Cervical stitch - experiences?

[BabsUnited]

Hi everyone

I am 10+4 weeks and I'm booked in for a cervical stitch for when I'll be 12+3. The reason I'm having this is that my DS was born prematurely at 30+2 weeks. It's officially gone down as 'unexplained' but the consultant thinks some sort of infection made my membranes rupture which then kicked off labour. So the stitch will keep my cervix tightly shut and the plan is to remove at 37 weeks (if I get there). DS suffered as a result of his early arrival and has cerebral palsy so I feel desperate to do anything I can to prevent something similar happening again.

I know a little about the procedure (I'll be having a spinal, and its done as a day case) but does anyone know of any good resources to find out about success rates? Consultant said there's not been any widescale studies on it but she thinks that the stitch, along with progestone pessaries, will likely help me. But other people I speak to seem to be pretty 'for' this, and others say it won't do anything (including a GP relative).

The procedure itself carries risks (risk of membrane rupture/miscarriage and, ironically, introduction of infection) so I'm trying to be totally sure I'm making the right decision. My consultant has recommended it, but another I saw said she wouldn't recommend it and I had to push her to contact the other consultant who then said she should go ahead, so she booked me in for it. The procedure will be done at Homerton Hospital which has a very good NICU and I think they do a fair amount of research into premature birth. This is where my DS was born.

I feel like I should be doing something proactive to reduce my risk of premature labour again. I think I'm doing the right thing but wobbling a bit. .

Has anyone had one? Any positive stories?!

[willnotbetamed]

Firstly, I'm sorry to hear about the problems your son has. My DS1 was born at 32+3, and I know what a shock it is when it happens suddenly. I wasn't offered a stitch with DS2 though - they thought as well it was probably an infection that caused premature labour. But then monitoring during pregnancy picked up a shortened cervix at 27 weeks, so I spent 7 weeks of that pregnancy on bed-rest, partly in hospital. In the end, DS2 was born at 36+4, so almost full term.

I'm now 32 weeks pregnant with DS3 - this time I was offered a stitch, but since I managed ok with DS2 and was prepared for everything this time round, I decided against it. So far, so good - I've not done any strict bed rest, but have been off work since 18 weeks and have not been very active, and it seems to be working. I'm also taking progesterone as a pessary, which wasn't offered last time round, and so perhaps that is helping.

There are a few people around with experience of a stitch (as far as I remember, all positive experiences!). If I can find the thread, I'll bump it for you.

Good luck with your DC2!

[BabsUnited]

thanks willnotbetamed for your reply. Interesting you weren't offered a stitch second time, it seems to vary so much from borough to borough (and even hospital to hospital). The pessaries were suggested early on before I got pregnant but the consultant said she'd prefer not to use them for now at these early stages, not sure why as I understand it some people who have recurrent miscarriages have progesterone pessaries from early on.

Thanks for the good luck! I am trying to take it easy, I'm only commuting one day a week now and having naps at lunchtime the other days I work from home (early pregnancy tiredness still flooring me) so am hoping I can continue to take it easy as it progresses.

Will do some more searching on the site for stitch stories. Thanks

[willnotbetamed]

I am in Germany, so different again, but most of the people I know with similar stories were not offered stitch unless they knew that it was incompetent cervix that had caused the premature birth. I couldn't find the most recent thread about this when I looked yesterday, but there might be some stories on this one:
www.mumsnet.com/Talk/pregnancy/2342354-Short-cervix-and-pregnant-again

[BabsUnited]

Thanks for that link willnot, some good info on there!

[Pizdets]

Babs sorry to hear about the complications with your DS, that must have been really upsetting.

I'm on my second stitch and am a big advocate. Both times the procedure has gone well and allowed me to continue 'as normal' without worrying too much about pprom. I had my DS at 40+1 and am currently 18 weeks with the next baby and still able to walk the dog, carry my toddler around, do the shopping etc etc albeit while trying not to overdo it too much.

