when does labor start after stopping progesterone shots

I am currently 35 weeks and getting weekly 17P shots, progesterone shots to help prevent pre-term labor, and I am on 20mg of Procardia every 4 hours for constant contractions, I've only dilated to 1cm and 20% effaced. If you feel a message or content violates these standards and would like to request its removal please submit the following information and our moderating team will respond shortly. I know Im on bed rest until 37 weeks, currently 29w3d, but my OB hasnt said anything yet about when to stop the progesterone. Practice Bulletin No. Is the ketogenic diet right for autoimmune conditions? Romero R, Conde-Agudelo A, El-Refaie W, et al. Stress, exercise, body weight, and overall health can all influence when periods will return and how regular they will be. If you have a history of premature birth, your health care provider might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate, starting during your second trimester and continuing until week 37 of pregnancy. Tomorrow I have an appointment and going to ask him to stop giving me the shots because I cant feel like This every single day..", "I had my first child at 28w 5d baby stayed in NICU for almost 3 months but perfectly healthy now and 4 years old! 2023 Dotdash Media, Inc. All rights reserved. The #1 app for tracking pregnancy and baby growth. With typical use, 6 in 100 women get pregnant during the first year of using the injection. At 30 weeks i went back in with contractions and was 3 cm dilated. Mayo Clinic does not endorse companies or products. You're almost there - how exciting! She didnt have to spend anytime in the NICU at all unlike our son did. https://www.uptodate.com/contents/search. Compare all 7 medications used in the treatment of Premature Labor. Birth control pills, hormone replacement therapy and pills to regulate menstrual cycles often contain a synthetic form of progesterone. Taking progesterone and then stopping generally causes a withdrawal bleed similar to a menstrual period. Typically, the sutures are removed after 36 completed weeks of pregnancy. ins.id = slotId + '-asloaded'; Its very unsettling. It can be difficult to stop preterm labor, especially if the cervix has already started dilating. Your doctor may offer you medication as an alternative to cervical cerclage. About 90% of women with preterm labor do not give birth within seven days after labor begins. 2023 Healthline Media UK Ltd, Brighton, UK. Accessed Oct.14, 2019. Bed rest, pelvic rest, and hydration (sometimes with intravenous fluids) can sometimes slow or stop contractions. So ready to stop taking these medsbut wondering how soon ppl typically delivery after stopping. I do not get the bumps, itchiness, burning, etc symptoms like lost people I have read. I truly believe I have the makena shots to thank for that. Available for Android and iOS devices. If you are diagnosed with a short cervix before week 24 of pregnancy, your health care provider might also recommend use of progesterone until week 37 of pregnancy. McGraw-Hill Education; 2018. https://accessmedicine.mhmedical.com. The only issue she has is latching as I'm breast feeding her. Resnik R, et al., eds. Progesterone supplementation to reduce the risk of spontaneous preterm birth. When I got pregnant with my 2nd it was recommended to take the shot. Use of vaginal progesterone to prevent miscarriage can be traced to the mid-1950s, Coomarasamy noted. Preterm labor: Clinical findings, diagnostic evaluation, and initial treatment. 20062023 BabyCenter, LLC, a Ziff Davis company. I get the injections above my butt and they do hurt like anything. If you're at risk of preterm labor or premature birth, you might feel scared or anxious about your pregnancy. Tell me about it! Antibiotics can also prolong pregnancy in women who have previously experienced a preterm rupture. No, my blood pressure had steadily crept up starting at about week 32 so dr thought it was best to go ahead and induce. Unfortunately, this can continue after stopping the injections. Usually it's weeks later. Mayo Clinic. (2018). They did say they would be thrilled if I made it to 37 weeks though. GL with everything! Well it looks like everyone is all over the place lol. They had to lay me down and cool me off. I was curious how long after ending P17 shots people delivered their babies. My cousin gave us a ton of baby cl. It definitely was scary! ins.className = 'adsbygoogle ezasloaded'; They include: It is common for periods to be late, absent, or irregular after stopping birth control. Within 10 months of the last injection, 50% of women who discontinue Depo-Provera will get pregnant. Does Ginger Root Decrease a Woman's Menstruation Cycle? Return of fertility after discontinuation of contraception: A systematic review and meta-analysis. eating disorders, such as anorexia or . My doctor said that they should still be effective just in case my boy decides to come earlier this time. Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. We'll definitely have interesting stories of their to share with our LOs when they are older! Preterm birth. She was 7 lbs. Your doctor will likely schedule a blood test 10 to 14 days after the egg retrieval. So I will no longer be taking makena, as it is causing my body more harm than good. Some women report feeling anxious and depressed while using Depo-Provera. having a low body weight. Other causes for late periods after stopping birth control include: pregnancy. I guess there is no way to know. March of Dimes. They are super painful. She did say that it's hard to know if you will go into labor shortly after stopping she said most people do but there are a few who will go until the very end or have to get induced. Update Marth 2018. MNT is the registered trade mark of Healthline Media. Preterm (Premature) Labor and Birth: Resources and Overview. She was early but no where near as early as our son was. If you are at risk for preterm labor, your doctor or midwife may perform a fetal fibronectin test, which checks vaginal secretions for a protein that may indicate that labor is imminent. And a few hours after the shot I get strong contractions, pelvic pressure, and cervical pain. She was also on bedrest for 4 months. I called their customer service line and Amax pharmaceuticals and they also have never heard of these reported side effects. 2017; doi: 10.1097/AOG.0000000000002237. Just wondering how quickly you did have the baby after stopping? If you're in true preterm labor, however, your contractions will continue. Ive never had pain in or around the injection area after the initial shot. Meredith Shur, MD, FACOG, is board-certified in obstetrics and gynecology, as well as a certified medical examiner. I started on the injections but had to stop because I was allergic to something in them. I asked on Friday at my doctors..unfortunately my OB was away so I had someone else who wasn't familiar with me or my pregnancy and didn't read my file at all either. Additionally, spotting is common early in pregnancy, so light or irregular bleeding does not mean a person is not pregnant. I was off bed rest at 34 weeks and I took the suppositories up until I went into labor at 36 weeks. As much as we are grateful to have him in our lives, people need to know of the inherent dangers. Stopping progesterone generally induces menstrual-like bleeding within three to five days. Your health care provider will review your medical history and risk factors for preterm labor and evaluate your signs and symptoms. However, your doctor might recommend the following medications: . Hang in there! It's hard not to get jealous :-/, Oh, I also forgot to add that my shower has been postponed as well. How long would it take you to get to the hospital in an emergency, including time to arrange any necessary child care or transportation? However, if a person experiences persistent or severe symptoms after they stop birth control, this could indicate an underlying condition. If you are between 23 and 34 weeks, your doctor will likely recommend corticosteroids if you are thought to be at increased risk of delivery in the next one to seven days. My step-mom & bio-mom told me they were going to wait til after the shower to see what we got & pick up whatever I still needed but I have a feeling they may end up being the first ppl to buy from my registry since we have to wait till after he is born for the baby shower. If you're not hospitalized, you might need to schedule weekly or more-frequent visits with your health care provider so that he or she can monitor signs and symptoms of preterm labor. She is a healthy happy 8 yr old now (I thank God everyday) My son was born at 32wks weighing 3lb 15oz. 4% vaginal gel: Administer 45 mg vaginally every other day, up to a total of 6 doses. I didnt have any bad side effects other than the injection site sometimes itching. Is Breast Engorgement Normal After Giving Birth? Im due April 7th. We werent sure if it was the progesterone or not so we waited a few weeks before starting me on the suppositories. I still have 1 shot left tomorrow. Night sweats and/or cold flashes. As many as 30 percent of women report an increase in bowel symptoms such as loose stools when progesterone levels drop abruptly right before the start of their menstrual period., according to Case. How do you stop taking birth control pills? We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Norwitz