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-   -   What do you think of "Medical Intervention" (http://www.justmommies.com/forums/f256-recurrent-miscarriage-and-pregnancy-loss/236091-what-do-you-think-medical-intervention.html)

beck12 June 24th, 2006 01:05 PM

Well - I have seen plenty of Drs.

We have been dignosed with a chromosomal abnormality. So - no more need for further tests really. We got the dignosis a day before we found out we were expecting during this last pg...

So - during this last pg - my RE tested blood levels every other day - which all looked great. Then did early u/s...etc. And told me we had b/o..and did another u/s, etc. In the end - when I mc'd - I didn't have b/o - and we still don't know why we couldn't see the baby on u/s - but anyway...

Dh & I have talked about it. I don't think I want to see a Dr that early the next time. They couldn't truly tell me anything & all it did was give me all these nervous times of waiting on tests results, etc. I don't see how it helped me. There is nothing they could do to help me....and there usually isn't in 1st trimester. Knowing the mc was coming wasn't even really helpful. I would have wondered if I was going to mc anyway - after having 2 previous & then our dignosis - I have a 40% chance that I will mc every time.

So I think we decided that next time to go solo. No early u/s - just prenates & fate. I want to enjoy being pg as much as I can & getting poked & prodded & diagnosed, etc - isn't aiding in the best experience for me. Last time the Dr put me on progesterone & aspirin - but I don't even think I want to do that again. That has never been shown to be low in me anyway - and it was such a high does it made me sooooo sleepy I could barely function at times & was very nervous to drive (and I have a 45min-1hr commute - each way).

I don't think Dr's have ever really helped & when I go in for my next follow-up I think I will tell my OB that I do not want an u/s before 12 wks unless she can explain to me the real benefit & I don't want all the bloodwork either unless again she can tell me what it prevents. Otherwise I am going to try to relax as much as I can & accept whatever happens & try to maintain a little more peace. I just think there is more anxiety added into it when I think of all the stupid Dr appointments, lab draws, etc - in an already busy schedule & then waiting on hearing about the results every day - UGH.

So does that sound crazy? I jsut think waiting to "know" is what makes me so anxious & if I decided ahead of time on giving up on having any absolutes, maybe I won't be so anxious & certainly - it was all money down the toilet - becasue it didn't help us any. I do think it is good to do those things until you have a diagnosis, so maybe it helps determine what is happeneing...but I don't see the point for us now in having all this monitoring. KWIM?

calicocat June 24th, 2006 01:46 PM

For my first two miscarriages I did nothing special and lost the pregnancies. For my most recent two, I did everything--Prometrium, near bed-rest, went to the doctor every week, etc., and still lost the pregnancies. So I think medical intervention did nothing for me. Either they stay or they go and it's pretty much out of my hands. With my most recent, the doctor even suggested the "heroic measures" might have prolonged the inevitable, and he may be right. My stress level right at the end of this pregnancy was unbelievable--although I think I subliminally knew something was wrong. Or maybe it contributed to the loss, I don't know.

If there is a next time, I'm doing nothing until 12 weeks (or longer), like you Beck. I pretty much know the drill and if something happens I can't handle, the ER is just 15 minutes away. Otherwise I'm going to go on with my life and let whatever happens happen. Progesterone makes me go nuts and I didn't like it, although I would be whistling a different tune if it had worked, of course. But it didn't, and I threw away the partial bottle I had left the day I found out the heart beat was gone.

I think that if a person is having multiple losses, that they should of course give these things a try. Maybe they will work for someone, even thought they obviously don't work for everyone. But women should just try not to look at it as something magical that will always work, because that's the way I looked at them, and was bitterly disappointed when they didn't.

lizard June 24th, 2006 06:13 PM

I would like to just sit back and do nothing, but I don't think that I can, at least not at this point. For my last 2 p/g (the ones I m/c), they haven't really done anything besides check HCG levels and do the u/s. Maybe I feel different because my two m/c have been blighted ovums. I feel that the dx the doctors gave me both times were accurate too, because by 10 or 12 weeks we should have been able to see something, or I should have seen something during the m/c. I don't feel that any amount of testing that they can do would have changed anything. Since the p/g were pretty much over by the time I ever went to the doctor (even though I carried them much longer), I don't think there was anything they could have done to save them. I think I would still go to the doctor early, because I would be in hopes that there was a baby there (that I could see!) and that if something was wrong that they might be able to do something. So, I guess at the moment, the pros outweigh the cons.