I agree it's very frustrating the lack of consistency when it comes to info on how the stitch performs and even aftercare. I think it would make life a lot easier for women facing it if there was a NHS standard on it, the problem now is you end up googling and getting advice from many different and unofficial sources and being totally confused by the whole thing!

Happy to answer any questions you might have. Also look for the 'Short cervix club' which is a thread I started when I had the first stitch 2 years ago - some lovely ladies on there all had healthy babies at term!

Good luck making your decision.

Piz

[AliceAnneB]

I would push hard for progesterone pessary (400mg). I was very high risk and made it to 40+1 thanks to the progesterone and bed rest past 20 weeks. There is a ton of clinical data/evidence to support the use of progesterone.

[Hellobump15]

My eldest child was born at 28 weeks due to infection (I'd had a UTI treated with antibiotics 2 weeks prior to that).

I was closely monitored in my second pregnancy & had many cervical length scans but a preventative stitch was never mentioned. It would only have happened had an issue shown up with the length scans.

I've since gone on to have DC2 at 38 weeks, DC3 at 36 weeks and am now 39 weeks with (our surprise) DC4 with no intervention needed in any of the subsequent pregnancies.

So in my case such a premature birth really was a one off.

If you're unsure about the stitch, I would definitely ask for another opinion.
I have heard good things about progesterone from other ladies who had prems around the time I had my first

[Summerdaydreams]

Hi babs [waves] from the CP thread!
As you know I am pregnant again too, and I had a premature rupture at 25 weeks last time around.

I can't help you with your questions around the stitch as I have not been offered this but have been started on the pessarys mentioned by pp. I started these three weeks ago at 23 weeks. My consultant also tested/swabbed me for bacterial vaginismus, which is also a trigger for a PPROM apparently. This came back negative.
I would push for cervical length scans, if not already arranged. I had one at my 20 week scan and then One three weeks later by the consultant.

Wishing you all the best in your pregnancy.

[BabsUnited]

thanks everyone for the info. (and waves back to Summerdaydreams!)

thanks to those links and info i've found from there I now feel happier about the stitch and will def be going ahead. I just need to convince them to give me the progesterone pessaries too.

[Brummiegirl15]

Hi all

I'm following this with interest as I'm 7 weeks pregnant and my consultant has mentioned me having a cervical scan to see if I need a stitch round about 12 weeks.

My history is that I've had 2 x lletz procedures plus had 3 miscarriages (although all first trimester) so he's keen for me to have the scan.

Might have to have a nose at the short cervix club thread!!!

[shopperholic101]

I have had stitches with both my pregnancies due to two severe Lletz treatments. I wouldn't hesitate if the consultant has recommend it.
I did have a option to not have it with my second child as cervix was longer (don't understand this part) but didn't want the risk so had it anyway. Ive had it under general and epidural due to how hard it was to put in for me. Removal isn't something id like to repeat but the end result was my babies both born full term.

[April1984]

Hi, I had an emergency stitch in December but still lost my baby two weeks after he was born at 25 weeks. I had a preventative stitch this time at 12 weeks. No history of cervix issues though seems to be short. I was told the risk of issues when stitch are placed are v minimal. Rupturing membranes is only an issue if you have the stitch when you are further on. Ideal time is 12-14 weeks. I was never diagnosed totally with Incompetent cervix (IC) but the signs point to that. It's notoriously difficult to diagnose unless you've had multiple losses which no one wants to risk. You obviously got to a v good gestation with your last pregnancy and even mine at 25 weeks is considered on the outskirts of whether or not I had IC. It generally (but not always) affects people between 16-24 weeks.

My advice is get a second opinion but don't be scared of the procedure. I had a v high Shirodkar stitch (aka TVCIC) and went privately to get it. Experience of the doctor is a must. The higher they place it the better and the lower chance of infection.

Good luck with it all.

Piz - unfortunately the short cervix club isn't v active now. I met someone through it back in December. So I haven't had much advice from others.