ER. Advertising revenue supports our not-for-profit mission. I think the thing I'm most excited about is having the "normal" after delivery experience.having the baby in the room with me after delivery.andgoing home with the baby in tow and not having to spend weeks in the NICU. It turned out she never did go into labor and then had to be induced. After stopping birth control, the risk immediately becomes higher, even if someone is not yet experiencing regular periods. After a person stops using hormonal birth control, two factors other than pregnancy can cause late periods. https://www.acog.org/Patients/FAQs/How-to-Tell-When-Labor-Begins. Im also on progesterone as well started it two weeks ago 27 weeks. I havent had any cramping or contractions yet. You can learn more about how we ensure our content is accurate and current by reading our. I never thought it would end up quite this dramatic lol. I was kind of bummed about the showerwe were rushing to get it done early though b/c they have been telling me they think he is coming early since 25 weeks. They are the auto injection ones though and quite intimidating. I don't really care if they say it is effective or not, there have been millions of women who have taken this shot and it prolonged their pregnancy. It goes away, then I get my next shot and it starts up again. I am expecting out third child which is a girl this time and they will be stopping my shots at 34 weeks again.and expect her to come withing the week after. These typically get better with time, and may include: Some people may find that stopping birth control leads to beneficial effects, particularly if the method or brand of birth control they were using gave them unwanted side effects. She and the doctors thought that she would go immediately into labor as soon as the meds were stopped. Right now I'm a day away from How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. I was on Nifedipine also~ boy we had a difficult time getting this prescription - we could only find it @ the hospital pharmacy. Will keep you posted! Do you have a fever? An expert panel wants the Food And Drug Administration to withdraw its approval for Makena, because a large study shows the drug doesn't work. Have you had any changes in vaginal discharge or bleeding? Perkins also has extensive experience working in home health with medically fragile pediatric patients. There are also treatments that may be able to slow or stop preterm labor if contractions begin prematurely, before 37 weeks gestation. Why You Might Need Bed Rest During a Multiples Pregnancy, Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History. I spent over 24 hours in L&D on mag with . Most people find that their cycle returns to normal soon after stopping birth control, so there is often no need to try any specific techniques to help the body adjust. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Stopping birth control: What to expect and management. The medication has the advantage of not requiring surgery or anesthesia. If pregnancy hasn't happened, your period should start 2-3 days after you stop taking progesterone. doi:10.1002%2F14651858.CD002255.pub2. In the absence of another health condition, though, normal fertility - including regular ovulation and periods usually resumes within 3 months. Yep! has an average rating of 6.9 out of 10 from a total of 133 reviews Good luck!!! Women using birth control or hormone replacement therapy who don't want to have a withdrawal bleed take progesterone for up to months at a time to avoid having monthly bleeding, a method known as menstrual suppression. Ive been on them for about two weeks now, but was put on bed rest a week ago because my cervix was suddenly short and I was experiencing cramps and contractions. So it was schedule for Sunday may 18th the day after I turned 32 weeks (I almost made it 30w4d today!) In later pregnancy, progesterone helps breasts get ready to make breast milk. This content does not have an English version. With my first I was only on it for a month or so.I don't remember when I stopped taking it, and I went into labour at 33w3d and had him at 34w0d. Read on to discover if stopping these pills mid pack has any associated risks or side. Accessed Oct. 16, 2019. Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Looking forward to a better experience in the hospital this time and getting to hold my baby immediately and have in the room with me and go home when I do :)", "4 years ago my 1st pregnancy i went into preterm labor at 26 weeks. Thanks!! Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. If no response, may try 90 mg of the 8% gel vaginally every other day, up to a total of 6 doses. I just got home tonight. We respect everyones right to express their thoughts and opinions as long as they remain respectful of other community members, and meet What to Expects Terms of Use. Some of the most telling symptoms of preterm labor include:. Feb 2, 2018 at 2:05 PM. What about procardia? this year I have been on makena since 17 weeks I'm now 37 weeks with no shots left I've made it :-) I was worried at first but have nothing negative to say and if your doctor recommends this for you I say do it and don't forget prayers ..", "I started the hip injections of this at 16 weeks. Premature, or preterm, labor can be very distressing, and most parents are unprepared for this situation. If a sperm does not fertilize the egg, shifts in hormone levels trigger a period. Symptmes de grossesse ne jamais ignorer, Moyens naturels pour dclencher l'accouchement. I was on the suppositories with my daughter. Elsevier; 2019. https://www.clinicalkey.com. container.style.width = '100%'; During fertility treatment, a woman may be prescribed the following progesterone supplements in these common doses: Crinone 8% (vaginal gel, once or twice per day) Endometrin (vaginal tablets, 100mg 2-3x/day) Progesterone in oil (intramuscular injection, 50-100 mg once a day) These three routes noted above have been shown to be effective in . Sanchez-Ramos L. Vaginal progesterone is an alternative to cervical cerclage in women with a short cervix and a history of preterm birth. I got my last shot at 34 weeks and my youngest came 3 days after. She went off bedrest at 34 weeks. Progesterone hormone use in preterm labor has decades of research behind it. Shortness of breath, a big weight gain, or swelling in the arms or legs. D. hey D. That seems to help tremendously!!! No earlier warning signs or problems. ", "The Makena new way the administer the auto injection is HORRIBLE. This might stop false labor contractions. I started 17P at 16 weeks.I will be 35 wks tomorrow! Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Guide to a Healthy Pregnancy. Raises awareness to parents who are facing early prematurity and parents of preemies to cope with one another for support or questions during or after their NICU stay. I get them in my butt cheek and they do not hurt! Most women will see their fertility return within 5 to 7 months of their last injection. When a person is not using hormonal contraception, ovulation typically happens once per menstrual cycle. DD was born at 32 wks. ", "I had a premature baby at 24 weeks old. You can suck it up if your more concerned with having a healthy baby. So I ended up in the Hospital for a month then at 28 weeks they sent me home cuz nothing changed. Makena has an average rating of 6.9 out of 10 from a total of 133 reviews for the treatment of Premature Labor. I started the injections at 19weeks, I am at 23 weeks now. I'll update ya when I have him and let you know how long after the shots I lasted. This provides the baby with additional time to develop in the intrauterine environment. Now I am currently stoping Makena last week. Hey mama's.. any mama's have stories to share about when they stopped progesterone shots or suppositories and when labour started afterwards? I wonder too. But most women can get pregnant within a . I am barely dilated but am 80% e. if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[320,50],'mamapedia_com-banner-1','ezslot_5',650,'0','0'])};__ez_fad_position('div-gpt-ad-mamapedia_com-banner-1-0');if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[320,50],'mamapedia_com-banner-1','ezslot_6',650,'0','1'])};__ez_fad_position('div-gpt-ad-mamapedia_com-banner-1-0_1'); .banner-1-multi-650{border:none !important;display:block !important;float:none !important;line-height:0px;margin-bottom:5px !important;margin-left:auto !important;margin-right:auto !important;margin-top:5px !important;max-width:100% !important;min-height:50px;padding:0;text-align:center !important;}Hello D., Examples include: Similarly, people who used birth control to manage a health condition may find the symptoms return. ; April 2006. I started the p17 shots at 16 weeks and also was on trebutiline starting at around 23 or 24 weeks for mild contractions on and off. Yes the shot in the butt hurts and you stay sore about 4 days. My last pregnancy I was on progesterone due to a previous loss at 22 weeks. ", "After having my first child at 27 weeks. So yes, even though you aren't starting at 16 weeks the shots are still useful! I highly recommend the Makena shots. Glasier, A. I'm looking foward to the "waiting game" that I didn't get to experiece last time. More posts in "Pregnancy After Preemie" group, Create post in "Pregnancy After Preemie" group, the most helpful and trustworthy pregnancy and parenting information. Is there anything I can do to help prolong my pregnancy? American College of Obstetricians and Gynecologists. Birth control pills. As you begin to transition into menopause, your ovaries no longer produce high levels of estrogen and progesterone. I just had a discussion with my doctor regarding this because she advised me that it was safe at 36 weeks to stop taking the progesterone. This information is not intended to endorse any particular medication. Clean the injection site with alcohol and let the alcohol dry. