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Cervical Length (again!)

(19 Posts)
Midori1999 Wed 15-May-13 13:58:40

Sorry, another post from me re: cervical length.

I am 18+2 and had my first cervical length scan today, due to having had two Lletz procedures last year. The cervix measured 2.8cm with no funnelling and was closed. The sonographer asked if I was seeing the consultant today and I said they hadn't arranged to see me after my scan, so my next appointment is in 12 days.

I know over 2.5cm isn't urgent, or at least, I think it isn't, but should I try and see my consultant or discuss the results with them befpore my next appointment?

Thanks.

diege Wed 15-May-13 14:21:11

Hi midori smile. I'm in a similar situation to you. I've had 2 lletz procedures, though had 3 dds since, and am being assessed for cervical length in this pregnancy. I also measured 2.8cm but at 13 weeks and am going for another scan next week when I will be 18 weeks.
I asked the consultant what would happen after the scan and he said just keep my next clinic appointment (21 wks). As a worrier I asked if that wasn't too late, and he said the sonographer would only refer 'on the day' if things looked 'really bad'. So of course I pushed him on what 'really bad' meant to which he replied 'We ideally like to see cervical length over 1.5cm'. Looking at current guidelines 1.5 seems to be the old 2.5 in terms of defining a cervix as 'insufficient'.
Hope this helps. I will be delighted if my cervix is still 2.8 next week grin.
Oh btw was your scan internal? I was presuming mine would be, though the scan letter says I need to have a full bladder (NHS) ,when I needed to empty it for my 13 wk cervical scan!(private)

Kelly1814 Wed 15-May-13 14:22:31

how did they measure, through your tummy or vaginally?

i ask as through my tummy said 2.5 but then vaginally was less.

Midori1999 Wed 15-May-13 14:28:31

Yes, it was an internal scan, I felt the sonographer was very thorough, he took his time.

Diege, My appointment letter said full bladder too, but I was asked to empty it before they did the cervical length scan.

Plinky82 Wed 15-May-13 14:37:54

Hi Midori,
I had the same dilemma a couple of weeks ago and tried to get an appointment to discuss my cervical length result (2.8-2.9cm at 19+3 weeks - an internal scan), as I hadn't been told to book an appointment to discuss before the scan, only that they wanted the length to be 3cm.

I have an appointment next Thursday where I hope I'll get some info as to what I should be worrying about!

My daughter was born at 33+4 after a SROM and I had been given no reason why it happened, so this time they tested for an infection (can't remember the name of it but it was negative) and said a needed a cervical length scan at around 20 weeks as my situation didn't have enough cause for concern to have an earlier scan.

I am still worried though and am trying to rest more, but with working and a 2 year old it's tricky.
I spent too much time on google too which never helps.

Anyway, rambling aside I just wanted to say I understand, a bit maybe, the worry.

diege Wed 15-May-13 14:54:37

Thanks midori smile. I suppose it makes sense asking for a full bladder so that they know you can then empty it fully if that makes sense! I am also quite nervous, though reassured that I have carried to term previously after my surgery. A lined-up appointment after the scan would be so helpful, even just to say all seems well.

Alexandra6 Wed 15-May-13 15:53:39

Hi, I wondered what your cervix lengths were at around 12 weeks? I'm having mine looked into now - one consultant has said to have a precautionary stitch now at 12 weeks and another has said not to and to wait and see (eek).

Also Diege and Midori, did they talk at any point about elective stitches and having one early as it's better/more effective than an emergency one later? Or have you been given any reasons for not doing that?

Feeling so anxious about it all, feels like a gamble either way.

diege Wed 15-May-13 16:19:24

Hi Alexandra. Nobody seemed (or seems now) especially concerned about my cervical length. Prof Nicolaides at the FMC did mine at the 13 wk nuchal (at my request) and said 2.8cm was within normal limits. I did mention stitches and he told me they wouldn't even consider it (in his clinic at Kings I am presuming?) until under 2.5 with evidence of funnelling and serial shortening. This scan next week is again at my own request. I am aware that later ('emergency') stitches are riskier statistically than pre-emptive ones, but with my measurements at 13 wks they would only ever adopt wait-and-see policy. I do think that if my cervix was say under 2mm early on that I would feel a lot happier having an early stitch than doing nothing at all - I don't think they are massively risky at that time are they? I agree that it is a horrible place to be in mentally flowers

Alexandra6 Wed 15-May-13 20:22:16

That's really interesting diege it seems to agree with what the second consultant said to me today. He reckoned my cervix looked around 300mm but said it's hard to say exactly, especially as the placenta is lying on it early on (hard to say where the cervix ends and placenta begins). I worry how they can be accurate when we're talking about blurry ultrasound and a matter of 1cm less! I'm back in two weeks for another scan.

