Short cervix and pregnant again

[Dewdrop2015]

I had a short cervix 1.5cm at 20 weeks with my daughter. Spent 13 weeks in hospital on bedrest. Came off bedrest at 32 weeks and went full term. I'm pregnant again and have been offered a suture at 12-14 weeks or can wait and see. Anyone else been given a choice about this and did you have a suture? Really don't want to spend 3 months in hospital again.

[willnotbetamed]

Hi, I'm 21 weeks with DC3. With DC1 I went into premature labour at 32 weeks, and with DC2 I had a short service at 24 weeks. I spent 7 weeks in bedrest with DC2, was discharged at 34 weeks and delivered him at 36 weeks.

I was offered a stitch, but since the bedrest worked fairly well last time and the stitch doesn't seem to be entirely risk-free nor overwhelmingly effective, I decided not to take it. I was also terrified of the spinal anaesthetic, which probably played a part. I am also determined to avoid hospital though! I was supposed to do the full 7 weeks in hospital with DC2 but discharged myself after one, and did the rest at my PIL's house. They helped out with looking after DC1 (who had just turned two) and did all the cooking etc. so I could keep bed rest pretty well.

This time round, I went off work at 18 weeks and have been at home since then, trying to rest as much as I possibly can but not (yet) on bedrest. So far cervix is looking ok, but it is slowly shortening...if I have to, I will go to hospital for steroid injections and then go to my PIL again. My kids are at least older this time (7 & 5) so it's not so traumatic for them if I drop out for a while.

It's really hard to know the right thing to do! Perhaps the stitch would have helped me stay a bit more mobile. Has your doctor offered progesterone therapy at all? I am trying that this time - I'm in Germany. In the US they give injections I think, here it is inserting tablets three times a day.

Good luck with making a decision and with getting to term (or as close as possible).

[Dewdrop2015]

Hi, thanks for replying. I did have progesterone suppositories last time but they won't think about them until I get to 12 weeks. i don't really have anyone who can look after me if I have to do bedrest at home, my In laws live3 hours away and my daughter is at school. I know the suture has some risks and no guarantee it will hold it in but feels like I should at least try. I can't bear the thought of staying in hospital especially as I would have to leave my daughter this time. My partner thinks I am even mad for wanting another baby when there could be complications. I also had 2 miscarriages last year. This feels like my last chance!

[willnotbetamed]

Oh gosh, that's tough. Is there an option of being off work from early on? I don't know how the system works in the UK (I'm British but have had my kids over here) - I was able to get sick leave from 18 weeks (could have had from 16 weeks), on full pay. It means I can rest all day and only really get up and scurry round in the morning to get the boys ready for school and again when they come home. My DH has reduced his working hours for the next couple of months (it took a bit of a fight, but they couldn't actually refuse him in the end) so that he can drop the kids and pick them up every day, so that I don't need to do that either. I feel a bit useless, but I think this is the best chance I have of avoiding hospital, at least for as long as possible. I don't think the stitch is really risky in terms of losing the baby (apparently there is a very slight risk of miscarriage, but it is really slight) - my worries were more about tearing or an emergency c-section if I went into labout early. Since I did manage ok last time in the end, it didn't seem worth all the uncertainties. But it sounds like it might make more sense in your case.

I did try and do some reading in medical literature about cerclage and the pros and cons. I'm not completely sure I got it all right, but my understanding was that no one exactly knows what causes premature shortening of the cervix - in some cases, it's purely muscle weakness and then the stitch really helps. In other cases, there are other factors (stress, sport, standing a lot at work) that cause it to happen and then the stitch doesn't help as much as rest/bedrest does. My instincts is that I fall into the latter group, which influenced me deciding against the cerclage.

I really hope you can get some good advice and things go well for you! And if you do go into hospital, then I'm sure everyone will cope somehow. I worried a lot about my two-year-old, even after we went to my PIL - I couldn't take him out anywhere for two months, or cook for him or give him his bath or anything. But I don't think he remembers a thing about it, and he gets on so well with his brother. It wasn't a fun time, but it definitely doesn't seem to have had any long-term effects.

Fingers crossed for us both!

