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Frequently Asked Questions
As a physician practicing for over 20 years, I have encountered countless questions and have heard infinite concerns from mothers and their families about everything from smoking during pregnancy to what sort of music may or may not be harmful to the development of a baby’s ears. Hopefully, going through this list will ease some of your worries, or in the least inform you as to what you should and should not be concerned about. - Alexander D. Kofinas, MD

» Premature Labor

» Incompetent Cervix

» Pregnancy Loss

» Nutrition & Exercise

» Thrombophilia

» Fetal Monitoring

» Meds and Supplements

» Cerebral Palsy

» Medical Conditions

» Miscellaneous


What is Indomethacin?
Indomethacin is a non-steroidal, anti-inflammatory medication, which was primarily used for treating arthritis (similar to Motrin). Because labor involves the activation of compounds known as inflammatory cytokines, Indomethacin is the most potent medication used to effectively stop the production of these compounds, thus preventing PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor.
What are the side effects of Indomethacin, which should concern my unborn baby as well as me?
Use of Indomethacin does not result in any serious side effects for the mother. The most common effects are mild gastrointestinal symptoms and fluid retention. Occasionally, patients complain of headaches. It is important to note however, that most of these symptoms subside within 2-3 days. In rare cases we have been forced to reduce the dosage in order to get rid of some symptoms, but more often than not the symptoms subside on their own. Indomethacin has been found to cause temporary constriction of the ductus arteriosus if used after 34 weeks and for more than 48 hours. At KOFINAS PERINATAL we never use Indomethacin after 32 weeks and we have never seen any signs of constriction in fetuses prior to 32 weeks when the medication is in use according to our protocol. We rarely use Indomethacin for more than seven days, and we always monitor the condition of the ductus arteriosus with color and pulsed wave DopplerDoppler:
Often used as a non-invasive method of measuring blood flow in humans.  before and after the treatment. Another fetal side effect is oligohydramnios (reduction in volume of the AmnioticAmniotic:
Of or related to the amnion or characterized by developing an amnion; "amniotic membrane"  fluid). We have seen a few cases where AmnioticAmniotic:
Of or related to the amnion or characterized by developing an amnion; "amniotic membrane"  fluid volumes dropped slightly, but as soon as we stopped the medication, the fluid rebounded to normal levels. Overall, the benefits of Indomethacin far outweigh any theoretical risks.
What are some of the reasons that labor would be induced?

Labor is usually induced for medical reasons. Reasons may relate to both the mother and the fetus. With respect to the mother some common indications are poor maternal health, severe HypertensionHypertension:
This is a cardiovascular disease in which chronic high blood pressure is the primary symptom. , maternal uterine infection, rupture of the fetal membranes prior to the onset of spontaneous labor etc. With respect to the fetus common indications are growth failure, non-reassuring fetal condition (stressed fetus), decreasing fetal activity, decreased AmnioticAmniotic:
Of or related to the amnion or characterized by developing an amnion; "amniotic membrane"  fluid (oligohydramnios), etc. Many Obstetricians choose to induce labor if spontaneous labor does not commence by 39-40 weeks because fetal morbidity and fetal mortality increase exponentially after 39 weeks.