I would have liked to say that I don't want intervention, but since I really haven't had any (since they haven't 'treated' me for anything, then I guess I would have to try it to find if the outcome would be different.

beck12 June 24th, 2006 07:42 PM

Quote:

I would like to just sit back and do nothing, but I don't think that I can, at least not at this point. For my last 2 p/g (the ones I m/c), they haven't really done anything besides check HCG levels and do the u/s. Maybe I feel different because my two m/c have been blighted ovums. I feel that the dx the doctors gave me both times were accurate too, because by 10 or 12 weeks we should have been able to see something, or I should have seen something during the m/c. I don't feel that any amount of testing that they can do would have changed anything. Since the p/g were pretty much over by the time I ever went to the doctor (even though I carried them much longer), I don't think there was anything they could have done to save them. I think I would still go to the doctor early, because I would be in hopes that there was a baby there (that I could see!) and that if something was wrong that they might be able to do something. So, I guess at the moment, the pros outweigh the cons.

I would have liked to say that I don't want intervention, but since I really haven't had any (since they haven't 'treated' me for anything, then I guess I would have to try it to find if the outcome would be different.[/b]
I think in your case it's different though. It is different when you really haven't had any answers sweetie. :confused: I copied & pasted this for you:

Quote:

Future Pregnancies: Should You Worry?

The vast majority of women who have suffered from blighted ovum go on to experience healthy pregnancies in the future. Though it is possible to suffer from multiple miscarriages, this is highly unlikely unless there is some reproductive issue. To give your body time to heal, it is advised that you wait for one to three menstrual cycles before attempting to conceive again. Use birth control during this time to prevent any possible pregnancies.

If you have experienced more than two consecutive miscarriages, you may want to make an appointment to speak with a reproductive specialist. You or your partner may be suffering from underlying issues that are complicating pregnancy. There are a number of treatments that can help you to prevent future miscarriages and carry a healthy baby to term.[/b]
It is possible to find some reason for b/o I think. I am not certain though & my RE told me that b/o's aren't related to typical recurrent issues. I hope that means for you that it is just a really bad twist of fate & that you never experience one again.

My issue is that I had medical intervention through 2 pgs & losses, then did testing - got results, had more medical intervention than ever during the last pg - and still ended up with the same outcome, but more medical bilss & more poking & prodding.

I hope that we can get the host thing straightened out soon & get the stickies up for tests to ask for & questions to ask your Dr when you go in for tests. I have been looking for some of my old info for all the tests I have had done, what they mean, etc. I will email it to you even if we don't have a sticky by then - so that you feel more prepared when you go in for this stuff & know what you want to ask, etc. I hope to have it done soon...because perhaps it will help someone else not feel as clueless & overwhelmed as I did walking into this.

4iris June 24th, 2006 08:31 PM

I'm not really sold one way or the other. Doc sent samples for testing after my 2nd m/c and the initial and final results said the same thing, just trisomy 16. No progesterone issues or anything else, just a bad chromosome mix/split. I hate "not knowing", so I'd prefer to have early and regular u/s to make sure things are progressing or to find out asap if they're not. I get too attached too easily, which just makes it hurt that much more when I lose one. I also don't want another natural m/c if I can avoid it. I want to think that I wouldn't even POAS until AF is late, but not sure my resolve will hold. I'll be to anxious to know one way or another. I'm an analyst at heart and by trade, so the not knowing/have to know kicks in pretty early.

Beyond the early and frequent u/s, though, once my initial/standard bloodwork is done to make sure hcgs and progesterone are good, I wouldn't want more of the same done. Mostly because I hate getting stuck with needles and I bruise for 1-2 weeks afterwards. Also, tracking the numbers would make me insane. As long as they're strong to start with and the doc is happy, I'm good.

But that's just me. I completely understand for those who don't want to do anything until after the first trimester. That's probably my DH, but he'll go with whatever I decide.

