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Testing for incompetent cervix

(75 Posts)
EmmaHealy23 Sun 26-Nov-17 11:32:40

Ok so I'm going to come access like a hypochondriac. I've had quite a few early miscarriages and some D&C operations as a result. I'd like the chance to be checked for an incompetent cervix...a lady I work with lost a baby to this and I'm really paranoid about it. My midwife said unless you have had a late loss the NHS won't check you, but as I've never got this far before I wouldn't know how my cervix would behave.

Basically the NHS have shut down on me, told me it only happens in 2 pregnancies out of 100 and if something did happen they would prevent it if I got pregnant in the future.

Does anyone know any companies that do this! I don't mind paying for peace of mind. I'm in the West Midlands area but can travel a bit.

I just feel really sad for all the people who have to lose a baby because the NHS are too tight fisted to check them over sad they say it's so rare they can't justify it. So would you just need to go into labour before they will check you? I know they didn't check mine at my 20 week scan, j asked specifically

Sorry, long post!

PickingOakum Sun 26-Nov-17 11:48:53

I'm not really sure what you are asking here.

There is a test for cervical incompetence that can be done pre pregnancy, but it involves a general anesthetic and needs to be done by a specialist in the area, so usually one of the regional senior consultants that specialises in the condition (there aren't a lot of them in the UK). No private company does them.

I presume you are talking about having your cervical length checked during pregnancy, and to be fair, your midwife was correct. The condition is rare, and in order to monitor the cervix for incompetency, you need a baseline measurement at the beginning of pregnancy and then a scan every two weeks from week 12 to week 26. All these would need to be transvaginal. You'd still need your anomoly scan and your anatomy scan as well (the abdominal scans that every pregnant woman has).

These are a lot of scans for the NHS to provide for every pregnant woman.

As a rule, cervical incompetence is usually caused by surgical treatment to the cervix for cervical cancer, cervical trauma after a complex birth that led to an emcs, or Ehlers Danlos syndrome. It is very rare for one of those factors not to be present, though it does happen (I was one of those flukes).

Another thing to consider is that if you've had no problems by week 26, you are pretty much in the clear. Cervical incompetency is a condition that affects pregnancy prior to this gestation.

EmmaHealy23 Sun 26-Nov-17 11:57:07

Thanks for your reply, sorry if my post was unclear. I'm 23 weeks at the moment.

I just wondered if anybody had any suggestions of private places that might do this scan, I.e. anyone in the West Midlands who knew of any private scan facilities who do the cervical scan. All the ones I've called only do normal ultrasound.

I haven't had any procedures, just feel a bit nervous as my lovely colleague had none either, no previous miscarriages and lost her son to this, she so I'd like to check mine. I know I can't expect it on the NHS but I'd like the opportunity to pay to put my mind at rest.

It scares me that it can happen silently and you wouldn't know until it's too late. Wish the NHS offered a private scan service for extra anxious ladies!! After all my problems getting this far, I think my anxiety is at least somewhat justified.

PickingOakum Sun 26-Nov-17 12:02:51

Just to add... checking the length of the cervix at the 20 week scan isn't particularly useful if you have no idea whether or not the measurement has changed dramatically from previous weeks.

Some women carry pregnancies to term perfectly well with short cervixes. It's just what their body does, so a measurement of, say, 2.5 cm might mean nothing in their case. What matters with cervical incompetency is the change in cervical length as this shows the extent to which the cervix can stand the weight of a mid trimester pregnancy. After 26 weeks, as the uterus tips, the weight is no longer directly upon the cervix so incompetency no longer becomes an issue.

Shehz21 Sun 26-Nov-17 12:08:57

May I ask at how many weeks did your friend lose her baby OP?
I am currently undergoing the same kind of anxiety and when I asked to be put under cervical monitoring due to my paranoia and anxiety, I was plainly refused sad
I am also currently 23 weeks so can relate to you on so many levels OP.

