Stitch in my cervix

[MrsSET]

Hi there - looking for some advice from anyone who has been in the same situation.

I went to see an obstetrician at UCH today as I had some treatment for pre-cancerous cervical cancer cells a few years ago, which basically involves burning out the effected area of your cervix.

As it can leave your cervix weaker, they want to put a stitch in mine when I am 24 weeks.

Has anyone had one? What was it like? I've been told I'll have an epidural for it and stay on labour ward. Would this be a day procedure or do you stay in overnight?

Any tips, advice or info you can share would be greatly appreciated!

hi, no experiance directly but me best friend had exactly this for exactly the same reasons. she was out within 2 days, not sure she had an epidural but i think was put under GA. she was absoultely fine, they did give her a couple of extra scans throughout her pregnancy but she wasn't silver star or anything. she gave birth fine with an epidural and i think the only thing is if she has another baby she'll have to have a c section as this babe was large and with the weakened cervix they wont risk another large baby and forceps delivery etc. but not sure if thats to do with the delivery in general or the stitch she had. dont think the stitch caused any issue whatsoever!
x

Thanks so much Feekerry - really appreciate your response.

Do you think it is something I can have done privately or is it treated like the rest of pregnancy and not covered by usual insurance cover? I know my insurance doesn't cover most pregnancy stuff but I wonder if this is different? x

well hers was done on the nhs. she was due to have it around 26 weeks but had a little scare at 24 weeks so they put the stitch in then. are you in the uk? i presume its something you could pay for, at the end of the day its seen as a required procedure i think given the circumstances.

good luck- i'm sure someone with more useful advice will be along soon!
x

Also, does anyone know what is happening re elected caesarians? When is the scheme coming and will it be at all hospitals? I've checked the UCH website and it says they don't offer them.... Are all women going to be able to choose? And if so, from when?

Thanks!

Thanks Feekerry :)

My mum had one with me and my brother because she had a still birth at 8 months because her cervix wasnt strong enough- she has always said that it was quick and painless

ummm have they actually measured your cervix for any incompetence? i had the same procedure done as you about a month before i got pregnant and heard about shorting/weakening of the cervix causing late stage miscarriage or prem labours. but with no evidence to show that i actually have an incompetent cervix they had no intention of putting a stitch in. suppose it could be different in different areas and they could just put one in in your area as a precaution.

Hi there, I had my stitch inserted at 18 weeks. I'm now 34 weeks. It was done in theatre with spinal epidural. The actual stitch took a few minutes and they did an ultrasound scan before and after in the theatre to check the baby and that the membranes were intact. DH was able to stay with me for the whole procedure.
It was done at 9am or so and by 2pm the catheter was taken out and I was able to get out of bed. The spinal wears off much quicker than the one they use for a c-section. I went home at around 4pm. My cervix measures 2.4cm and I lost my previous pregnancy at 24 wks due to rupture membranes which they think was caused my the short cervix. Hope that helps.

I've had four stitches in four pregnancies. My eldest daughter was stillborn at 25 weeks after my membranes ruptured at 22 weeks. The question I would ask your ob is why they are putting the stitch in so late? Why not at 12-16 weeks? I've generally had it done under ga. My second was done under spinal but i felt the op and was given ketamine to knock me out (t'was awful). On this basis I've basically demanded a ga subsequently. In all instances I have had strong contractions afterwards. With the first and second for hours and I was in overnight, with the last two I had morphine pretty early on and contractions weren't for long and I was out of hosp in the evening. I think in different areas they will treat this differently, i.e., not all areas will put in a stitch automatically but will measure your cervix instead. To me, 24 weeks is quite late to put a propholatic (sp?) stitch in. I have no medical training on this, but I would ask your ob anyway??? Miscarriage is a risk for a stitch, if it is not an emergency, why not put this in at 12 rather than 24 weeks?

Also worth reading the RCOG guidelines on cervical stitches as im pretty sure they dont recommend putting them in after 24 weeks except in exceptional circumstances as theres a risk that it may rupture membranes etc. Sorry, dont want to scare you but think you need to know all the facts so that you are properly informed of the pros and cons. Sorry on phone so cantnlink but google should find it for you.