Rina42308 June 25th, 2006 09:48 PM

I battle back and forth...ever since we discussed this Beck, I've thought about goign the no u/s route until 12 weeks as well but honestly i don't think I could do it. I am way too impatient...i think i would freak out in the middle of the night one night and make DH take me to the hospital to get an u/s because I'm a whackjob at times...I don't know. I think I'll talk it over with him and see what he thinks. But I do feel if I have another loss to have a natural m/c....multiple d and c's are too risky...if what happened to me (the scar tissue that was found) was a result of that. Ugh I just hate that we can't be "normal" ya know?...I know you all know...

tang17 June 26th, 2006 05:05 AM

Oh Beck, you must read my mind..I was thinking the exact thing the other day.......Here is my story, well you know most of it...3 miscarriages no explanation well FSH high not much of an egg reserve...well here we go again...so this month that did an IUI...my hopes were up...the doctor stood there and said you will must likely get pregnant this month...I was so excited...well after taking Clomid and a HCG trigger shot and promterium, guess what I AM NOT PREGNANT.....I am so sick of doctors...and to top that off I am like 5 days late on my period, the doctors nurse said that is common because of the progeterone(prometruim) it delays your period.....me and my husband sat down the other night and I discussed with him how I hate this...it seems that medical intervention is not working on me...I had a better success rate getting pregnant on my own.....Now to top all that off the doctor wants me to go and get a Rubella shot and wait 3 months, take 3 months off??????.....ok the doctor tells me on one hand my FSH is really high and I have low egg count, so treat me one month with IUI and then take a break for 3 because you need that rubella shot? I mean what the hell???? Most woman don't even know that are not immune for Rubeela until they are pregnant and then it is too late they have to wait until the baby is born to get the shot????????? So I have decided to do this by myself....worst case I miscarriage again.....I really just need a break from the stress of doctors trying to tell me what to do and in my eyes are confusing me, I mean taking Clomid etc can';t be good for the body........Somedays I think I know more than them......So BECK I understand what you are saying...I think you helped me...what I feel in my heart I have to do...and that is try myself? I think your feeling are right and you know what I bet once you get pregnant you will tell all of us that you went for your 12 week u/s and everything was great! WE really cannot give up! I admore your stength!............

Nykoal June 26th, 2006 08:42 AM

DH & I had that discussion last week. I don't want any screening blood tests or u/s until I have to. I know I'll have to have an u/s at around 6 weeks to ensure that it's not another ectopic but only want to know that everything implanted in the right area. I could never abort and we would deal with whatever happened anyways so knowing in advance wouldn't do us any good.

I want to enjoy being pg. I hated knowing that something wasn't right for 2 weeks. It was the worst 2 weeks of my life and I knew there was nothing I could do. I want to be blissfully ignorant and not have any medical intervention. I would rather have nature take it's course than to worry about everything out of my control.

I know some women need to know but after so much heartache I can't stomach the thought of going down that road for me personally. I'd rather be taken by surprise than to know in advance and worry and make things worse with the stress. This last pg I had more blood work and 4 u/s in 11 weeks and still had a bad outcome.

Sarah-Jean June 26th, 2006 08:52 AM

I think I'm the same as some of you. After my first 2 or 3 miscarriages I wanted answers, I wanted testing, I wanted intervention. Only problem was the Drs here in the UK aren't that keen on helping young people and despite all my suffering I have never been allowed any tests to see if there is a reason for my miscarriages or not.

After my 2nd or 3rd loss, I just decided to leave everything in fate's hands. If I get pregnant and it all works out, that's great. If it doesn't, well there's probably not a lot I could have done to change that outcome anyway...

Love,

Sarah-Jean

beck12 June 26th, 2006 08:03 PM

Quote:

I think I'm the same as some of you. After my first 2 or 3 miscarriages I wanted answers, I wanted testing, I wanted intervention. Only problem was the Drs here in the UK aren't that keen on helping young people and despite all my suffering I have never been allowed any tests to see if there is a reason for my miscarriages or not.

After my 2nd or 3rd loss, I just decided to leave everything in fate's hands. If I get pregnant and it all works out, that's great. If it doesn't, well there's probably not a lot I could have done to change that outcome anyway...

Love,

Sarah-Jean[/b]
Sarah-Jean,
I think it is TERRIBLE that they wouldn't so any testing. I think at a minimum all Dr's should be willing to do the most common tests...like thyroid, diabetes, etc. I am sorry that they didn't offer you more in your after care.

I am sorry you haven't been given the option to get the tests you wanted. That makes me mad - and I'm not even in the UK. <_<

beck12 June 26th, 2006 08:29 PM

tang17- Geesh - what is the deal with the Rubella shot????

