17wks pregnant with a shortened cervix...don't know what to do.

[shropshireblue]

Hi,

I'm 17 weeks pregnant with twins and I have been experiencing abdominal cramps for 1 week. When it first happened I was examined the next day by a doctor who couldn't find any problems. The cramping continued so I returned to the hospital and have been told that I have a shortened cervix. I saw a specialist who advised me that the length of my cervix is 13mm but at my stage of pregnancy it should be at least 25mm.

The specialist has said that I am at risk of premature labour but there isn't much that they can do. I was advised that I could be placed in a trial where I am given progesterone pessaries but they don't know how effective this treatment is. Until I see my consultant later today I don't know what action they will take.

I've not slept at all and I am so worried. This is my first pregnancy and I'm so scared that I'll lose my babies. I was in so much shock yesterday that I really didn't ask many questions. Does anyone have any experience of this?

Thanks

what about a stitch...??? I too ama pregnant with twins and got my cervix measured at around 16 weeks... All they told me was that it was normal and nicely closed.? I have had 2 previous treatments for abnormal cells. They informed me it shouldnt make a difference unless you have had around three...

I just know some hospitals will put a stitch in, and this can assisst you to carry longer. ?? ask about it, google it...speak to your consultant.... I do know it can be done but most wont do it after a certain point.

Deff ask for another appointment and ask about this..... ?? Might be worth a try...?

Accept the progesterone pessaries, have heard good things about them, apparently they may be as good as a stitch. Ask why you can't have a stitch. If they refuse a stitch, ask them to write the reasons why not in your pg notes. Did they say you have any funnelling? When are you seeing them again? Did they let you go home? If so you should be in bed. You may have to fight for treatment - they can be so negative about probs in the second trimester. Fight as hard as you can so you know you are doing everything you can for your babies.

Having said all this - I was monitored for incompetent cervix (I didn't turn out to have it, never went below 20mm) in pg 3. My MW told me about a woman who was 15mm at the twelve week scan and her cervix actually lengthened. Mine also lengthened between 18-22 weeks.

Personally I would also be concerned about the cramps. Have they taken swabs for infection? I am sure they dipped for a UTI?

I really really feel for you.

Also - ask for help from the 'multiple births' people on here. Someone else may have experience of this.

Thanks Hippy and Shamechanger. On my notes it does say I have funnelling which I will ask about when I see my consultant later today. The specialist told me that at this point bedrest wouldn't make any difference.

I have had a swab done and it turns out that I also have b.v which I have been prescribed medication for. It's recurring so I'll have to ask them to keep an eye on it. They said the cramps were contractions type pains and I should have asked more questions but after receiving the news I just couldn't think.

I think I'm more prepared now and will really push for questions today at my appointment. I just feel as if I can't plan anymore.

I was monitored for an incompetent cervix and was told the options for me would be: progesterone pessaries (not as a trial though, you might be given placebo), a stitch (although they don't like to do this after a certain point as there is greater risk of infection) and bed rest. Good luck

I'd ask for a second opinion NOW. Mr Paul Armstrong has an interest in this area. I think it's Kings College Hospital which is a specialist site for early/threatened labour, but I'd call Mr Armstrong first. Very best of luck, please do update, hopefully with good news.

Kings College is my hospital BagofHolly so I'll ask to see him. Is it possible to just call him or do I have to be referred?

Paul Armstrong doesn't work out of Kings, he's a private obs with an interest in this area. His main rooms are at The Portland or The Lister I think. As for the lead cons with an interest at Kings, I'd call the obstetric medical secretaries, and ask, and/or look to see which consultants there have published papers on this. I'm sure Kings are doing a huge study on cervical measurement as an indicator of risk of mc but I don't know who the lead researchers are. A bit of googling/phoning should get you loads of info, esp if you're already a Kings patient. (I'd do it for you but am typing with one hand and feeding 3 kids! Crossing everything for you!)

www.drpaularmstrong.co.uk/

Shropshire try the pessaries, I used cyclogest from 14-34 weeks. Am 35 weeks with twins and they are still in there. What have you been prescribed for BV? Although this is reoccurring the antibiotics will wipe it out long enough for it not to effect your pregnancy.

Prof Shennan at Kings. He's lvoely. Can't understand why they wouldn't offer you a stitch. Asap.

Sorry, he's the stitch expert/incompetent cervix/second tri mc expert.

Shame changer can i ask why you were monitored? Although un derstand if you don't want to put anything here that might worry Shropshire.