There are some great Facebook groups though like incompetent cervix groups and all the girls there have had stitches. They tend to be American tho and they do do things differently there. Eg they are v big on bedrest whereas the UK is a bit more reserved re bed rest. Since my stitch I have done v v little and am not working. That's more my choice tho, not doctor ordered.
X

[April1984]

Also great to hear people's positive stories. I am all over the place since losing my first baby in December. I'm now 20 weeks and feel petrified everyday.

Plus wanted to add you should defiantly push for progesterone. I take 2 x 200mg a day. As someone else said, there's lots of research to support its use. I can't vouch for the benefits myself yet but many doctors are big advocates.

Keep in touch. X

[Pizdets]

April I'm so sorry to hear about the loss of your son. We lost our first baby in summer 2012 and I fell pregnant with DS a few months later, it was a very stressful time and I'm not surprised you're playing it safe! I'm 19 weeks now so we must both be due in November?

shopper thanks for reminding me about stitch removal - something else to look forward to!! Pleased both stitches worked well for you.

Babs I'm pleased you're feeling happier. My consultant actually said they now think the stitch helps protect against infection because it holds the cervix shut and stops infections getting into the womb. I think really they don't actually 100% understand it, but they know it seems to work!! I was given progesterone this time around but haven't really used it, they said to use it 'as and when' and as I didn't have it last time I'm not sure when that might be, I'm sure if you ask for it they'll take you seriously and hopefully give you some. Best of luck and let us know how you get on!!!

[imip]

Babs, I've had 4 stitches placed at the Homerton (immediately outs self!!)...

I'm about to do the school run, but I'll come back later tonight to update...

[April1984]

Thanks Piz.

So sorry to hear you've had the same experience with your loss.

We also got pregnant very soon after losing our son so a lot has happened in the last 6 months. I also feel like I've been pregnant forever.

Can I ask, when did you get your stitch out and how long after did you go into labour? My due date is around 7th nov tho in my head I just want to get to October as my main milestone. Tho ideally I'll go to full term. So yes, we must be due at a v similar time! I'm 20 weeks tomorrow.

It's great to chat to u guys. I am a regular on a thread where people are pregnant again after a loss which is a great group but those ladies very sadly lost their babies for different reasons so it's good to hear people's expeiences with a stitch. X

[BabsUnited]

Oh have you imip! I was there today for another scan and am due in for the stitch on Monday. Do you know what I can expect in terms of recovery from the stitch? As in how quickly I can walk after (from the effects of the spinal) and how quickly I can go home? I'm having a Macdonalds stitch.

Am also hoping to harangue the consultant on Monday about getting some progesterone pessaries, I don't seem to have another appointment with them booked in yet and want to get the ball rolling on that

[April1984]

Hey imIp I'm sure can give you the best advice re recovery since she was at the same hospital. But for what it's worth my recovery was ok. I bled pretty heavily but I had a high shirodkar/TVCIC where they cut you in order to bury the stitchc under vaginally mucas and they mobilize your bladder. Otherwise wasn't bad, I had a general tho had a spinal for my emergency stitch and found the recovery from that quick.

My only real tip is to take prime juice/raisins with you! I was so scared to push for a number two post stitch! It is fine but just feels scary! So take any foods that can help you get things moving!

[Pizdets]

babs I had a spinal and was in and out same day. There was a lot of waiting around but I left about 8pm I think. I had hardly any bleeding both times and the first time was back on my feet and walking the dog the next day. This time I had quite a lot of cramping which was a bit worrying but it settled down in about 5 days and all been since since.

april yes very close I'm due 12/11! DS actually arrived at 40+2! Waters went at 40+1 and he was born the next morning. I was going mad by then though as had been on high alert since the stitch came out at 37 weeks so felt like I was overdue!

[April1984]

I've heard a lot of people say they end up getting to 40 plus weeks post stitch removal, probably more that way that the other.