I had a stitch at 14 weeks as I lost twins in May at 20 weeks and they wanted to make sure it didn't happen again. I'm surprised they are waiting as late as 24 weeks, as if they are doing it for preventative reasons then they usually do it at 12 - 16 weeks as later than that there is a higher risk of rupture of membranes etc. Also, the later they do it the more likely it is to trigger contractions, apparently.

You can have it down privately, but BUPA doesn't cover it - I checked when I had mine - it comes under preventative treatment rather than a covered complication of pregnancy. About the only thing they cover is a caesarean for medical reasons, such as breech baby. They didn't cover anything to do with me losing the twins either. I believe this is also true of other medical insurance providers.

I had my stitch done under GA. Wasn't offered spinal. It didn't take very long, and they scanned me while I was in theatre but I didn't get to see the baby as I was out. Apparently it looked fine though! It was just a day procedure - I wasn't kept in overnight.

They will explain things to look out for afterwards, but you will have some bleeding so don't be scared of that. I had red bleeding for three days, and it was hard not to get freaked out by it, but the doctors said it was normal.

Ok. Thanks for all the advice. I guess I'm not sure what to do now as they've told me to go back at my 20 week scan for them to look at my cervix and then come in at 23 weeks to discuss it. I have booked to see my GP on Fri so I'll chat to her and then perhaps call UCH and see if I can speak to someone too? Thanks again.

MrsSET, I am really interested in your post as I also had a cervical operation (cone biopsy, where they cut a section out of the cervix - different to the laser treatment you had but also for abnormal cells) only a few months before getting pregnant.

From what I've been told, the cone biopsy has a greater indication for potential cervical incompetence than the laser (even then the increased risk is still small), but then I guess it would depend on the amount of cervix that was removed by either procedure as much as anything.

However, like Samwellsbutt there has been no suggestion of a cervical stitch and I'm almost at 24 weeks. I have had my cervix measured every few weeks since about week 13 and as it (thankfully) shows no sign of shortening they really don't seem bothered.

To be honest, this relaxed attitude has slightly troubled me, but then my understanding is that they only do a stitch if there is evidence the cervix is giving way, or as a preventative measure if it has tragically happened before. Susie, Imip and Diffed really sorry for your losses, just so sad.

Did UCH explain to you what factors are making them recommend a stitch? Is your cervix under or around 2.5cm? It does make me wonder that policies seem so different.

Thank you HotPinkGingham it was indeed a tragedy.
This pregnancy was monitored with weekly cervical scans and the cervix was fine (>4cm) when suddenly at around 18 weeks or so it shortened to 2.4cm. I also went to UCH for a referral and it was agreed that the stitch was the best option when the history was taken into account. I also took Cyclogest until this week (34 weeks). At around 24 weeks the cervix started funnelling and the membranes bulged down into it. At that point I had steroids for the baby and was put on almost complete rest - I haven't really left the house since the end of July!
Weekly scans have shown that the cervix has remained the same - short, funnelling and bulging membranes but nothing more. C-section booked for 38+3.
Good luck to you all in similar situations.

Hiya MrsSET

I had a cone biopsy a few years ago and mentioned it to the doctor at my scan appointment (13 weeks), she was concerned about the effect on my cervix and referred me for a cervical scan, which should have happened quickly, but didn't end up happening until I was 16 weeks.

At the cervical scan they said that my cervix doesn't look too bad and that they are going to scan me again in four weeks and see how it is then. So if they do decide it needs doing I'll be at least 20 weeks.

Thanks for sharing Susie, I am seeing the consultant this week and I will ask again about management and monitoring as it's been quite ad hoc - from your experience it sounds like things can change quite quickly. So glad to hear you are at 34 weeks - not long to go now! Must be so hard to be on bed rest for such a long time, but you're on the home stretch (with good Christmas telly coming soon at least...).

Yes, it can change quite quickly. In my case, the increasing size of the baby had a dramatic affect. I do think the rest has played a major part in getting this far. My consultant said not to sit upright for long periods and to take the weight off the cervix.
Section on 23rd Dec so hopefully I'll be home for Christmas day!

Aaah what an amazing Christmas present

All the best of luck for the next few weeks!!

My first pregnancy ended in miscarriage at 20 weeks. My baby was born alive so it was likely I had an imcompetent cervix.

