Incompetent cervix monitoring

[buttonqueen]

I am 14 weeks pregnant and because of previous operations on my cervix to remove cancerous cells my consultant had told me previously that I could be at risk of my cervix becoming incompetent. As at my 12 week scan the cervix was closed and the right length he did not proceed with stitches and will scan me again at 16 weeks. My question is when there is a problem with the cerix shortening/ softening how quickly does this develop? I'm worrying a lot and feel like I should be scanned every week (I'm seeing my consultant privately as he treated me for the cancer). Does anyone have any experience/ knowledge in this area? Thanks very much.

Hello ButtonQueen, nice to 'meet you.' I have also had cervical cancer and had a deep cone biopsy in late 2009 to remove my 1b1 tumour. I am now in remission and am currently 20 weeks pg after having a cycle of IVF. I was told that I would be at risk of cervical incompetence as I have hardly any 'external' cervix - I am told it is virtually flush with my vaginal wall. I was warned that I might need a transabdominal or vaginal cerclage when I fell pregnant and I was referred to a high risk obstetrician for close monitoring.

I started off being seen every 2 weeks and after my initial examinations my obstetrician felt that I did not need a stitch afterall. In her words, it would be more risky for me and the baby to have the stitch than not, at least in my case.

Apparently I have scar tissue on my cervix, caused by the op, which my obs says is very strong and effective at holding the cervix closed.

Now my pregnancy has progressed I am being seen weekly, and my obs checks my cervix is closed using an abdominal scan or an internal exam. I understand that if my cervix was going to 'give' that she would likely be able to tell this prior to it happening (cervix starting to funnel, membranes bulging etc) so I feel fairly ok for now.

It is nerve wracking to feel a bit like I'm leaving things to fate, and I spend much of my time worrying and counting down the time until my baby could survive if he was born. All I can do is go with the medical advice though and keep everything crossed (including my legs!)

Have you seen an obs yet and had an exam? Are there any plans for you to have a stitch. I have done a fair bit of reading up so might be able to answer some of your Q if you have any. At the very least I can certainly sympathise with what is a very stressful situation. Many congratulations too on your pregnancy, it is such a blessing after having cervical cancer, despite the worries.

Sorry for any crapness in this post - typing on stupid iPhone!

Hi buttonqueen, i have had two operations to remove abnormal cells and was also told I would probably need a stitch. They did an internal scan at 16 weeks for me and I was told if my cervix was less than 1.5cms they would recommend a stitch. Despite not much being seen it was actually 4.3cms, positively long!! The consultant saw me again at about 19 weeks but did say that if I had managed to get this far she would doubt very much that things would go wrong and advised no further scans, gulp!
The thing that helped for me is knowing the length of my cervix (don't know if you do), this made me relax to know I wasn't boderline (eg 1.7cms) and I made a conscious decision to try not to think of it!! (and I haven't too much!)
I am now nearly 30 weeks and now, ironically, worrying about how well my cervix will dilate (I too have scar tissue that has needed to be 'opened' twice so I may infact have real trouble dilating) but that's an OK worry!
I remember them saying something about worry points being any loss of fluid, a sign things may be weakening, I assume you have been told about this?
I think, having read posts about this before, that women are often told they 'may have trouble with their cervix' after removal of cells, I really hope you are trouble free.

Hi there, I was also in this position in my first pregnancy and so had the scan. My situation was completely like Janus's and I had a long cervix and was ok, so you may be too.

My mum had to have a stitch for an incompetent cervix when pregnant with me though and she said she went to the doctor at 20weeks as she felt like she was sitting on my head, so I think that you get a bit of warning, at least in some cases.

I'm sure you'll be fine, and the doctors don't like to take risks so I'm sure they are monitoring you appropriately. Good luck

Thanks very much for your responses. I don?t know anyone else in this situation and when I?ve looked at the literature everything seems to point to stitches/ cerclage so it?s very helpful to hear your experiences. My consultant had talked to me about cerclage before I became pregnant so I always just assumed I?d have it done. When I found out it wasn?t that simple I felt quite confused. Now I?ve looked at it a bit more, and heard your experiences, I can see that it is a last resort option given the risks involved.