[willnotbetamed]

PS www.mumsnet.com/Talk/antenatal_clubs/1776448-The-Short-Cervix-Club?msgid=53428443#53428443

[Dewdrop2015]

Hi, last time I was just signed off sick from 20 weeks. Im not sure what happens if i have a stitch, whether i would still need to be off work i don't know. Im only 7 weeks so may not even get that far! how many weeks are you? I'm also wondering if having a short cervix makes labour quicker? what was your experience. my labour was 3 hours and i was almost fully dilated after 30 mins which logically seems to be connected to having an already shortened cervix. 2nd labours are supposed to be shorter. wouldn't fancy having a baby at home. presumably they take the stitch out well before 40 weeks?? I will check out the other thread, thanks, once to know I'm not alone in this and not completely mad for wanting to do it again!

[LittleBairn]

I have an incompetant cervix I lost my first baby at 16 weeks and the 2nd at 19 weeks. I'm pregnant with my 3rd and had my stitch put in at 20 weeks when I was once again found to be shortening. I've just had my stitch out and I'm 37 weeks today.
I got this far with the stitch, the pessaries I took 400mg each night, 5 weeks of tilted bedrest in hospital and then a further 10 weeks on strict bed rest at home.

To me its a no brainier next time I will be having the preventative stitch (that is if I can't convince them to give me a permant one) all research that I have read has shown me that this is the most effective way to prevent a late MC or premature birth. You are far more likely to end up in hospital for weeks if not months because you didn't have the preventive stich compared to if you had it. Those that have it early appear to need very little bed rest.

I have a really interesting PDF from the Royal College of Obstetrics that has a lot of research info in it. I will try work out how to post it.

[LittleBairn]

My experience of having the stitch in (keeping in mind I was an emergencey) was being in and out of the hospital within 20 hours. It's not a major operation, I was awake for mine under a spinal.
I was kept on the post surgical ward for a few hours then moved onto the anti-natal ward for the night (my stitch wasn't done till 8pm) I was still numb from the spinal until the early hours of the morning.
By 11am I had a scan to make sure the stitch was in place and everything looked good and then I went home.
I was a bit swollen and delicate for the first few day but had I not needed to go on bed rest I could easily have gone back to normal life.

[willnotbetamed]

LittleBairn congratulations on making it to 37 weeks! That's amazing - even though it must have been a long haul to get there. I met someone in hospital when my first baby was born prematurely who had a similar story - a series of late miscarriages and then a successful pregnancy that she basically spent entirely in hospital. I was really in awe of her. Good luck for getting even closer to term, and for an easy labour and healthy baby!

[Dewdrop2015]

congratulations from me also Littlebairn, although sorry to hear of your losses. Its interesting they put a stitch in at 20 weeks as I was told at 20 weeks that it was too late to put one in then but anyway must have worked for you and all obstetricians have different ideas. I will certainly try to look up the research you mentioned. Thanks for sharing and good luck.

[LittleBairn]

Thank you both.

Dew I was 20+2 and had shortened to 1.4mm when it was put in. It was a very difficult surgery, it took 4x longer than they expected, my poor DH thought I had died!
I suspect one of the main reasons I was given it despite it being so late on was I had made it very clear I disputed their finding of the Cervical resistance study I had done and that I knew my cervix was weak and by refusing me the preventive stitch I would hold them responsible.

But my hospital is also becoming well known for it's success over the last two years with cervical issues. They even got one woman to 32 weeks after putting a stitch in at 18 weeks with bulging membranes.
My 2nd pregnancy was exactly like that at another hospital and I was told I was being treated as a managed miscarriage and that was that.

The stitch was originally only to buy me a bit more time but the titled bed rest and super strict bed rest has managed to get me this far. But there is no way I could manage only spending a maximum of 15 minutes a day out of bed if I had to care for another child.
This is my main reason for perusing a preventive or permant stitch.

One thing I have learned not all NHS hospitals are equal.
My main tips for choosing a maternity unit now is

1. Does it have a dedicated Fetal medicine department
   
2. Does it have a NICU
   

I find hospitals that have both have seen more high risk pregnancies and have the knowledge and expereince to deal with it leading to better results.

[Dewdrop2015]

Hi, wow that sounds pretty amazing that they managed to do that and that you've done so well! my obstetrician is an expert in late miscarriage and the hospital is part of the sw london neonatal network, large NICU, and fetal medicine unit so feel quite happy with the hospital. they managed to get me through last time! hope it all goes well for you. I had a very quick labour with my 1.5cm cervix, i don't know if that is related but might be! lots of people say that i was lucky to have a quick labour but it was pretty intense, no slow build up. will be interested to hear how yours goes!

[LittleBairn]

Dew yes those of us with short cervixs usually have quick labours and no latent labour. I've been told its likely I will just go straight to contractions so get to the hospital ASAP.
At least there is one benefit to having a useless cervix!