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. In some cases, it may be possible to prevent premature birth by knowing the early signs of labor. Dennis, et al. Without the effects of progesterone to maintain the lining, it starts to break down. If you're taking progesterone replacement therapy for longer than one month before stopping the drug, ask your doctor about potential side effects. I started the shot at 16 weeks my last pregnancy and made it to 39 weeks, so the Makena worked to prevent pre term delivery. About 90% of women with preterm labor do not give birth within seven days after labor begins., Sometimes doctors just don't know why labor begins prematurely. Depo-Provera (contraceptive injection): Depo-Provera is a well-known brand name for medroxyprogesterone, a contraceptive injection for women that contains the hormone progestin. May | 2.8K views, 54 likes, 15 loves, 21 comments, 4 shares, Facebook Watch Videos from ABS-CBN News: Start your day with ANC's rundown of news you need to know (1 May 2023) If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. The built-up uterine tissue, mixed with small amounts of blood, passes as menstrual flow. Your health care professional will give you a shot of DMPA in your arm or buttock every 3 months. Guess it just depends on the person then! So Im writing this on 5/14/20 , trying so hard to fight back the tears of what is supposed to be the happiest time of my life. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. It was extremely painful in my arm and the pain doesn't subside til after about 10 mins and even after that you still feel soreness. ins.dataset.adClient = pid; I know I can make it to 32 weeks without the injections, just praying I can make it to 36 weeks. Has any one else experienced this? I have been taking progesterone vaginally since I was 20 weeks and Im 31 weeks tomorrow. Call your doctor right away if you experience any of the following symptoms: sudden pain or swelling in one . I am on that too to help with contractions but will stop at 36 weeks. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Its takes at least 6 weeks from start to finish to complete this process. However, there are a few things people can do if they want to generally support balanced hormones. January 2019. Accessed Oct. 15, 2019. They broke my water at the hospital. It. Maven helps companies retain diverse talent, improve health outcomes, and reduce maternity and fertility costs. I did go into preterm labor at 27.5 weeks but . My hip is sore for a couple days, thats it. In this article, we will look at the cause of late periods after stopping birth control, other symptoms a person may experience, and how long those symptoms may last. We avoid using tertiary references. I reached 36 weeks with no problems my daughter is moving all around and she is right where she's supposed to be on weight, and size. Tocolytics may be used for 48 hours to delay preterm labor to allow corticosteroids to provide the maximum benefit or, if necessary, for you to be transported to a hospital that can provide specialized care for your premature baby. Just wondering if anyone has ever been on 17P and/or Procardia (Nifedipine) and how long did it take you to go into labor after stopping the meds? The only side effect I had was my urine was very strong for a couple days, and the shots do sting and hurt for a couple hours. There are a number of treatments doctors turn to during premature labor. I am now wondering if this is due to Makena. Ive never been this far along and I am miserable hope baby comes soon but set to be induced in two weeks. var lo = new MutationObserver(window.ezaslEvent); It hurts, but contractions hurt more ;) Anything for the safety of my baby boy. While doing research and asking appropriate questions you will know that the shot isn't 100% effective to stop preterm labor. At 18 weeks, I was hospitalized for severe pain, but fetus was growing normal, 19 weeks spoke to ob about the side effects and she said she never heard of this complaint yet. Today is my birthday but its a birthday that I will always regret and wished