EmmaHealy23 Sun 26-Nov-17 12:12:08

Oh ok thanks for your help. I was just really worried, it's horrible to hear of something happening to somebody so sad. I suppose there is nothing I can do then until I get to 26 weeks. Although this did happen to my colleague at 27 + 3 so maybe hers didn't tip.

I guess I'll just keep praying if there is nothing I can do. I just thought maybe I could have done something to put my mind at rest but thanks for putting me straight.

EmmaHealy23 Sun 26-Nov-17 12:16:22

Shehz21 glad its not just me worrying! Have been told all along that after 12 weeks you are safe but this has really frightened me. The feeling of helplessness and being treated like a hypochondriac doesn't really help either. Just wish I could feel more secure about this, I guess I'm just one of those anxious people who like to check things before they becomes problematic....I suppose being vigilant is frowned upon in these circumstances!

PickingOakum Sun 26-Nov-17 12:18:16

I don't know of any private places that offer a trans-vaginal scan to check cervical length, unless you contact one of the regional specialists in this area and offer to pay privately.

As I mentioned above, such a scan at 23 weeks gestation would only provoke further treatment if your cervix measured less than 2.5cm and such treatment would just be probably to monitor you until 26 weeks to check for any changes as after this date, the incompetency of the cervix no longer threatens the pregnancy (unless you have no cervix left at all because of radical cervical surgery).

It strikes me that maybe you've got a slightly skewed perspective of the condition from your colleague's experience. Almost all losses due to cervical incompetency occur either prior to 23 weeks or the condition manifests prior to 23 weeks (your waters break etc).

BubbleFrog Sun 26-Nov-17 12:19:51

i think babybond offers it - have a read on their website.

EmmaHealy23 Sun 26-Nov-17 12:24:23

Thanks Bubblefrog they aren't near me unfortunately but that's the sort of place I'm after! X

PickingOakum Sun 26-Nov-17 12:29:35

Although this did happen to my colleague at 27 + 3 so maybe hers didn't tip.

I suspect the condition manifested prior to this gestation. I've never heard of a loss this late due to IC "out of the blue" and I know a lot of women with the condition (I am a member of the UKs primary support group for the condition).

Where women have suffered a loss at 27 weeks, it tends to be because the cervix has failed between 16 and 22 weeks and their waters have broken or they have gone into prem labour around this time, and the pregnancy has either failed in the subsequent weeks or the baby has been delivered but not survived NICU.

EmmaHealy23 Sun 26-Nov-17 12:38:43

pickingoakum thanks, I'm not medically trained so can't comment. It's what her doctor told her caused the loss, perhaps if she had had it checked they could have done something,perhaps not. You seem to have a much better understanding of the condition than I do, I'm simply asking for any private places that could spot the problem early on, better to be prepared, even if it's just monitoring the situation.

From what I understand, if they had caught it earlier they could have given her some drugs for his lungs...I don't even pretend to know what they would be or how much earlier they would have had to catch the condition. All I know is that if there is something I can do to watch our for any problems, I'm going to do it. Don't mind or care if I sound somehow ridiculous, but if it can't be done then so be it. At least I asked, that's all I can do.

EmmaHealy23 Sun 26-Nov-17 12:58:48

I think the thing that got me here w bit is that thy give you all the risks for downs, Edwards and Pataus and they seems to be comparatively rare, plus the testing they do for GD and pre-eclampsia, yet my midwife never mentioned this until I did...and she said it happens to 1-2 people in every 100. That doesn't seem incredibly rare to me.

I had urinary retention and an indwelling catheter through most of my early pregnancy and was told that happens in about 1 in every 4000 pregnancies...that's more along the lines of what I would call 'rare'!

CouldntCatchACold Sun 26-Nov-17 13:01:43

I lost twins at 23 weeks due to suspected cervical incompetence/ premature labour. I have had previous premature deliveries.
My consultant has agreed to fortnightly cervical scans and progesterone in this pregnancy from 16 weeks.
You don't necessarily have any risk factors that would warrant any investigation of your cervix.
At 27 weeks your friend my have had true spontaneous premature labour, rather than an incompetent cervix. The two are sometimes difficult to distinguish because they both often happen without 'visible' warning.
My advice- don't obsess over something you don't need to, pregnancy is tough enough.

