10/2 Yom Kippur

• Midnight – On the monitor at NYU contractions are one minute long, one minute apart. Exam by Jackie shows 1 cm dilated. Preterm labor is official. One SQ shot of tertbutaline stopped the contractions for 15 minutes. Then a 2 mg load of magnesium and 2 mg/hr drip with the expectation of minimum 48 hours. Contractions space out to q3-4min. Plan for indomethacin.
• 2 AM – Received PCN G (q4) for potential GBS.
• 4 AM – Mg increased to 2.5 mg/hr and 1 extra dose of tertbutaline given.
• 5 AM – Jenny gets IM injection of betamethasone to mature the baby’s lungs
• 8 AM – Dr.Schweizer arrives and changes the plan. The terb has been more effective than the Mag so magnesium is stopped and a terb drip starts. Contractions start to spread out to 2-4 painful (6-8/10) contractions an hour. UA is positive with leukesterase and bacteria. Macrobid planned for but changed to keflex. Azithromycin added for coverage of mycoplasma or ureaplasma.
• 9 AM – Ultrasound normal for dates (estimated weight 887 g)
• 2 PM – Temperature 100.4
• 4 PM – Temperature 101, BP on cuff 88/55. Coverage increased to Gentamicin.
• 5 PM – SCD boots to the thighs are placed.
• 6 PM – Painful contractions start to come more frequently. Contractions are associated with bleeding.
  
• 8 PM – Dr. Schweizer does a manual exam and finds the cervix is 8-9 cm dilated. The baby has to be delivered. Caesarean section had been discussed earlier as the plan if the pregnancy had progressed but since delivery would be at 25 weeks, a vaginal option was still considered viable. The baby’s heart rate was strong and the delivery of such a small baby would be fast.
• 9 PM – Jenny is moved to a Labor and Delvery room (805) and starts pushing. Contractions are coming only every 5 minutes so pushes are far apart.
• 10:06 PM – Baby Boy Stein is born crying. His nurse (Belle) insists on a name. When none comes she declares him "Mr. Stein." Apgar 8/8. 1035 grams. 35 cm. He is whisked to the NICU. He is intubated electively about 2 hours later.