never happened. ins.style.height = container.attributes.ezah.value + 'px'; I've only had 3 shots so far and they recommended I stay away from it because of the discomfort. Hi I am 34 weeks today and have been on weekly progesterone shots since 19 weeks to help stop ptl (with ds# 1 had ptl stopped @ 30 weeks). I did the 17P for my daughter. Right now I'm a day away from being 36 weeks and I will be completely off of bed rest as well. They have an area in mother & baby for high risk & I was there after I got of l&d triage yesterday until tonight. In: Current Diagnosis & Treatment: Obstetrics & Gynecology. Reaffirmed 2019. if(ffid == 2){ 57% of reviewers reported a positive experience, while 22% reported a negative experience. . Makena Thankfully my insurance completely covered the cost of the shots. Placement is key with getting it not to burn like heck. Can diet help improve depression symptoms? It is so worth it to be able to hold your healthy baby after birth. I keep reading like a week or 2. All rights reserved. While these reviews may be helpful, they are not a substitute for the expertise, knowledge, and judgement of healthcare professionals. Naturally I was very scared to even try for a third, but after much consideration we decided to go for it. Will I Have to Go on Bed Rest During My Twin Pregnancy? In other words, about two months after that 90-day period ends. Progesterone during perimenopause. Have you been exposed to an infectious disease? Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Taking multiple early pregnancy tests is a bad habit many fertility-challenged women struggle with . Beta #1 339 Beta #2 649 44 hour doubling time. Of those, about half occurred after preterm labor. I had my first son at 33.6 weeks. It feels like the start of labor. Accessed Oct.16, 2019. But some doctors say the evidence isn't clear-cut. They said I had an incompetent cervix . But its honestly worth it if I can stay pregnant for at least 10 more weeks . And other women go into labor while still on the meds. It will not help anyone who has an incompetent cervix etc. There are so many other reasons & complications that could have occurred to make u go into labor early. If labor does not stop and you give birth early, a team of health care professionals takes care of the baby. Cunningham FG, et al., eds. By 10am I was 8cm dilated but I ended up stalling (after I had the epidural) at 9cm with a fraction of cervix left. (Mine has been going on since 23 weeks but it didn't get this bad til recently! Here's some information to help you get ready for your appointment, as well as what to expect from your health care provider. lo.observe(document.getElementById(slotId + '-asloaded'), { attributes: true }); Hi D. ~ Create an account or log in to participate. Is it normal to have late periods after stopping birth control? Were you induced because you were measuring big or? My labor was super painful because she was posterior and somewhat sideways. People may experience: Some people experience side effects after stopping birth control. So relieved! The practice isn't common in the United Kingdom . Took the last one at 36 weeks and had her at 37w5d. PCOS. Im currently on weekly Makena injections and I was told after my last shot at 36 weeks, I could go into labor within a week or two. Im curious as to how long before I go into labor! Pregnancy prevention shots like Depo-Provera essentially provide your body with a hefty dose of birth control intended to stay in your system for three months which makes going off this type . I'm curious too! Thank you, {{form.email}}, for signing up. 2005-2023Everyday Health, Inc., a Ziff Davis company. For most people, they will return to normal after a few weeks or months. I had my little girl yesterday at 4:45PM. Ugh! No firsthand advice as I'm also a FTM mom but also on progesterone suppositories and have been since 20 weeks for a short cervix. Changes in these hormone levels can cause uncomfortable symptoms. Help Me, Information on Pre-term Labor the Second Time Around. Depending on the circumstances, you might need immediate medical care. The shots will stop at 36 weeks and 4 days and the Procardia will stop somewhere around there too. Started them 4 weeks ago and havent felt the same way ever since, I believe my doctor thinks Im being dramatic and doesnt listen to me . I asked my OB and she said that she has never seen someone stop taking progesterone and then go into labour the very next day. & just to go with the flow. Ovulation is the release of an egg from the ovaries. American College of Obstetricians and Gynecologists. 2018;219(1):5-9. doi:10.1016/j.ajog.2018.05.010.

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