Peanuthead I'll PM you.

Shropshire I am under the impression that they sometimes don't want to do a stitch if the cervix is funnelling. But this may be wrong and I have heard very good things about the pessaries.

BagofHolly it was Kings who were doing the cervix measurement study but I believe it finished in 09 / early 2010, could be wrong though.

The Bliss messageboards (prem baby charity) can be quite helpful - there are a few people with incompetent cervix there so they know all about the stitch etc.

It sounds like they think the BV has given you contractions which are shortening your cervix rather than you actually having an incompetent cervix though - so it could all just sort itself out.

I'll be thinking of you.

The pessaries are fabulous (am on them myself right now, but I have a transabdominal stitch placed prophylactically at 13 weeks and they're for contractions as my cervical length doesn't matter)

You may well be told that there is no evidence cerclages improve the outcome with multiples - be prepared for that. I have no idea how true that is but it is something I have heard.

The Fetal Medicine Centre is doing a trial with silicone ring things and twins - they're the same people as at Kings, well, the fetal medicine bit rather than the hospital itself. Take a look:

www.fetalmedicine.com/fmf/10-randomized-trials/01-prematurity-in-twins/introduction-1/index.html

Nick Wales at Chelsea and Westminster is another expert, as is Prof Bennett at Queen Charlotte's.

I was under Kings for my second pregnancy (although my rescue cerclage was placed in the US) and wasn't hugely impressed to be fair.

Keep us updated on what your consultant says and DO get a second opinion if you can!

OP, echo what the others have said, have a look at the pregnancy board at blissmessageboard.org.uk and you will meet many others in the same boat. I hope your appointment went well and that you have have had a few answers.

I have the dubious distinction of a very short cervix (19mm or so outside pregnancy)and was very lucky to have this picked up at the 23 week scan and monitored thereafter. They did not place a stitch in my case, I was recruited to the progesterone pessary trial and had dd at 27+5. It turned my world upside down - I left work for what I thought was a routine scan and never returned.

At the time I worried that I should have had a stitch - however the failure rate for late stitches is very high and carries risks such as infection and puncturing the amniotic sac so recognise it's a difficult decision for an OB to take. BV in particular is a risk factor for complications.

I would strongly suggest that you ask to be referred to a specialist fetal medicine centre - but where depends on where you are in the country as I think all those mentioned above are in London. You can pm me via the Bliss board - username Liza

Another one here on the pessaries - for both contractions and cervical length. Still going now at 35+5, which is something I never thought would happen 8 weeks ago.

They're working really well, yesterday I was booked a c-section for 3 weeks today. (I'm not allowed to deliver naturally but that's another matter)

It's amazing how long the doctors can 'keep you going' for.

I see my consultant weekly and have cervical scans every other week.

I hope you got some answers today seeing your consultant.

I saw the consultant yesterday who was really helpful. He said there were a number of options, one of which is a stitch. The reason he has reservations about this is due to the BV but he has also said that the BV may be causing the contractions - much as you said Shamechanger.

He also said that progesterone is good with singleton pregnancies but not very helpful with multiples, but that there was no real reason not to try.

Sparklies - He discussed the silicone ring and although this is still in trial he is going to speak to the doctor involved with this about me.

They are going to call me today to let me know which they feel are the best options for me. His biggest concern was that the BV is treated first before anything invasive is considered due to the risk of further infection.

The strangest thing is that the contraction like pain I have is nothing to do with my womb but with constipation! So, it was a lucky coincidence - if I hadn't gone to the hospital they wouldn't have discovered the issue with my cervix.

I guess I now have to wait until I get that call but at least I feel there is some hope. I'll take a look at the Bliss board as suggested.

Thank you all for your help, I'll keep you updated.

Glad to hear your doctor is being pro-active and on top of things! Who is it out of interest?

Yep, after I posted I remembered reading that progesterone hasn't been proven to be as useful with multiple pregnancies. A real shame.

So annoying the way bowel issues (and let's face it, we get a lot of them!) are in the same area and feel like bad news. But in your case it seems to have worked out!

Good luck with everything and I hope the BV is cleared up quickly.

Good to hear they're taking care of you. Keep us posted Shropshire.

I went to see my consultant today, I'm going in for a cervical stitch on Monday. I've been ruled out for the silicone ring as I would need to be 20 weeks and they won't risk leaving it that long.

I'm so pleased that it is happening soon but at the same time I'm a bit apprehensive about it. At least it's only 3 days away although after that I'll be counting every hour of the day!