Just so you know...a little anecdotal story ( I seem to be full of them :rolleyes: ).

My sister tested lacking immunity to Rubella with her first pg. Right away after delivery they gave her a shot. Next pg - same thing - no immunity...again another shot.... Follow up with that Ob a year later - no immunity - told er to go to health clinic & get it again :blink:

She went to a immunologist - pushed her Dr to send her - they study immune disorders - she wanted answers as to why she didn't have immunity. THat specialist told her she didn't need more shots - that her body had it's own immunity & was killing off the live culture they were injecting. She was glad to get not get another shot - but Pi$$ed that she had done the 2 previous - each time she got flu like symptoms, ran a temp, etc & while trying to recover with a c-section. In Michigan there is a immunology clinic (where you can go for specialized vaccines) that I visited in ALma prior to travelling overseas. That Dr told me that I should get a booster for my Rubella - but it was really not necessary he said - he said I should have the immunity from my childhood records - but i too came up as not having immunity. He told me thne that it would potpone TTC & we weren't - so he said it might be a good idea & since I was traveling to a 3rd world country (Bali - which got canned anyway because we were due to leave right after Sept 11th) I got it - he said he wouldn't have recommended it if I were staying in the US...that it probably was fine & I probably did have my own immunity.

There are some risks associated with MMR - although I believe it is more mild than many...I have copied & pasted this for you...make sure to read up before you decide anything...best wishes! (I know it's a lot of info...but it's the most thorough I could find..your Dr should be able to give you more specific info about it - they usually have pamplets, etc that tell all hte possible complications & benefits, etc.)

Quote:

MMR (measles, mumps, and rubella)
[This section last updated on October 23, 1999.]

Q3c.1 What is measles, and what are the risks of the disease?

Measles is one of the most contagious infectious diseases. "A child can catch measles by breathing the air in a doctor's waiting room two hours after an infected child has left." (Fettner) 90% of susceptible household contacts get the disease (Harrison). Measles spreads very rapidly in unexposed populations. In 1951, it was introduced to Greenland by a recently arriaved visitor who went to a dance as he was coming down with it, and in three months it spread to more than 4000 cases and 72 deaths. The attack rate was 999 cases per 1000 people. In 1875, measles was introduced to Fiji and killed 30 percent of the population (Smith).

In areas where it was endemic, before the measles vaccine, measles epidemics used to occur at regular intervals of two to three years, usually in the spring, with small local outbreaks in intervening years. Mortality is low in healthy, well-nourished children unless complications ensue (Merck), but nevertheless there were 400 deaths a year before an improved measles vaccine was introduced in 1966 (Pantell, Fries, and Vickery). Complications include brain infection, pneumonia, convulsions, blindness, various bacterial infections, encephalitis, and SSPE (a fatal complication which can occur years after a person has had measles). Pregnant women who get measles have a 20% chance of miscarriage.

Worldwide, measles is one of the leading causes of childhood mortality. "Measles has been called the greatest killer of children in history." (Clements, Strassburg, Cutts, and Torel) In 1990, "45 million cases and around 1 million deaths were estimated to occur in developing countries. Thus measles is still responsible for more deaths than any other EPI target diseases. The true number dying as a result of measles may be twice the estimated 1 million if the recently documented delayed effect of the disease is taken into account." (Ibid.) Mortality is higher in developing countries due to a difference in the age at which most people catch it (measles is a more dangerous disease in the very young), poorer nutrition, less availability of treatment for bacterial chest infections, and other environmental factors. However, "Even in countries with adequate health care and healthy child populations, the complication rate can reach 10%." (Ibid.)

More information on the incidence of measles complications is found in the answer to Q3c.2.

Q3c.2 How common was measles before routine vaccination, and how common is it now?

************************************************** ***********************
From Anthony C.:

I havent finished reading this thread so pardon if someone else has
already posted this information

Rates of complications of measles and measles immunization
Measles per 10^5 Vaccine per 10^5
Encephalomylelitis 50-400 .1
sspe .5-2.0 .05-.1
Pneumonia 3800-1000
Seizures 500-1000 .02-19
Deaths 10-10000 .01

These statistics are worldwide, hence the variablility in numbers. The
higher rates of pneumonia and death represent figures collected from
India, Nambia, Nigeria, bangladesh and other countries with developing
health care industries.