I delivered my first baby prematurely because of preterm labor. Can this happen again?
Most PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  deliveries are caused directly by poor placental development, which itself is often caused by an underlying and recurrent problem in the mother. This is why patients who delivered prematurely in a previous pregnancy, are as much as 60% more likely to experience a premature delivery in the next. ChronicChronic:
Lasting for a long period of time or marked by frequent recurrence, as certain diseases.  inflammation of the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  due to poor placental blood flow and tissue necrosis (tissue death) may cause PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor. At Kofinas Perinatal, we are able to reduce the number of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  deliveries by 50% in both singleton and multiple gestations simply by helping the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  develop normally and to its full capacity. Early placental development (prior to 12 weeks) is of paramount importance, something that other physicians do not recognize. In addition, our outpatient management of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor with Indomethacin and Ca++ (calcium) channel blockers helps us in our quest against prematurity.
I delivered my first baby prematurely because of preterm labor. Can this happen again?
Most PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  deliveries are caused directly by poor placental development, which itself is often caused by an underlying and recurrent problem in the mother. This is why patients who delivered prematurely in a previous pregnancy, are as much as 60% more likely to experience a premature delivery in the next. ChronicChronic:
Lasting for a long period of time or marked by frequent recurrence, as certain diseases.  inflammation of the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  due to poor placental blood flow and tissue necrosis (tissue death) may cause PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor. At Kofinas Perinatal, we are able to reduce the number of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  deliveries by 50% in both singleton and multiple gestations simply by helping the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  develop normally and to its full capacity. Early placental development (prior to 12 weeks) is of paramount importance, something that other physicians do not recognize. In addition, our outpatient management of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor with Indomethacin and Ca++ (calcium) channel blockers helps us in our quest against prematurity.
What is Procardia?
Procardia (a.k.a. Nifedipine) is a calcium channel blocker used primarily as an anti-hypertensive medication (blood pressure lowering medication). Procardia achieves this by relaxing the muscular fibers, which compose the vessels, allowing the blood to flow more freely. Because the uterine muscle responds the same way to Procardia, the medication causes relaxation of the uterine muscle fibers and thus stops PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  contractions. Although Procardia can be used throughout the entire pregnancy, it achieves its best results when used after 15 weeks gestation.
What is preterm labor?
Preterm labor is defined as the presence of uterine contractions along with progressive cervical shortening before the 37th week of gestation. PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor does not necessarily lead to PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  delivery, which is defined as the delivery of a NeonateNeonate:
A newborn infant, especially one less than four weeks old.  before completion of the 37th week of gestation. The same is true of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  deliveries, which can occur in the absence of PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor.  In such cases, delivery is induced due to complications that affect either the mother or the fetus or both such as PreeclampsiaPreeclampsia:
A condition of hypertension occurring in pregnancy, typically accompanied by edema and proteinuria. , DiabetesDiabetes:
A medical condition where the body is unable to metabolize glucose and as a result experiences a rise in blood sugar levels. , infection, growth failure, etc.
What are the causes of preterm labor?
Preterm labor may be the result of an IntrauterineIntrauterine:
Occurring or situated within the uterus.  infection, non-infectious IntrauterineIntrauterine:
Occurring or situated within the uterus.  inflammation, placental ischemia (reduced placental blood flow), placental abruption, and placental ThrombosisThrombosis:
Formation or presence of a thrombus; clotting within a blood vessel which may cause infarction of tissues supplied by the vessel. . In addition, PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor may often occur for reasons that we cannot identify (a.k.a. idiopathic). At KOFINAS PERINATAL we have successfully treated thousands of patients with tendencies for PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor. From our experience, most patients encounter PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor due to some degree of non-infectious inflammation. The use of the anti-inflammatory agent Indomethacin has been instrumental in the successful treatment of such patients.
What is tocolysis?
The word "toco-lysis" is a derivative of the Greek words toketos, which means labor and lysis, which means, “to bring to an end.” Together they mean the process of ending labor. Over the years, a number of drugs were used to achieve tocolysis. The most commonly used tocolytics are Indomethacin, Procardia, Terbutaline, Ritodrine and Magnesium Sulfate. At KOFINAS PERINATAL, after 25 years of experience with all kinds of tocolytics, we have developed a protocol for outpatient treatment by using Indomethacin and Procardia in various combinations according to the patient's particular condition. Rarely, and only, if we have absolutely no other choice, do we use hospitalization with Magnesium Sulfate. Terbutaline and Ritodrine have never convincingly shown that they can successfully prevent PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  delivery. On the contrary, ChronicChronic:
Lasting for a long period of time or marked by frequent recurrence, as certain diseases.  use of Terbutaline may cause increased irritability of the UterusUterus:
A hollow muscular organ located in the pelvic cavity of female mammals in which the fertilized egg implants and develops.  due to its stimulation of the enzyme cAMP - phosphodiesterase.
What are Procardia's side effects?
Procardia is a very safe medication, and we have never been forced to terminate its use because of side effects. Use of procardia may drop the blood pressure of a normal individual slightly, but this does not affect a patient's ability to continue taking her medication. Some patients experience mild palpitations for the same reason and others complain of skin redness in the body’s lower extremities when standing upright, but this often disappears when the patient goes to bed. There are no known fetal complications caused by the use of Procardia, and in many instances in the past we used Nifedipine to treat fetal tachycardia (fast heart rate).
My first baby was delivered by cesarean section because of fetal stress and I was told that the placenta was full of clots. What does this mean?
When the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  has clots present either inside it (placental ThrombosisThrombosis:
Formation or presence of a thrombus; clotting within a blood vessel which may cause infarction of tissues supplied by the vessel. ) or under it (sub placental clots), it means that a portion of the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.  has been damaged, resulting in less efficient blood flow to and from the mother. In such cases, the fetus cannot receive the necessary nutrients and ultimately, the necessary oxygen for healthy development. Fetuses with such placentas are at risk for growth failure, PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  delivery, brain damage and even death. The risk for brain damage and death is highest during labor due to the additional stress imposed by the labor process.
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