Xfactorstar Sun 26-Nov-17 13:03:56

I understand your worries flowers I had ds at 34 weeks with almost painless contractions and my cervix was 9 cm by the time I got to hospital. It's good to hear from experts it's probably not an ic if I held on so long.

EmmaHealy23 Sun 26-Nov-17 13:10:19

Thanks for the replies. Guess as this is the furthest I've got I've never had to worry about any of this.

Guess the miscarriages have worried me because on the NHS website it states D&C procedures put you at a higher risk.

Total naivety on my part that if they could scan or monitor something then they would. It's surprised me you have to lose a baby first. I'm new to all this, I suppose I just expected too much.

This is my last go really and I just want it to work out so badly...I always wanted a baby and we have been through the mill a bit trying, I hoped for more support I suppose.

CouldntCatchACold Sun 26-Nov-17 13:16:29

Pregnancy is one of the most stressful things you can ever do. Honestly, even if they told you everything was ok, you'd be onto the next worry.
The fact that you are at 23 weeks with no problems is quite reassuring smile if something was to happen from now, the doctors would intervene to give baby the best chance.

HeyJupiter Sun 26-Nov-17 13:22:26

Oh I really feel for you OP! I’ve got hypermobility syndrome (which can be a risk factor) and spent most of the second trimester in a state of anxiety. Midwives weren’t interested as first pregnancy and have never had a loss. I considered a private scan but as others said it’s hard to know whether the measurement would be significant without a baseline. I’m 41 weeks pregnant now which makes me want to laugh in some ways given all that worry.

I suppose just wanted to empathise and wish you luck. Do what you need to for reassurance but sounds like you’re heading out of danger territory now anyway flowers

EmmaHealy23 Sun 26-Nov-17 13:24:15

Thanks couldntcatchacold your not kidding! I've become s total nervous wreck, I just didn't expect to worry quite this much. Then when you hear about such horrible things happening to all these poor women, and that some could be avoided, it just surprised me a little I guess.

I obviously feel silly now as another poster pointed out that's lots of extra scans, and they won't do it for everyone.

It's just...how would you know you had made it to 23 weeks with no problems? From what I understand it's painless with hardly any symptoms? So you might not know? X

PurpleTraitor Sun 26-Nov-17 13:25:06

I’ve lost two babies in the second trimester and been put on cervical monitoring for a subsequent pregnancy, however I do not in fact have a weak cervix and my losses are still unexplained, no cervical incompetence, no infection, no chromosomal abnormality, no malformations - just pure chance occurrences. I don’t know if that makes you feel better or worse.

Incompetent cervix affects around one in 100 pregnancies, and nearly always manifests in the second trimester (13-26 weeks) I can understand how that does not seem vanishingly rare but you need to put that in some context. It is very rare in women with no prior surgeries, with no underlying malformations or causes, no cervical trauma, no previous traumatic births, etc. And all those women with clear causes, and all their multiple pregnancies, are included in that 1 in 100.

You cannot test for it unless you know what you are looking at. You cannot know what you are looking at unless you have a baseline cervical length, which cannot be determined in your stage of pregnancy. It can only be determined by looking at changes of the cervix, and comparing them to what went before. And by monitoring it on an ongoing basis, looking at funnelling etc, finding out what is normal for you.

I know pregnancy is scary but we really don’t know enough about miscarriage to prevent miscarriage, even second trimester ones. 12 weeks has never meant anything much really. It’s not a case of the NHS being tight fisted. Even in the US it is usually diagnosed by history of 2 or more second trimester miscarriages.

I hope you have a happy and healthy pregnancy.

EmmaHealy23 Sun 26-Nov-17 13:35:30

Thanks for all the replies. Obviously this has stirred up lots of emotions for lots of women and I apologise for asking what appears to be a stupid question.

