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Advice.. Preg with twins (23w), short cervix, stitch booked for Tues

(37 Posts)
legallyblond Fri 31-May-13 14:53:02

That's it really! Just had a scan at 23 weeks (first after my 20w scan). I'm preg with DCDA twins and agreed to the internal scan to measure cervix length. It's quite short. 25mm is the bottom of the "safe" range for twins (15mm for singletons) - mine is 21mm, so fine for DD (my first) as she was a singleton, but I'm high risk of early labour.

Headlong chars with my consultant and I'm booked in for a stitch on Tues (general anaesthetic probably). The risk is that the stitch itself provokes early labour, but the potential benefit is not going into early labour.... I really pushed and said what would he do in my shoes. He said have the procedure. I have faith in him, but.... A hard choice as a short cervix doesn't automatically mean early labour.

Any thoughts or advice or experience? Obviously I hope all goes well and I make it all the way to 38 weeks....

LauraSmurf Fri 31-May-13 15:23:04

My only suggestion in this case would be to try and wait a couple of weeks so if it does prompt early labour you are in the viable widow.

I know that's not really a very helpful
comment but it was my initial response.

Also how closer is your cervix currently? I hear it never goes back to completely closed after your first. If it's quite open then the stitch is definitely a good idea.

Congratulation by as well!

Kelly1814 Fri 31-May-13 15:40:30

I had a stitch at 14 weeks (am on some other threads in here) under a general and have sufferd no infections or ill effects as a result. I've since met another lady where I live ( am overseas) and she had a stitch at 14 weeks too with twins.

Both of us had cervix length of 2 or 2.5. Neither of us had any hesitation about having it. Best of luck and congratulations!

Alexandra6 Fri 31-May-13 17:00:14

Really difficult dilemma for you. I've got another thread running on here about short cervix/stitches as I have a short cervix (pregnant with only one baby though) - there might be some useful info for you on there from the people who had a stitch? If I were having twins, I think I would def have a stitch but it is a very hard choice. Is yours short naturally or have you had treatment on it? Is this your first pregnancy?

I can also see what laura means above about waiting to the 'viable window' BUT from what I gather, a stitch is more successful done sooner rather than later and when the cervix isn't open/funnelling, so that's something to bear in mind too.

Has your consultant mentioned modified bed rest? Just wondered as have been reading about this, seems to be more a US thing.

Lots and lots of luck smile

legallyblond Sun 02-Jun-13 18:01:24

Yes, the consultant felt that there is a "window" for the op to be successfully preventative - waiting until the babies would be definitely viable would,in his view, render the op pointless and higher risk (as the membranes would be that much closer to the cervix).

In a sense i am surprised i have a short cervix (its 2.1cm/21mm) I carried DD until 42 weeks and have never miscarried, so it clearly works fine for one baby! I suppose the concern is twins..? I am also v concerned re a general anaesthetic for the babies. I'm still booked in on Tues but we're going to try and get a second opinion tomorrow.

legallyblond Sun 02-Jun-13 22:27:16

Bump sad

pocketandsweet Mon 03-Jun-13 16:56:15

At risk of scaring you senseless with my horrible cervix history I will only say that I would probably go with your consultant's opinion. There is only a window as he says and after that trying to put one in a "rescue situation" is an entirely more risky thing. My opinion is of course coloured by my experience.

pocketandsweet Mon 03-Jun-13 16:57:48

I also did bedrest with stitch in place.

AWhistlingWoman Mon 03-Jun-13 17:31:41

Like pocket I don't want to scare you but I would probably go with your consultant's opinion. Coloured by experience of my own short cervix (always <2.5cms) one twin pregnancy and one single baby.

legallyblond Mon 03-Jun-13 22:52:44

Thanks both. That's what I think too. Booked in for 11am tomorrow on the labour ward. It is very short! I guess I am just shock that with that length, I clung on to DD for 42 weeks! I am speaking to a second consultant tomorrow before the op, but v much planning to have it. Please don't worry, you won't scare me! I am a big fan of knowing all facts, good and bad.

Thanks again. I am planning berets for 5 days then beck to work (office job - I'm a lawyer) tdk

legallyblond Mon 03-Jun-13 22:53:50

Posted too soon! Bed rest for 5 days then taking it v easy at work. I could extend bed rest if needed and work from home. Any ideas?

AWhistlingWoman Tue 04-Jun-13 12:56:19

Hope it all goes perfectly legallyblond whatever you decide to do with regards the stitch, the very, very best of luck to you. Definitely worth getting a second opinion with a such a major decision. I can appreciate that it is a very difficult choice to make, with risks to weigh up on either side.

I didn't have a stitch with either of mine, my single hung on to 38 weeks (when I was induced). I had to reply as, sadly, my twins arrived at 23 weeks. Don't know if my short cervix was entirely to blame but, from my own experience, I think a stitch may well be worth investigating?

