Q: I am 36 years old and have hypothyroidism (was taking 25 mg Thyronorm all throughout pregnancy). I delivered a 26 weeks baby last month. The baby was alive for just a week in the NICU. One month earlier, I had a cerclage done at 22 weeks as the internal os was found to be 1 cm dilated and length of cervix was 3 cm. Three days before delivery, I had leaking of amniotic fluid and was admitted to the hospital where the amniotic fluid level in ultrasound was found to be just 3.3. Next day with suitable medication and strict bed rest it went up to 5. One day before the delivery, the doctor saw my sanitary napkin and suspected that the baby had passed meconium. However after a lot of exhaustive internal vaginal examination she was still unsure about the meconium an as there was no sign of any fetal distress, delivery was postponed. However, the baby was delivered spontaneously without much pain. The baby was alive for a week only. I had a bit of high blood pressure in the pregnancy and was on ecosprin and susten till the time of delivery. Is it possible for the baby to pass meconium through my vagina? What all can I do to prevent another preterm delivery? And when I can try to get pregnant again?

A:I am sorry to hear about your loss. It is very difficult for such preterm babies to survive. Even if they do, they may have some handicaps. Whatever has happened is for the best Yes, the baby does pass meconium, and if the membranes are ruptured, it will come into the vagina and outside. The cerclage was required from the details you have provided. I suggest: 1. Keep your thyroid levels under control - have an endocrinologist take care of you. Dosage needs to be adjusted during pregnancy. 2. After your normal menses, you must have a hysterogram (special x-ray of uterus) or a hysteroscopy done. Your gynaecologist should examine you before this test to make sure there is no infection. This is to rule out any associated malformations in the shape of the uterine cavity, which can be associated with the incompetent os. If there is any malformation, that may / may not require surgical correction (endoscopically or otherwise) before attempting the next pregnancy. Otherwise, the cerclage stitch alone may not help. 3. Try to avoid the next pregnancy for at least 6 months. You need to recover, and get all other tests done.