I had a cervical suture in my next two pregnancies at around 12 weeks. It was very simple and with both I had a tiny bit of blood on wiping for the first day and nothing after. My pregnancies carried on as normal, both ofr a week or two after the suture was removed at the end of my pregnancies.

I also had a suture during my fourth pregnancy, this was not succesful. I had a huge bleed after the suture but the babies heart was still beating. I was discharged the day after having it despite all the blood loss as I was told it was normal. I was reallt ill when I got home and stayed in bed for a couple of days. I then started having comtractions so went to hospital, it was too late to remove the suture so I delivered the baby with it still in place (16 weeks pregnant). I later found out I had measles at the time but the post mortem of the baby showed he didn't have any signs of infection, I do believe that it did cause the mc as my temp was 41c when I reached hospial and I felt it was lower as had felt worse before.

With my fifth pregnancy I had 2 weekly scanning form 6 weeks to measure my cervix. I had decided not to have a suture. The pregnancy was stressful but my son was born at term.

MRSSET, it sounds as though they are just monitoring you then, with an emergency stitch an option if your cervix starts shortening. As others have mentioned, a cervix is dynamic and can sometimes be long, sometimes short. My hospital (not too far from yours) doesn't really measure cervixes (well have never measured mine), since I had lost my daughter, I guess that they just went straight for the stitch rather than monitoring???

goingtoofast, I am really sorry to hear that you have lost two babies. Dreadful..... I am on my fifth pregnancy and have often wondered whether it was actually cervical incompetence or not. It is interesting to see that you went full term with your son. It must have been a difficult decision whether or not to have had the suture.

hotpink, I think you're right, they are pretty relaxed about it all unless their is evidence of cervix shortening or a previous loss of a baby. I think the risk of a miscarriage outweighs the 'just in case you have cervical incompetence' risk. But within the same hospital, I think different obs would have treated me differently.

Well done susieq - what a nerve wracking pregnancy. Did they put the stitch in as a response to losing your first baby or because your cervix showed signs of shortening. I ask because 18 weeks is quite late to have a preventative stitch put in. My earliest stitch has been around 13 weeks, and I had awful contractions, five mins apart, for hours. They were ready to take the stitch out and let nature take its course.

mrsset there is great info here for you to go back with some questions for your ob!!! I hope they are seeing you more. I would have thought at least four weekly scans would have been approptiate. Wondering whether NICE have guidelines for this???

Hi imip, the stitch was put in in response to the shortening cervix. Up until 18 weeks they were adopting a position of watch and wait. With the shortened cervix and history, the stitch was the best option. I am experiencing a lot of pain very low down, walking and turned over in bed and am wondering if it's the stitch? I'm seeing my consultant on Monday. They also want to take the stitch out at 37 weeks and do the section at 38+3. I'd prefer that it stays in until the section but apparently if I went into labour it could rip? If labour starts I will have section anyway. I suppose I want to avoid another theatre visit! Any opinion?

SusieQ73 I'm sure I could feel my stitch in my pregnancies, it was uncomfortable but worth it at the time for peace of mind. I went into labour with my third stitch still in situe and it was agony, definatley worth having it out at 37 weeks just in case. I had progressed to far to have it removed, thankfully at 16 weeks it didn't damage the cervix too much although I did bleed small amounts for a long time after which I suspect was from where the stitch cut into my cervix.

goingtoofast so sorry to hear of your losses. I certainly has been reassuring having the stitch. Thanks for that advice - it sounds like taking it out early is a good plan. I'm also wondering if taking it out will start labour straight away. At my last scan, there was still a little closed cervix above the level of the stitch.

I didn't go straight into labour. The stitch was removed in labour ward and I was told to bring my stuff just in case. I suppose though mine wasn't an imcompetent cervix as I later had ds without one.

Good luck!!!

I had a suture with DD. I'd had a M/C at 22 weeks and it was blamed on an incompetant cervix.
My situation is different, I was in Oman and, to cut a long story short. My cervix was thinning and something else.
I was scanned at 6.30am and on the table having the suture put in by 11.30.
I had to stay in hospital for three days, although that could have been so they got the 55p from my insurance company.
DD was born at 37 weeks by CS and a GA. I was striclty told not to swim or engage in sexual activities with DH. The obstetrician didn't say anything about other men
Good luck OP.