I have never done bedrest but I shouldn't imagine that trying to maximise your time spent resting could do any harm!

pocketandsweet Tue 04-Jun-13 13:26:12

yes good luck legallyblond. I had my son at 24 weeks ( he sadly didn't make it) and that was the first I knew about my cervix ( they couldn't place an emergency stitch as things had quickly gone too far). At 14 weeks with dd I had a stitch put in but because of what happened with my son I had quit work and decided to it myself on bedrest at home. My obstetrician told me it sent necessary but I must have had some sixth sense because at 26 weeks even with the stitch in I started to have trouble. Amazingly I got to 34 weeks with strict hospital bedrest. I wouldn't even have attempted another pregnancy except that my amazing obstetrician arranged for me to meet a surgeon to talk about whether an abdominal suture might be a solution for me. I had one with dd2 at 15 weeks ( a very big and painful op) BUT I managed to carry her to 35 weeks ( the last month though was a constant in and out of labour). Im now gratefully retired from baby making. I am not typical though for most women who have a problem cervix a regular stitch works fine and they work and exist largely normally. I would say though try and take a rest whenever you can and if you have any niggles I would not hang about and get them checked out. I had scans of my cervix every 2 weeks ( more often if I had had a bleed or some other problem) and things do change quickly. Again that is not meant to scare but rather inform.

pocketandsweet Tue 04-Jun-13 13:30:11

Sorry. Weird typos. That should read that I decided to put myself on home bedrest ( which is a very conservative response and although common in North America is not the typical UK response ). My obstetrician told me it was not necessary BUT if it made me feel better then he was all for it. Given what happened later he said it probaby had been a good decision but that there was not any clinical trial evidence to directly indicate that it helps.

TheNobodies Tue 04-Jun-13 16:29:21

Hello. Best of luck!

I had my little boy at 23 weeks, I had him because I had an infection in my placenta. They think i got an infection from a weak cervix. I didn't even know I was having contractions let alone 10cm dilated so it was to late for me to have a stitch. I would personally go for it, especially as there is two in their, extra pressure on your cervix.

Good luck for you and your babies. X

legallyblond Tue 04-Jun-13 20:45:13

Thank you so much everyone. Had it done this afternoon (under general) and so far so good. I'll be scanned every 1.5 weeks now. Cervix was 2cm (so v short) but no signs of funnelling, so hopefully we got there in time! Fingers crossed I won't see the labour ward again for another 12 weeks at least! I will keep this thread posted, but hopefully with no news....

pocketandsweet Tue 04-Jun-13 20:55:50

Fabulous news! Everything crossed for you and hoping the babies stay put and things are un eventful.

AWhistlingWoman Wed 05-Jun-13 10:10:59

That's brilliant news. So glad everything went smoothly and here's to at least another 12 lovely weeks of pregnancy smile

Kelly1814 Wed 05-Jun-13 10:30:22

legallyblond, so glad to hear this. i am so very glad i had my stitch at 14 weeks - am 22+1 today.

welcome to the short cervix club (!) and best of luck with the rest of your pregnancy, please keep us updated?

Shellywelly1973 Wed 05-Jun-13 13:05:26

Just wanted to wish you well.

How long is the average cervix?

diege Wed 05-Jun-13 13:52:49

Great news legallyblond smile.
I was told yesterday at the FMC that the top limit for cervical length that they might expect to see where there's been no surgical procedures (ie. LLETZ etc) is 4cm, if there have been procedures (as with me) the very greatest they would expect would be 3cm. I was also told that the newest research suggest the threshold for intervention for singleton pregnancies is now 2cm (as opposed to 2.5cm). Obviously different if there is more than 1 baby in there!

legallyblond Thu 06-Jun-13 08:37:20

Thanks all! Yes, those ranges sound about right diege. My consultant is a twin specialist (v well known apparently) and he said that generally, with a singleton, he wouldn't take drastic steps like stitch unless the length was under 2mm (he'd just monitor), and only under 17/15mm would he say, right, let's operate tomorrow type thing like he did with me. With twins, that action station mode in his opinion kicks in under 25mm (I was 21).... Anyway, I felt really well looked after (apart from the general chaos of labour ward, which of course I have seen before.... V surreal to be on labour ward then post natal at 23 weeks!) and really really happy I agreed to have it done and under general. I'm also really pleased there were no signed of funell

legallyblond Thu 06-Jun-13 08:40:15

Ooops... Funnelling or other signs of things getting ready to go down there, so my new goal is 36 weeks...!

How are other short cervix ers getting on? Alexandra?

By the way, can't remember if I said earlier, but I've had no gynae procedures or anything - the short cervix is just a quirk of my anatomy. It's also very, very awkwardly positioned...

Alexandra6 Thu 06-Jun-13 09:48:02

legally I'm really pleased your doing well, sounds like you've def made the right decision with your consultant. I am hoping I've done the right thing by not getting a stitch yet with my measurements and with a singleton pregnancy. I get measured again in two weeks and I can't wait to see how it's looking then and if it's measuring up ok and not shortening lots.

One thing I'm a bit concerned about is I know sonographers struggle to get accurate measurements but hopefully they will feel confident I can carry on without panicking. It's def affecting how I treat the pregnancy though and how much time I want to be on my feet, but then I guess it's bound to. When do you go home (or are you home now?) and have they told you how to manage lifestyle-wise with the stitch?

legallyblond Thu 06-Jun-13 10:33:53

I came home yesterday morning, so just one night in post op (because they needed a dr to scan the twins after the procedure and also just in case I was wobbly or started getting tightenings). I have been told to "rest" for a week (I've taken that to be bedrest, albeit getting up to go to the loo, shower, get the odd thing), then "take it easy", but returning to work (office job) is fine. The absolute though us absolutely no sex until I've had them as it is far too triggering/stimulating for the cervix. I would have assumed that anyway to be honest. In my last preg (and I believe this is the norm), I always noticed a single tightening/contraction when I got up after sex. It's a combo I believe of stimulation plus actual hormones or something in the sperm.

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