As far as the number of people afflicted with measles in the US
Cases Deaths
1963 385,566 364 Inactivated measles type vaccine available
1964 458,093 421
1966 204,136 261 public health administration of vaccine
1967 62,705 81
1968 22,231 24
.
.hovers around 20-70,000
.
1977 57,345 15
1978 26,871 11
1979 13,597 6
1980 13,506 11
1981 3,032 2
1982 1,697 2
1983 1,497 4
1984 2,587 1
1985 2,822 4
1986 6,273 2
1987 3,588 2
1988 2,933 not available
1989 16,236 41
1990 26,520 97

iMajor foci of retransmission barring the complete elimination of measles:
1) unimmunized indigent, inner city youngsters.
2) illegal aliens.

I hope this is useful. My source is Zinsser microbiology, 20th edition
pages 1013-1015, joklik et al.
************************************************** ***********************

As the above table shows, there was a marked increase in measles incidence in the US from 1989 to 1991. This resulted in more than 50,000 cases including 125 deaths (http://www.immunize.org/nslt.d/n21/paradx21.htm). Measles has been on the decline again in the US since 1990 (MMWR Feb 4, 1994, p. 57). Colleges enforcing the requirement for a second measles vaccine report fewer measles outbreaks than schools with no requirement (JAMA, Oct 12, 1994, p. 1127). (Both of these citations from Journal Watch for Jan 15, 1995 - paper edition, or Feb 7, 1995 - electronic edition.) During 1998, a provisional total of 100 measles cases was reported to the CDC, making for a record low, 28% lower than the 138 cases reported in 1997 (MMWR 48(34);749-753, 1999. Centers for Disease Control).

Q3c.3 How effective is the measles vaccine?

The Merck Manual and the Physician's Desk Reference estimate its effectiveness at 95%. This estimate is based on studies of the immunity induced by a series of vaccinations beginning at 15 months. Another article, estimating the immunity induced in field conditions (including some Third World countries, which may have less reliable vaccine storage) by a series of injections beginning at 9 months (the injections are started earlier in areas where measles is widespread), estimated effectiveness as 85% (Clements, Strassburg, Cutts, and Torel).

A recent article in Pediatric News (Imperio. Vaccine-Exempt At Higher Risk For Measles. Pediatric News 33(9):9, 1999.) reported that "Individuals aged 5-19 years who were not vaccinated due to religious or philosophical exemptions were, on average, 35 times more likely than vaccinated individuals to contract measles, according to a population-based, retrospective cohort study."

Q3c.4 How long does the measles vaccine last?

The Merck Manual describes it as "durable." The PDR says that all of the antibody levels induced by MMR have been shown to last up to 11 years without substantial decline, and "continued surveillance will be necessary to determine further duration of antibody persistance."

Q3c.5 What are some of the risks of the measles vaccine?

There is a small chance of complications similar to the complications of measles (pneumonia, encephalitis, SSPE). Information on the frequency of these complications is included in the answer to Q3c.2. There is some risk of anaphylaxis. This risk is low; from the time that VAERS was instituted in 1990 till the publication of Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions by ACIP in 1996, >70 million doses of MMR vaccine had been distributed in the US, and only 33 cases of anaphylactic reactions had been reported to VAERS. It has been traditionally believed that this risk is mainly for people allergic to eggs or neomycin. However, recent studies indicate that anaphylactic reactions are not associated with egg allergies, but with some other component of the vaccine. There have been some case reports, in the US and Japan, of anaphylactic reactions to the MMR vaccine in people with an anaphylactic sensitivity to gelatin.

In rare instances, MMR vaccine can cause clinically apparent thrombocytopenia within 2 months after vaccination. Passive surveillance systems report an incidence of 1 case per 100,000 doses in Canada and France, and 1 per million in the US. Prospective studies have reported a range from 1 in 30,000 in Finland and Great Britain to 1 in 40,000 in the US, with a clustering of cases about 2-3 weeks after vaccination.

An article in the Feb 28, 1998 Lancet (based on 12 cases) about a possible association between inflammatory bowel disease, autism, and MMR vaccine (Wakefield et al) raised concerns that the vaccine might increase the risk of autism. Wakefield and his colleagues did not claim to have actually shown that the vaccine caused autism, but rather called for further investigation of the question. An accompanying editorial in the same issue of Lancet expressed concerns about the validity of the study.