[LittleBairn]

Forgot to add London is defintely the place to be for soecilst help and nonstop care if you need it. Good luck with the pregnancy.

[LittleBairn]

Neonatal not non stop.

[LittleBairn]

I managed to find the pdf online, there is meant to be a new study coming out soon too.

www.rcog.org.uk/globalassets/documents/guidelines/gtg_60.pdf

[willnotbetamed]

I had quick labours with my two too - went straight into contractions. First time I was in hospital anyway but I was 7cm before they examined me - second time I came straight from home and was at 5-6cm at booking in. So yes, there seems to be an upside. I have my next appointment tomorrow (22 weeks) - cervix was at 3cm a week ago but 4.5cm three weeks previously, so it has shortened... I really hope it has stayed put at 3cm so that I can stay at home a bit longer. It's nervewracking every time...

[LittleBairn]

willnot I can imagine how nervous you are, I was a total wreck before I got 24 weeks despite having a stitch.
Let us know how you get on, hopefully its stayed put for now.

[willnotbetamed]

Back from doctor and all is ok! Cervix still at over 3cm, so the hours and hours of lying on the sofa seem to be paying off so far. Still only 22 weeks today though, so have a while to go before I can start to relax. Next appointment is two weeks today, so I reckon I have about 1 week of feeling good about things before I start worrying about the next check-up...

Thanks for the support here! Littlebairn hope you are still doing well.

[LittleBairn]

willnot glad to hear the good news. I was exactly the same when I had two week appointments I would be fine the first week but a nervous wreck the 2nd.
Are you on progestrone Pessaries?

I'm good I've been booked for an induction at 39 weeks, I might well have a baby in 10 days time! When I think back to 20-24 weeks how stressed and worried we were it's unbelievable I could now be having an induction full term.

[willnotbetamed]

Yes, pessaries three times a day. So perhaps it's those that are making the difference. Either way, it's good to have good news for a couple of weeks.

What is the induction for? It's weird to think that you can spend weeks worrying about the baby falling out, and then end up with an induction! But whatever it takes, right?

[LittleBairn]

willnot ah yes I think we might have been on another thread together. I remember your Pessaries 3 x a day, I hated doing my 2 at night so I had great sympathy! I do think the Pessaries make a big difference I'm certain my stitch wouldn't have held so well without them.

It appears standard at my hospital they induce women with cervical issues at 39 weeks, there doesn't seem to be much of a reason why (although I suppose we are more likely to silently dilate and be risk of infection) just that's the earliest they are allowed to induce if you are high risk.
I was thinking I would never get to the induction until today I remembered I've never actually laboured by myself. My babies died due to complications because my cervix dilated (DS Pproms, DD infection) but even at 6cm dilated and bulging sac I still didn't go into labour.
At least when they induce me I labour rediculously quickly.

[willnotbetamed]

Well, I hope it holds true this time too, and you have a speedy and straightforward labour - after everything else you've had to deal with, it seems only fair! Good luck.

[applecore0317]

Hi willnot similar to you in that at 21 weeks mine measured at 3.5 and then at 24 weeks it had shortened to 2.4 so I was then put on the progesterone pessaries three times a day and signed off for two weeks. I also had steroid injections.

By 28 weeks it had lengthened to 3.5 and I am now 32 weeks and its at 3cm. I have been signed off for four weeks as my cervix is soft and baby's head is very low down in my pelvis, but wanted to share a positive story for the progesterone and resting as much as possible :)

Great to see all is good with you littlebairn

[kirstylouise20]

Hi all I was just hoping for some reassurance, I am currently 20 weeks pregnant with my 4th baby, I have had the loop procedure done in 2011 so was concerned about incompetent cervix & asked for it to be checked at my scan yesterday, after some persuasion they did an internal scan & sent the picture off to my consultant who was very happy with my cervical length, no funneling etc but I noticed the measurement was only 26mm! I am so stressed & worried about this as all over the net this seems short & has risks of preterm labour, I cant understand how my consultant is happy & hasn't requested a repeat check or anything? Thanks in advance for any advice xxx

[LittleBairn]

What was 26mm? The main concern is funnelling once that starts happening your at risk of dilating and premature labour.

He probably hasn't requested a repeat scan because they are usually done every 2 weeks (once I was funnelling and had stitch I had weekly but this isn't always done) and by 22 weeks its really too late for a stitch.
I'm really shocked you weren't having earlier transvaginal scans with your history.
I would insit on a meeting ASAP with a consultant obstetrician for more info and to query a out the Progestrone suppositories.