because I have a congenital anomaly that makes me very prone to pre-term labor. In fact, I don't know that it is really even possible to go term for me, but maybe by some miracle? My midwife and the OB she is with knew that from the beginning. I had a full work up with ultra sounds, MRI's and the like, but I felt like they just blew it all off. Then, when I was hospitalized in another state, by another doctor, they were all "Oh! Goodness Gracious! Wow! Okay, you need to be monitored closely by a Perinatologist...yada, yada, yada..." and then I was put on this drug and that and bed rest and a belly support binder 24/7 and it was just crazy intense.... I didn't have time to research the drugs before I started them, like I would normally do. I was overwhelmed.

The MFM doctor said I should be on Nifedipine, the Midwife and OB said "no, no, no, terbutaline is best" and that Perinatologist said "neither one will help and they have side effects so you shouldn't take either" which was SO CONFUSING! I ended up doing what the Midwife (and OB) told me to do, because she was my primary care provider, but looking back... well, I don't think I would have done the same thing, if I could do it again. I just hated feeling like I wasn't in control of my body and I almost felt pressured into taking the terbutaline without ever really being told what the pros/cons were. When I asked, I was kinda told that I should just trust them because they know what they are doing... I'm not a fan of that type of patient/provider relationship.

I will say, though, that the Nifedipine made me feel sick but the terbutalin... Oh, the Terbutaline! That was some awful stuff! It made me feel like a train wreck and my heart would just pound all day. I seriously wondered if my heart would give out on that drug and every 4 hours, when I had to take the next dose, my heart would pound harder... I never want to take that drug again. I found out later that it can cause problems with the baby's heart, too and I can see the connection since my heart was pounding so hard but luckily I had stopped taking it about a week before LO came and he didn't seem to show any side effects.
Nifedipine (procardia) and Terbutaline are both not approved by the FDA for use on pregnant women - but they never have been. The Procardia is a blood pressure medicine that relaxes smooth muscles (that is why your digestive issues, and heartburn (reflux) ) will be worse on it.

The two medicines have only statistically been show to be able to stop active labor. They are not recommended to be on long term (like weeks and weeks) to stop PTL issues. This said my first two pregnancies I was on procadia and bedrest for 7, and 8 weeks - and made it a lot farther being pregnant. I have super low blood pressure normally and it made me feel horrible.

OP - I'm glad you are already 34 weeks - that is a relief. But I would definitely find out what your provider has to say.

With a FFN that is positive - that isn't saying much - other than you really want a negative because that has like an 96% chance of being accurate. The positive just means it isn't negative.

Plus if you had a vaginal exam before, or any special marital "activity" before the test (in the 24 hrs before) - this can result in a false positive.

GL mama!!
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Old 01-15-2012, 02:23 PM   #7
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Re: fibronectin positive cervix thin

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Originally Posted by Kayla1981 View Post

I started having episodes of contractions at 19 weeks with my daughter. I went to the ER at least 3 times because I was having too many in a certain amount of time. My uterus was very active but, thankfully, my cervix did not change until some time after 34 weeks. I was treated with 17P shots (but they start those much ealier in pregnancy) and Terbutaline (which is no longer used in pregnancy). I had my last appointment with the Perinatologist at 34 weeks and that last fetal fibronectin test came back negative. I went into full on labor at 36 weeks exactly and my daughter was born at that time.
I didn't know Terb. was not used anymore.. I had it 3 years ago with my DS and 5 years ago with my DD.... Having contractions again but dr. doesn't wanna do anything yet (my last two made it to 37weeks) since I"m not dialating with regular contractions...
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Old 01-13-2012, 07:53 PM   #8
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Re: fibronectin positive cervix thin

we heard the same thing about terb from our mfm. but in reality all drugs have risks and side effects. you have to weight the risk of having a baby born EXTREMELY premature vs the risk of using the drug for weeks on end. if you are earlier than 20 weeks, i would think the risk of being on those drugs long enough to get the baby to a gestational age that has a good chance of survival without major complications would be too high than someone who is late 20/early 30 weeks along. for those who used it, you did what u had to do to give your baby a fighting chance.
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Old 01-13-2012, 08:44 PM   #9
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Re: fibronectin positive cervix thin

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Originally Posted by fish3737 View Post
Nifedipine (procardia) and Terbutaline are both not approved by the FDA for use on pregnant women - but they never have been. The Procardia is a blood pressure medicine that relaxes smooth muscles (that is why your digestive issues, and heartburn (reflux) ) will be worse on it.