The article, and the public concern it raised, led to several further investigations of whether such an association existed. A research letter in the May 2, 1998 issue of Lancet reported on a 14-year prospective study, in Finland, of children who had experienced gastrointestinal symptoms after receiving the MMR vaccine. 31 children (out of 3 million vaccine doses) reported gastrointestinal symptoms; all recovered, and none developed autism. A Working Party on MMR Vaccine of the United Kingdom’s Committee on Safety of Medicines (1999) examined hundreds of reports, collected by lawyers, of autism or Crohn's disease (a gastrointestinal disease) and similar problems, after the MMR vaccine, and concluded that there was no causal relationship. A Swedish study (Gillberg and Heijbel 1998) found no difference in the prevalence of autism in children born before the introduction of MMR vaccine in Sweden, and children born after. Wakefield and colleagues did laboratory assays in patients with inflammatory bowel disease (the mechanism which they had proposed for autism following the MMR vaccine), and found them negative for measles virus (Chadwick 1998, Duclos 1998, cited by the CDC at http://www.cdc.gov/nip/vacsafe/vaccinesafe...cts/autism.htm).

Finally, a study in the June 12, 1999 issue of Lancet examined children born with autism since 1979 in eight North Thames health districts, to look for changes in incidence or age at diagnosis since the introduction of MMR vaccination in the UK in 1988. The study found a steady increase in cases of autism, with no sudden change in the trend after the introduction of the MMR vaccine. Parents most frequently reported first noticing symptoms of autism at around the age of 18 months, after the MMR vaccine would have been received, but there was no difference in age at diagnosis between those vaccinated before and after 18 months and those never vaccinated. Developmental regression (which occurred in about a third of the cases of autism) was not clustered in the months after vaccination.

Q3c.6 What is mumps, and what are the risks of the disease?

Mumps is a viral disease which is less contagious than measles or chicken pox. It causes swollen salivary glands. The most common complication is swelling of the testes (in about 20 percent of males post puberty) and, less commonly, ovaries. Rarely, it can lead to sterility. Other complications are meningitis (less common than in measles) and acute pancreatitits. (A much longer list of complications can be found in the Merck Manual.)

Q3c.7 How common was mumps before routine vaccination, and how common is it now?

105,00 cases were reported in 1970; by 1990 the rate of reported cases was down to 5,300.

Q3c.8 How effective is the mumps vaccine?

The Merck Manual estimates its effectiveness at 95%. The Physician's Desk Reference gives its effectiveness as 96%. Switzerland has gotten lower efficacy rates, for mumps, out of its strain of the MMR vaccine, and Swiss scientists have been comparing the efficacy of different strains to improve this situation (Swiss Medical Weekly, http://www.smw.ch/archive/1997/127-26-360-96.html and http://www.smw.ch/archive/1998/128-17-351-98.html).

Q3c.9 How long does the mumps vaccine last?

The Merck Manual describes it as "durable." "Mumps immunization provides protection through the blood serum antibodies for at least 12 years, and possibly much longer." (Pantell, Fries, and Vickery) (See also Q3c.4 for the PDR's description of the duration of all the MMR-induced antibodies.)

Q3c.10 What are some of the risks of the mumps vaccine?

"Rarely, side effects of mumps vaccination have been reported, including encephalitis, seizures, nerve deafness, parotits, purpura, rash, and prurittis." (Merck. Encephalitis and convulsions were also on Merck's list of complications for mumps itself.) According to ACIP's 1996 report on vaccine adverse reactions, "Aseptic meningitis has been epidemiologically associated with receipt of the vaccine containing the Urabe strain of mumps virus, but not with the vaccine containing the Jeryl Lynn strain, the latter of which is used in vaccine distributed in the United States." [MMWR 45(No. RR-12), 1996]

Q3c.11 What is rubella, and what are the risks of the disease?

Rubella is a mild illness, consisting of a mild fever and rash. Rare complications include ear infections and encephalitis, but the real danger is to pregnant women. During the last rubella epidemic, in 1964, 20,000 children were born with birth defects caused by rubella. Birth defects include deafness, cataracts, microcephaly, and mental retardation. Children born with congenital rubella are als susceptible to rubella panencephalitis in their early teens.

Q3c.12 How common was rubella before routine vaccination, and how common is it now?

