cerclage at 18 weeks

[pali1978]

Does anyone have experience of having cerclage at this stage of pregnancy? My story is that I had LLETZ done about 7 years ago and, when I mentioned this at my booking appointment (which I had rather late at 14 weeks) they referred me for a cervical scan - I was 16w3 by then. It showed my cervix was 27mm and I was told this was borderline. I am being rescanned on Tuesday (so 11 days after first one) and preparing myself for decision on cerclage. I am slightly concerned that 18 weeks (which I will be on Tuesday) is late for cerclage though the consultant says not. and also, if there hasn't been a change, whether I should go for a stitch before the situation deterioates (though of course it may not) when, as I understand it, the procedure is more risky and less effective.

Most stories I read seem to be either early preventative cerclage or emergency cerclage - and I don't think I fall exactly into either category. Truth is I am terrified about the whole thing.

I had a cerclage at 17 weeks at the latest (I have had four). I felt it was too late, however, it was the cerclage that I responded best to (I.e., minimal contractions afterwards - they gave me morphine straightaway). I think my others were at 16, 14 and 12. They were all preventative and preventative cerclages are much more successful than emergency.

I don't blame you being terrified. I always went into 'labour' after a cerclage, but I don't know anyone else who has. They were always successful though, and all four cerclage babies were born at term.

I am also unsure of the differences between a preventative cerclage and an emergency/rescue cerclage.. I assumed it was just in the name given depending on the reason for the stitch? Or perhaps the gestation that makes it rescue v preventative?

For what it's worth, I had a stitch at 18+3 when I had 3mm (yes, 3mm - not a typo!) of cervix left. That was a particularly fancy stitch done by a very experienced doctor. I'm pretty sure that unless things have got really short in your rescan that any stitch placed will be just fine. From what I recall, they only like to stitch at under 20mm, and will monitor under 25mm.

Some cervixes are just naturally short but hold up perfectly well. The crap thing is that nobody has any way of knowing which it is.. and there is a risk with cerclage placement no matter when it is done. If you're being monitored properly though, getting it done at 20mm or so is probably no worse than a preventative one.

btw I should add DD was born completely healthy at 35+5 after that stitch!

I think emergency stitches can be performed up until you are 3cm dilated. After that, you have to let nature takes it terrible course. You wouldn't really know about having an emergency stitch beforehand and you'd be on pretty shaky ground I imagine, when having my stitches I always had a long cervix.

Regardless, I always went into labour after the stitch and that had to be stopped with morphine.

Hi Pali,

Sorry to hear you're stressed out by this, there's so much varying information about cerclages out there, it's hard to get a clear picture.

There are a few of us with cerclages or other short/iffy cervixes on another thread I started here so do feel free to read back through everyone's experiences and post if you want.

I had a cerclage put in at 15 weeks and have been very pleased with it - now 36 weeks and you wouldn't know it was there apart from a couple of small things. I don't think 18 weeks is horribly late and preventative is better than cure!

cispy and imip really good to hear all went well for you guys too - the more positive stories I hear the better! imip, out of nosiness, can I ask how soon your babies came after the stitch was taken out?

Good luck and hope you can reach a good decision with your doctor!

Piz

Good luck pali I'm on the other thread with piz but wanted to pop in and say I totally understand how confusing it all is, advice and treatment really varies. I think emergency is when the cervix is funnelling/opening/showing major shortening but one thing a good consultant said to me is that of course emergency stitches have a lower success rate as they are only done when they know for sure a problem is taking place. Precautionary stitch stats aren't accurate as sometimes a cervix would have been fine without it, it's so hard for them to predict.

27mm doesn't sound too bad to me, of course listen to the experts, but I have a feeling the good consultant I saw wouldn't operate on that unless it was showing signs of shortening or opening so fingers crossed your next scan will go well. I do know of someone who had a stitch at 23 weeks and it went well, just so you know. One thing you could ask about is fetal fibronectin testing as that is what diagnosed her as needing a stitch although I think this is quite a new innovative way of testing the cervix so not available widely yet.

At the same time, as piz says, prevention is better than a cure if your consultant is worried about the cervix at your next scan. Lots and lots of luck and let us know how your next scan goes or join us on the other thread.

Thank you all so much for the info and encouragement. Of course I'll see what the doctor says on Tuesday and talk through all options but it's good to get ideas from others who have some experience. It is quite scary but I'm doing my best to focus on good outcomes - and there seem to be plenty out there. thanks again - and I will let you know how I get on.

Wise words there from crispy. I have a short cervix from previous lletz activity. In this pregnancy (my 4th) it is very short - was 23/24mm at 14 weeks!

However, my hospital (Kings in London) prefer not to cerclage if possible and are scanning me every 2 weeks and have prescribed progesterone. At my last scan,at 18 weeks, the cervix was actually measuring 27mm!

I'm starting to think that though my cervix is short, it still holds up pretty well - with DS3 it shrank to 10mm at 27 weeks . We were primed for steroids and imminent labour if it went lower, bit it held there until he was born at 39+3

It is terrifying though, and I remember well the constant worry when it was discovered to be 33mm at 22 weeks with DS2 (how I dream of 33mm now ). It must have been short with Ds1, because the op predates him, but they didn't routinely scan cervical length at that hospital. He was born at 39 weeks.

What I'm trying to say - in a very roundabout way - is that it is terrifying, but it doesn't necessarily mean the worst outcome. Whatever your hospital's policy on treatment/management, they have picked it up and are monitoring you, which is great

Sure piz.

Dd1 stitch was moved around 38 weeks. I was induced at 40 weeks due to problems with the placenta that were detected at 24 weeks. Took two days to have here and ended up being an emcs anyway.

Dd2 I had placenta previa and vaginal birth was not an option. Elective section at 38 weeks.

Dd3 planned section, however, I had ployhydramasis at 38 weeks and my waters broke emcs.

Dd4 planned section at 38 weeks.

I did experience slight bleeding throughout pregnancy and in some pregnancies I could very clearly feel the stitches. Once I recovered from the labour pains after the cerclage, I never had a problem itself with the stitch and it quite clearly did its job holding the baby in till term.

With my first daughter (I've had five), my waters broke at 21 weeks. She was born at 25 weeks and sadly stillborn die to a cord prolapse. My cervix was never open, or any evidence which would suggest cervical weakness (apart from PPROM). However I felt my little girl kick very early (16 weeks in first pregnancy). And very clearly, very low down. None of this butterfly malarkey. I had a consultant who at that time just did stitches routinely, the hospital didnt seem to scan and wait and see. I'd suggest that was a financial issue, but I may be cynical?

Best of luck for the arrival of bubs, I am extremely clucky, but this most mothering business is very hard work and I've been put to pasture .