So scary and hard to relax isn't it. Can't wait to get into 30+ weeks and start feeling safer but it feels a long way away! At least I'll be monitored regularly and hopefully they would get a stitch done in time if I needed it.

diege Wed 15-May-13 20:38:37

That sounds very positive Alexandra, and regular monitoring will also help reassure you. I think they carry on with it until 28 weeks in my hosp, if indicated. Agree that 30 weeks will mean we can relax - until the next worry comes along no doubt!

Alexandra6 Wed 15-May-13 20:42:42

Please come back on and update this, really helps reading other people's stories. Good luck smile

Alexandra6 Thu 16-May-13 07:55:29

Hi ladies, just been obsessive googling and this study seems to show that if your cervix length is less than 4cm in first trimester, you have a baby at 32 weeks or less? That seems so early and is making me worry about my 3cm approx length?
www.obgynnews.com/specialty-focus/infertility/single-article-page/first-trimester-cervical-length-predicts-ivf-preterm-deliveries.html

diege Thu 16-May-13 11:29:21

Hi, I've not looked at your link yet but from my own (obsessive) research, plus life experience (this is baby no.6) I wouldn't put too much weight on that stat. I had 2 lletz after dc2, so have 3 babies to term with cervix measuring between 2 and 3cm throughout pregnancy. This also included a hefty 10 ib baby with polyhydramnios (so a lot of extra weight there) who was only a day earlier than his sisters (all 39 weeks plus). There will be so many other variables at play in the research (ie, med/obstetric history) that it would be really difficult to isolate cervical length as a key variable (I'm a medical sociologist so know a little about these sorts of stats/studies). I was told that a short cervix doesn't necessarily mean an 'incompetent' one .and there are women who have virtually no cervix left at 28 weeks that need to be induced at 40 plus weeks. Nonetheless I will read it now you have linked!!!

diege Thu 16-May-13 11:37:19

Having read it I stand by my concerns grin. The authors themselves acknowledge the poor predictive value at present of their claims, and also admit to not measuring beyond first trimester. The majority of women even in their sample delivered at term. I know it is so so tempting but I really think you need to step away from google. Your current measurement is within normal limits and the cervix, being dynamic, can also grow throughout pregnancy. There are more chances than not that all will be well, plus any issues that may arise will be spotted in your case before they create any problems. Will def feedback from my scan on Tuesday and make sure I ask as many questions as I can xxx

Kelly1814 Thu 16-May-13 11:42:15

my ongoing doctor is the head of the OBGYN department in the hospital i visit.

i also had the cervical measurement done by the fetal medical centre of harley street.

they all, plus my original obgyn, without hesitation, recommended the stitch.

maybe an extra opinion would help you. in my case i had 3 in agreement, which put my mind at rest and made me very happy to go with it.

Alexandra6 Thu 16-May-13 20:37:54

kelly it sounds like you really did the right thing. I'm so confused as I've had two different opinions but at least I'm seeing them both again in two weeks.

diege I can't stop obsessive googling about it all! Thanks so much for your reassurance though, it's great you had 3 babies at between 2 and 3 cm. Was it as low as that where I am (approx 12 weeks)?

I've got a theory that flying and the cabin pressure can be bad for pregnancy and induce labour, and won't help my cervix. I'm meant to go on holiday with DH in 5 weeks when I'm 17-19 weeks but am now thinking maybe I should cancel and just lose money (poor DH). Will see nearer the time. What does everyone else think and have any of you flown?

diege Tue 21-May-13 17:37:36

alex yes mine was 2. something at that time, but it has always 'grown' to around 3cm by 26 weeks.
I had a cervical scan today and it now measures 4cm hmm. Apparently most of us have 'dynamic cervixes' and the scanner did say she sees that sort of jump (2.8cm to 4cm) quite a lot. Pretty chuffed with that!

Alexandra6 Tue 21-May-13 17:50:42

Yay diege that's great! I hope mine grows (presume they also shrink that quickly but am determined to be positive about this, after being sure I've annoyed people with my worrying!)

How often will you go for scans now? How often did you go for scans, was this the first time since week 13 when you were 2.8?

Oh and have you/would you fly on holiday?

diege Tue 21-May-13 19:18:46

Hi! The consultant today didn't think they would scan me again, but said if I wanted I could ask for it to be done at the 20 week scan (don't think I'll bother tbh as I'm having my 20 wk at the FMC on Harley St and it's an extra £50 blush. I'll be seeing my consultant a few days after anyway, so will discuss then but my gut feeling is that things will be fine.
Yes, this was the second cervical scan, so that's 13 wks and 18 wks.
I did a bit of 'probing', though consultant not a 'talker'...apparently bed rest isn't indicated now, and yes the cervix can certainly grow. She was telling me about a woman who was booked in for a stitch this week but had a scan today and her cervix had grown from 1.6 to 2.6 so they're not bothering for now.
Re: flying yes I flew to Turkey and Spain with my short cervixes in 2 different pregnancies. There is no evidence that there would be any negative effect on cervical length - the only research I've seen links to is air stewardesses who travel on long haul flights day in day out having a slightly increased rate of mc in the first trimester. I would def go without hesitation if I were you!

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