Before the development of the rubella vaccine, epidemics used to occur at irregular intervals in the spring, with major epidemics at 6 to 9 year intervals. (This means that one was just about due when the vaccine came out in 1969.) There have been no major epidemics since 1969, but the number of cases of rubella and congenital rubella syndrome increased starting in 1989 (Merck, also California Morbidity for November 19, 1993). (It was still a small fraction of the pre-vaccine number, though, see table of disease frequencies in section 1.) "Serological surveys conducted in the late 1970s and the 1980s indicated that 10 to 25 percent of United States women of child-bearing age were shown to be susceptible to rubella." (California Morbidity, November 19, 1993) It now appears to be declining again: "Following a resurgence of rubella and congenital rubella syndrome (CRS) during 1989-1991, the reported number of rubella cases during 1992 and 1993 was the lowest ever recorded." (MMWR, cited in June 9, 1994 HICNet Medical News Digest.)

Q3c.13 How effective is the rubella vaccine?

The Merck Manual estimates its effectiveness at 95%. The Physician's Desk Reference gives its effectiveness as 99%.

Q3c.14 How long does the rubella vaccine last?

The Merck Manual describes it as "sustained." (See also Q3c.4 for the PDR's description of the duration of all the MMR-induced antibodies.)

Another reference, from Heather Madrone:

************************************************** ***********************
D. M. Horstmann "Controlling Rubella: Problems and Perspectives"
_Annals of Internal Medicine_, vol. 83, no. 3, pg. 412

Horstmann found reduced antibody formation 3-5 years after administering
the vaccine and 25% of those tested showed no immunity to rubella at
all.
************************************************** ***********************

Q3c.15 What are the pros and cons of vaccinating all infants for rubella versus vaccinating females only at puberty?

There is still some uncertainty about the most desirable rubella vaccination policy. In 1969, when the vaccine came out, it was decided to avert the expected epidemic by vaccinating all children over one year, so that they would not spread rubella to their possible pregnant mothers - the first time one group of people was vaccinated to avoid having them spread a disease to a different group of people. Supporters of this policy point out that the expected epidemic didn't occur. The possible disadvantage is that we aren't sure how long the immunity lasts. Now that generation of children is old enough to have children, and some of them may no longer be immune. In the past, 80% of the population was immune due to having had rubella in childhood.

Some countries follow a policy of vaccinating girls at puberty if they don't have rubella antibodies (Pantell, Fries, and Vickery). The disadvantage is that vaccine side effects are more common at this age. The most common is joint pain, which occurs in 10% of women who are vaccinated in adolescence or later. In some cases, it has lasted as long as 24 months. (Pantell, Fries, and Vickery) The PDR describes this same side effect in somewhat milder terms, saying that it generally does not last very long and "Even in older women (35-45 years), these reactions are generally well tolerated and rarely interfere with normal activities." It does agree with Pantell, Fries, and Vickery that the incidence of this side effect increases with age: 0-3% of children and 12-20% of women have joint pain, and the pain is more marked and of longer duration in the adult women. A few women (between 1 in 500 and 1 in 10,000) experience peripheral neuropathy (tingling hands). Another risk of vaccinating later is the risk that a woman may be pregnant. So far, no connection with birth defects has been demonstrated, but women are advised to avoid pregnancy for three months after getting the vaccination.

Current US policy is to vaccinate all children at 15 months, and give a booster during school years. Adult women are advised to get an antibody test before becoming pregnant, and, if it comes up negative, get vaccinated and wait three months before getting pregnant.

There has not been a rubella epidemic since 1964, either in countries which vaccinate all children at 15 months, or in countries which vaccinate girls only at puberty.

Q3c.16 What are some of the risks of the rubella vaccine?

The PDR has a long list of possible adverse reactions (besides arthritis and arthralgia, usually short-lived, see above). Most of them are either mild or rare.

Q3c.17 When is the MMR vaccine contraindicated?