The two medicines have only statistically been show to be able to stop active labor. They are not recommended to be on long term (like weeks and weeks) to stop PTL issues. This said my first two pregnancies I was on procadia and bedrest for 7, and 8 weeks - and made it a lot farther being pregnant. I have super low blood pressure normally and it made me feel horrible.

OP - I'm glad you are already 34 weeks - that is a relief. But I would definitely find out what your provider has to say.

With a FFN that is positive - that isn't saying much - other than you really want a negative because that has like an 96% chance of being accurate. The positive just means it isn't negative.

Plus if you had a vaginal exam before, or any special marital "activity" before the test (in the 24 hrs before) - this can result in a false positive.

GL mama!!
I guess what changed is now they require a "Boxed Warning and Contraindication" where as they didn't before? Whatever the specific changes are, I know that just two years ago my Peri prescribed Terbutaline for PTL and now she does not.

Well said about the positive FFN. A negative is much more conclusive than a positive. Just because you get a positive does not mean you will go into labor but it does mean you are at in increased risk of going into PTL. I think FFN helps the doctor determine what steps, if any, need to be taken. That's why I think you need to contact your doctor and find out what the plan is for you (direct to the OP).

Quote:
Originally Posted by colin-mylilguy View Post
Wow. So helpful! Thank you!

That explains my insane heart burn. And why my Perinatologist didn't recommend me to be on either drug long-term. I wish I had listened. I was so torn between what everyone was saying because they all said something different! I just hope my baby doesn't have any lasting effects... So far, he is the picture of perfect health (knock on wood) but it eats at me when I think about it too much. I am not the type of person to take a lot of medications without necessity, but I was bombarded during my pregnancy because of PTL and it totally caught me off-guard. I hate that feeling.
I am the same way about taking medications and I especially hate taking anything during pregnancy. But when you go to the hospital at 19/20 weeks and they tell you that if you are in labor then there is nothing they can do for your baby, you do what you have to do. Just know that you did what you thought was best for your baby.

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we heard the same thing about terb from our mfm. but in reality all drugs have risks and side effects. you have to weight the risk of having a baby born EXTREMELY premature vs the risk of using the drug for weeks on end. if you are earlier than 20 weeks, i would think the risk of being on those drugs long enough to get the baby to a gestational age that has a good chance of survival without major complications would be too high than someone who is late 20/early 30 weeks along. for those who used it, you did what u had to do to give your baby a fighting chance.
Very true. It can all be very scary for a pregnant mom.
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Old 01-13-2012, 09:28 PM   #10
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Re: fibronectin positive cervix thin

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I guess what changed is now they require a "Boxed Warning and Contraindication" where as they didn't before? Whatever the specific changes are, I know that just two years ago my Peri prescribed Terbutaline for PTL and now she does not.

Well said about the positive FFN. A negative is much more conclusive than a positive. Just because you get a positive does not mean you will go into labor but it does mean you are at in increased risk of going into PTL. I think FFN helps the doctor determine what steps, if any, need to be taken. That's why I think you need to contact your doctor and find out what the plan is for you (direct to the OP).
That could be very true about the medication. My brother's wife had twins last year. I do know that at the hospital she was at they did use terb and procardia. But had she been at my brother's hospital (he is an OB) - it is a teaching hospital - she would not have been given those medications. His hospital was more cutting edge and current being a teaching hospital. The one she delivered at was more traditional.

As far as the FFN they typically do it up until you would be into the 34 week window. They use it to determine whether to administer the steroid shots. If you are past 34 weeks they don't give the steroid shots for lung maturity - so they don't do the FFN.
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