Wednesday, July 30, 2008

So why was it so important to make it until morning?

Okay, you've forced me to confess a narrative trick.  We'd met the perinatologist once before, on Tuesday.  He had been asked to consult on our case because we were showing two signs of preterm labor -- fetal fibronectin (a protein that can appear on the cervix as a harbinger of labor) and the cervical thinning that had been showing up on ultrasounds for about a month.  He met with us at Peninsula and told us that we were showing risk factors, but it might be possible to get it under control.

And he did another thing:  He prescribed betamethasone.  Betamethasone is a steroid that boosts lung maturity in fetuses that are at risk of preterm birth.  It is administered in two intramuscular injections to the mother, placed 24 hours apart.  But it only has beneficial effects if delivery occurs more than 48 hours after the administration of the first dose, in order to give the steroid time to effect a change in the lungs.  He administered the first dose when he met with us on Tuesday morning at 10:00 a.m.  The second was administered at 10 a.m. on Wednesday morning -- just before the contractions started.

All of a sudden, our primary goal became to keep the babies in utero until 10 a.m. on Thursday -- i.e., 48 hours after the administration of the first dose of betamethasone.  Doing so would mean the babies, if delivered, would have a chance a sufficient lung maturity.  Delivery any earlier than 10 a.m. on Thursday might mean the steroids would not complete their task.

Okay, give Ginger a goal, and she will meet it.  Right?

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