People with an anaphylactic or anaphylactoid allergy to eggs or neomycin should not get the vaccine. Other allergies or chicken or feather allergies are not a contraindication. Vaccination should be deferred in case of fever. The PDR give active untreated tuberculosis as a contraindication, but the AHFS says that there is no evidence of a need to worry about TB. Both give immune deficiency as a contraindication (see PDR for a long list of immune deficiencies involved). Immune globulin preparation or blood/blood product received in the preceding 3 months. The same contraindications apply individually to measles and mumps vaccines, but the rubella vaccine can be given by itself to people with an anaphylactic egg allergy. The other contraindications still apply to the rubella vaccine alone. (California Morbidity, October 31, 1987)

Vaccine components capable of causing adverse reactions: for mumps and measles, chick fibroblast components; for mump, measles, and rubella, neomycin (Travel Medicine Advisor).[/b]

VegasMom June 26th, 2006 10:20 PM

This is my first time posting on this board but I have been active on the pregnancy after loss board. I honestly felt better having everything monitored closely by my Dr. Sure it was disappointing to go in and have a u/s and find no signs of life, but it eliminated the uncertainty of "is it okay or not". My Dr. took very good care of me during my pregnancies and I think he was just as upset by each m/c as my DH and I were. On the same note, he was so happy when he delivered our baby two weeks ago that he cried with us.

Just a little history on me, I had 6 m/c in a row. My first pregnancy resulted in a premature baby, my 17 year old DS Brandon. Then over the next 16 years I suffered one m/c after another. I took all the tests and basically couldn't really find any reason for the m/c after all I DID have a child so I should be able to have another. Fortunately the Dr. didn't give up on us and we didn't give up on our baby because June 9, 2006 we had our 2nd son.

I do agree that if it's going to happen then it's going to happen and basically there is nothing you can do about it, but I personally like to know what is going on inside of me and just maybe the Dr. can save me. On the other hand I understand the disappointment of doing everything you're supposed to and still losing the baby. It makes me feel like I DID SOMETHING wrong.

Rina42308 June 26th, 2006 10:33 PM

Quote:

This is my first time posting on this board but I have been active on the pregnancy after loss board. I honestly felt better having everything monitored closely by my Dr. Sure it was disappointing to go in and have a u/s and find no signs of life, but it eliminated the uncertainty of "is it okay or not". My Dr. took very good care of me during my pregnancies and I think he was just as upset by each m/c as my DH and I were. On the same note, he was so happy when he delivered our baby two weeks ago that he cried with us.

Just a little history on me, I had 6 m/c in a row. My first pregnancy resulted in a premature baby, my 17 year old DS Brandon. Then over the next 16 years I suffered one m/c after another. I took all the tests and basically couldn't really find any reason for the m/c after all I DID have a child so I should be able to have another. Fortunately the Dr. didn't give up on us and we didn't give up on our baby because June 9, 2006 we had our 2nd son.

I do agree that if it's going to happen then it's going to happen and basically there is nothing you can do about it, but I personally like to know what is going on inside of me and just maybe the Dr. can save me. On the other hand I understand the disappointment of doing everything you're supposed to and still losing the baby. It makes me feel like I DID SOMETHING wrong.[/b]
Vegas mom,
thank you so much for sharing your story with us. I have had 4 losses and no living children...some days I get so sad and hopeless...i never want to give up but at the same time the road feels so long, so hard, so catastrophic even...thank you for givn gme hope. Congratulatiosn on your son. I am so happy to hear you have your baby safe in your arms right now...I pray to join you in that "club" someday soon.
Continual blessing to you and yours,

tang17 June 27th, 2006 05:46 AM

Thanks so much Beckie for the info.... I am going now to get that stupid doctors cannot else to me...like you need that shot what if this happens what if that....if they come to me in another montha nd say I need something else I cannot be held responsible for what I will say or do.....This is so stressful on me....take a month off I mean don't these doctos understand what I have been through and want to help....no they want me to do what they want......I hate this..................

srs June 27th, 2006 11:13 PM

I have mixed feelings. On the one hand, I fall squarely into that category where it's time to figure out if something is worng and can be easily "fixed" to prevent another mc (two consecutive losses in six months, no living children, and no obvious health problems). On the other hand, I totally agree with the comment about doing everything right and still haveing the mc. After this last time, I pretty much have given up on me being able to keep a pregnancy just by doing everything right. I did really good last time, and I still lost the baby.
At this point, I have a feeling that no matter what I do I'm probably not going to enjoy the pregnancy, so I guess I will just see how it feels if and when I get pg again.

Beck, it's funny you should bring this up just now. I have an appt tomorrow (well today really) with a genetic counselor. I'll let you all know how it goes.

Sara

StephLS June 28th, 2006 08:37 AM

Beck, it's funny you should bring this up just now. I have an appt tomorrow (well today really) with a genetic counselor. I'll let you all know how it goes.

Sara
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Hope your appointment with the genetic counselor went well!


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