I'm looking forward to being a 'normal' pregnant person once the stitch is out, I'll have been holed up for ages and so will just want to go for a walk and get out and about. I will have my stitch out hopefully at 37 weeks. My doc did say I could go more towards 38 but I'm so scared of going into labour with th stitch in I'd rathe shave it taken out just before 37 weeks.

[imip]

Hi babs. Like I said, I've had 4 stitches at Homerton Hospital. My first stitch was in 2006 after I sadly lost my first dd. I prommed at 20 weeks but stayed pregnant till 25+4 when I had a cord prolapse and my beautiful girl was stillborn. I spent a month on the antenatal ward, a bit different to what it is like now. Ive spent a bloody long time at Homerton, and still do now with my dcs.

I fell pregnant 5 weeks after losing my dd. dh and I probably wouldn't have gone back to Homerton had it not been that we had gotten pregnant so quickly and the good NICU (we'd previously been treated for infertility, so it was a huge surprise for us). I asked for a general for my stitch, cons said fine. After it was put in, I began contracting and I was warned it may be taken out, eventually, I was given morphine, and the contractions stopped. Importantly, while I was contracting, my cervix was NOT trying to open. I stayed in overnight. Pregnancy was relatively uneventful (ESP considering we were told a 20% chance of losing her). She was born by emcs after failed induction at 40+2.

With dc2 they refused to give me a general. I was pretty distraught. iAd had a cord prolapse and it was a real emergency with dd, and I didn't want to be awake if the membranes ruptured during the stitch. After my emcs, I was still pretty numb around the section scar where they give you the cold spray for the pineal. I just couldn't tell whether I was numb. They began the op and I freaked out. I was given ketamine to knock me out. It was bloody awful. An awful experience. A nurse was singing Special K like the placebo song as it was given, I've had the drug recreationally before (I sound like a really druggie, im not, promise!) and I knew it was shit. Same scenario, I contracted badly, but they wouldn't give me morphine. I was in hospital again overnight. Contractions subsided, but that time was the longest it lasted.

Third stitch, I begged for a general and got it. Got the usual contractions, but they gave me morphine after a couple of hours afterwards and all subsided. I stayed overnight.

My final experience, 4 years ago now, I was refused a general. I freaked out a bit on the operating table, so they give a general. The very very brilliant Dr I had in recovery refused to let me out of recovery while contracting. Gave me morphine after it was clear they were not going, I was well enough to go home the same day.

Because I only had one experience where I wasn't automatically given a general, I was a little freaked out by what actually happened. I was tilted on the bed (to take pressure off the membranes) I felt like I was falling off, and then about 3 men were standing in between my legs (it's a university hospital, and it is more than likely students will actually do the op).

My experiences at Homerton were not always good. My dcs are now 8, 7, 5 and 3. When I lost my dd 9 years ago, I think they were pretty shit with bereavement and difficult pregnancies. i hear better things now. But, all my stitches worked, and in general, I hear of successful stitches (I am in co natch with lots of bereaved parents so hear this sort of things anecdotally) when they are placed prophylactically). All my surviving dcs were sections, so I have spent more time that is reasonable at the Homerton!

One thing, I had a bit of a reaction to the material they used in the stitch, it meant that I leaked a cloudy watery fluid throughout the pregnancy, that was a bit scary. It was worse in my first pregnancy. Also. I let the stitch a lot more in some pregnancies and not at all in others. I guess that some times they were just tighter. They were all macdonald stitches. On my last section, they FORGOT to take out all the stitches and they were discovered last year's during a routine smear test. I was back in hosp late last year to remove them - they didn't argue against a general!

Sorry this is long, but if you want more advice please feel free to ask or pm me.

[BabsUnited]

Thanks everyone for your experiences. Especially imip; what a time you've had. So sorry to hear about the loss of your DD. I will note what you said about students, I've been told it'll be the consultant but I will definitely make it clear j only consent to a consultant doing it, I don't want a student going near me (no offence any medical students reading!) Feel quite nervous after reading all that but will still go ahead, but if I expect the worst I can hopefully only be pleasantly surprised.

[BabsUnited]

Imip have sent you a pm