I suppose I'm just scared. I understand now that I have no reason to worry about it and can't jump the queue with wanting extra care when others have been through worse.

Thanks for the responses and sorry to all those people who have been through hell and back, I don't know how you have the strength to carry on but I appreciate your time in getting back to me.

EmmaHealy23 Sun 26-Nov-17 14:55:07

HeyJupiter just wanted to say congrats! And thanks, in a way it's comforting to hear that someone else worried about this, makes me feel a bit less silly! X

PickingOakum Sun 26-Nov-17 15:07:42

if they had caught it earlier they could have given her some drugs for his lungs

These would have been steroids to mature his lungs. Babies born under and around 24 weeks gestation do not really have the lung capacity to survive after birth, so if they suspect a possible preterm birth, they give steroids.

she said it happens to 1-2 people in every 100

Bollocks. grin I don't know where those figures actually come from, but they seem comically high. It would mean that there were 7500 IC-related second trimester losses in the UK every year, and err ... there just aren't.

Put it this way, my local hospital oversees 5000 births a year. I was the only IC case some of the consultants, and all of the midwives, had seen in their careers. The regional obstetric consultant that looked after me during my successful pregnancy, who is also one of the handful of consultants that specialises in IC in the UK, only surgically treats about three or five IC-affected women a year out of tens of thousands of pregnancies in our region.

The NHS website it states D&C procedures put you at a higher risk.

What you need to remember here is that not all D&C procedures are the same. The statistics that inform the notion of D&C procedures increasing risk could very well be referring to D&Cs done twenty years ago when procedures were different, or D&Cs that were particularly invasive.

Total naivety on my part that if they could scan or monitor something then they would. It's surprised me you have to lose a baby first.

You simply could not properly scan every pregnant woman for IC in the UK every year. It would cost a fortune. You are talking about an extra seven to eight scans per pregnant woman with the associated sonographical training.

To give you an idea of where the land lies with this, an IC support campaign group are just, at the moment, trying to work towards getting a consistent IC treatment pathway in place for women that have already had one or two suspected IC losses.

From what I understand it's painless with hardly any symptoms

This depends. My first IC loss was preceded by nagging constant abdominal discomfort and pain from about 16 weeks before my waters broke at 20 weeks.

* I apologise for asking what appears to be a stupid question.*

It was, most emphatically, not a stupid question. There are a lot of misunderstandings about the condition and the more people know, the better.

That you are already 23 weeks is an incredibly good sign. I really would not worry too much if I were you, but I know that is easy to say and very difficult to do.

EmmaHealy23 Sun 26-Nov-17 15:20:36

PickingOakum thanks! Wow that's a really detailed reply and I really appreciate the time you have taken to help me understand it more fully.

Tbh you have put my mind at rest a little, I thought that seemed a bit high, considering I'm 33 years old and of all the people I know I've just heard about it now, it's just really frightened me.

To be honest I've had great care and nothing particularly to make me think I could be suffering with this, I just freaked I guess! Have obviously googled this since and it at least seems like it's something loads of people have suffered with...though I do appreciate that all the women who haven't had this aren't going to be chiming in with advice.

I'm so sorry for what has happened to you, it's my worst nightmare really so all I can say is thanks for using your knowledge to help other people like me understand the condition, and why it can't just be solved with a simple scan like I thought.

EmmaHealy23 Mon 27-Nov-17 10:27:41

Just as an update on this...found a private place that do them. Had a chat with the lady. She said although it would be too late to start to get a base level, if the cervix was under s certain length it was their policy to do a letter of referral to the hospital. She did that whilst the hospital wouldn't take their scan as proof they would scan themselves and if they agreed there was a problem they would make a plan with me.

In my opinion it's best to be prepared and if there was any chance of a problem I'd rather know early. If not, then it's a bit of peace of mind for the sake of £40.

Is just this Friday so fingers crossed! Have to travel to Leamington but for me personally it's a bit of a weight off.

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