GG and Janus ? I?m glad it has worked out for you. Janus, I know you?re not there yet but 30 weeks must be a great place to be. I hope that your worries about the birth now don?t stop you enjoying the rest of your pregnancy. I can?t wait to get there. Though maybe I?m being naive and we never stop worrying...

Storminacup ? You?re so right. It feels like a miracle being pregnant after having worried that my scarred cervix would make conception difficult. As I?m 40 and it?s a first baby this is especially true. My cervix is still in place and my main problem is the scarring. I?ve decided to have as my obs the gynaecologist (he also does obs) who treated me for the cervical cancer. I?ve been seeing him for monitoring for the last seven years, when I had my first operation, so he knows me and my cervix quite well!

I had an internal scan and an internal examination at 12 weeks and the consultant said the 3.3cm length was fine. He said that above 3cm was acceptable and he?d check again at 16 weeks. After that I guess I?ll be able to have a more meaningful conversation with him about how we monitor things as I didn?t really have a lot of information at that stage. Depending on the result then I might ask for weekly scans. My main fear ? and I?m sure you?ve had this worry too ? is how frequent the scans need to be so that the obs catches any changes. He?s good so I am trying to tone done the worrying and trust in the fact that he?s check me when he needs to and won?t take any unnecessary risks.

Thanks again and here's to npt worrying!

Hi Buttonqueen, I forgot to say congratulations in first post!
3.3cms seems very generous to me! The way my consultant explained it was if over 1.5cms that was a very good sign. After that, if I made it to 20 weeks it really wasn't worth having the stitch as there is a real risk of rupturing the baby's membranes and so it was best not to disturb. I almost had to 'let it go' at 20 weeks as I went to see my consultant determined to ask for another scan but when she explained the cons of the stitch I decided I had to just be positive.
I am hopeless at remembering the possible signs of the cervix becoming incompetent, other than loss of fluid, I'm sure it has been explained to you but if not then go over this with your consultant as I think they prefer to take these warning signs into account more than constant scans.
One other thing I forgot to say is will be my fourth baby. I had one round of abnormal cells removed before my third baby and was monitored then too, think my cervix measured about 4.9cms that time and it held on to 40+1 that time! This has helped me this time too, to know I'm not that much shorter than last time!
And I'm 40 too, great age for having babies!!

Hi Janus. Fourth baby - how great! I am going to ask my consultant next week when I see him for 16 week scan for the possible signs. Hopefully with that and the scan info I should be able to look forward more calmly. Thanks again

Hi buttonqueen, I also had two surgeries (a LLETZ and a cone biopsy) to remove precancerous cells from my cervix, approx 2.5cm was removed in total. Was told all the same things as you, but I'm now at 32 weeks with no cerclage and the last measurement of my cervix was at 26 weeks when it was 39mm. I had my first internal scan at 16 weeks and then every 3 weeks after that, each scan showed my cervix was a little longer, and most importantly, there was never any sign of funnelling (otherwise they would have seen me mroe frequently).

The next issue is whether it'll behave so well during labour and dilate for me and baby! However, I feel very lucky to have got to this stage without any problems, especially as I remember sitting at home in tears when I was about 13 or 14 weeks because I was convinced I would lose the baby. I understand your worries completely. Hopefully you'll have the same news as me after your scans, and in the meantime I hope my experience helps you to relax just a little bit.

Hello... I've just started my own thread with questions about this.

I had LLETZ at the end of 2009, and Diathermy a few months later. I'm currently 25 weeks pregnant.

I've been given conflicting advice about whether or not I need to be seen buy a consultant, but after doing some research and asking on here it looks like I do need to be seen to get my cervix measured, so will push my midwife until she gives in!

I'm just wondering if anyone can help me to understand the information given to me by the consultant that did the treatments (I asked for it to pass on the MW/Antenatal Consultant.

They said my "LLETZ treatment removed 20x15x15mm with central tranverse os measuring up to 12mm"

It's the central transverse os bit I don't get... is that the length of my cervix do you think? Seriously panicking if it is... 12mm seems very short?!

I think os means opening, but whether that means that was the amount left or the amount taken I really don't know. However, the length of your cervix could have changed by now anyway and I would be really encouraged that you have reached 25 weeks without any problems. I started being scanned at 16 weeks as that is when problems can start to arise as the uterus and foetus get heavier. I was told if I got to 28 weeks and my cervix showed signs of weakening then that they would not do anything surgical to prevent it as that would pose greater risk to the baby. By 28 weeks your baby has a very good chance of surviving, although not ideal obviously.

It's a shame no one took your concerns seriously to begin with. I would mention it to your midwife again, but it is my belief from what my consultants told me (I'm certainly no expert) that if you had an incompetent cervix you would know about it by now.

Thank you AllBellyanBoobs. I mentioned it at the very start, and it was recorded on my notes. No one took any notice, and it's only since I mentioned it at my last midwife app (24 weeks) that I've realised something should have been done/checked, and especially since talking to the consultant at the women's unit that carried out the treatment, who told me I must be seen!

The last midwife I spoke to did say that if I've got this far then everything should be fine, it doesn't stop me worrying though, I would rather know, IYSWIM.

I was also unaware of the problems it may pose during labour. I was hoping to go to the low risk midwife led birthing unit... is this a bad idea?

Yes, I know exactly what you mean. I was told at 25 weeks that they would sign me off but because I'd originally been told they would scan me up to 28 weeks I asked for that last one scan. They didn't give it to me in the end but the consultant was great at putting my mind at ease :o

I don't know what to suggest other than asking the midwife to book you in to the antenatal clinic, or speaking to your original consultant and asking them to scan you or arrange for it to be done elsewhere?

Try and enjoy being pregnant, I found I relaxed after 28 weeks because I knew my baby had a good chance regardless of what my cervix did then. You're only 3 weeks away from that point which is great! But, if you are feeling stressed about it then I'm sure your midwife can help you get a scan.

It doesn't necessarily pose problems during labour, I didn't want to give you that impression! It can mean that you dilate more quickly or more slowly than you would have done if you hadn't had the treatment, or you may be exactly the same. Whats a normal birth or normal labour time anyway? The only thing my consultant said is that my history might mean that if I was labouring very slowly they would be tempted to send me for a caesarean more quickly than someone who hadn't had any treatment but really it's a wait and see what happens on the day. I'm going into a MLU and hoping for a water birth, no one has told me it's a bad idea.

I didn't really it was as early as 28 weeks that baby stands a good chance, that is reassuring.

I'm due to be scanned at 34weeks anyway as my plancenta is low, (I also wondered if that was due to the scarring on my cervix) if it hasn't moved I will be booked for a c-sec anyway!

I think I will continue to hassle my mw, I;d rather have all the facts...pregancy/labour is scary enough!

Forgot to say - good luck with everything! Hope it all goes smoothly for you.

Thanks, and of course the same to you. Hopefully I'll be on here in 6-8 weeks telling you how completely wonderful the birth was and that I can't wait to do it all again :o

Hello
Congratulations on your pregnancy! Lots of my experience isn't relevant to you - I had cerival shortening and funelling picked up and my 20wk scan (routine because it was twins) and was then scanned weekly until 23wks when they decided they'd have to do a stitch. I thought it might be useful to give you a cerclage success story in case it does happen to you: my twins were born by planned section at 38wks and no sign of them coming naturally. The other thing I wanted to mention is that I did feel different to my previous pregnancy - I can remember walking around at about 19 weeks feeling like the babies were about to fall out! I thought it was because they were twins at the time, but it was due to the shortening cervix. So what I'm trying to say is that if it does start to happen, in my experience you'll notice.
Hope all goes well