Shortened cervical length at 16 weeks

[LydiaGrace1]

Hi. I’m hoping someone can reassure me and tell me they had this and went on the carry to full term! I am a 38 yr old currently 16 weeks pregnant with twins after trying for a long time to fall pregnant. I’ve had 2 procedures previously for cancerous cells - once when I was 19 (laser treatment) and again approx 2 years ago (loop biopsy). Due to my history the consultant arranged a scan to measure the length of cervix. I had this done today (internal scan so more accurate) and it is showing length as 3.1cm. Sonographer advised this was normal so me and my OH went away happy. However I have since researched it and I’m horrified. The average cervical length at 34-36 weeks pregnant is 3.0-3.5cm, and I’m already at the lower end of that and only 16wks! The research article stated a much higher chance of going into very preterm labour if 2.0cm or less by 24 weeks. I’ve already been warned that I’m at higher risk of preterm labour due to my age and because I’m carrying twins - so now I’m freaking out! Consultant appt in a weeks time to discuss results but I know I’m going to stress no end until then. I’ve heard of women having a stitch put in and having injections but my midwife advised me that this is very rarely done now. My friend lost her baby last year at 24wks due to shortened cervical length so that is really playing on my mind too. Does anyone have any examples of where they had this condition but now have healthy baby/babies? Thanks so much.

Hi i had my cervix checked at 19wks & 22wks im 3.5cm both times i had mine checked.im getting it checked again at some point. My friend had a stitch in so if yours gets shorter fast they would do that,i got told i would if it happens to me, ive had. 2 prem babies not due to this.they will look after u & do whats best for your baby x

Are they going to do a follow up scan? Everyone is different with this, mine was 3.4cm on first measurement at around 22 weeks and 23 weeks, had some issues with spotting and some fluid leaks, scanned again at 24 weeks and it had shortened to 2.4cm, I was monitored for the rest of the pregnancy, given progesterone pessaries to insert three times a day and carried right up to 40+5. I didn't have twins, but there are things that can be done, I had scans fortnightly then up until 36 weeks. Did they say if they'd check again?

I had a short cervix throughout and my DS was born at 38 weeks via induction. Please don't get scared by google: People only tend to go online to share negative news! Listen to the doctors and experts, they will tell you if you should be worried!

Wishing you a healthy pregnancy

Thank you @Angelinthenightx and @annlee3817 I won’t know what checks I’ll have until I’ve seen consultant next week, but I’d hope they’d rescan me regularly to keep an eye on it. I’ll ask to be rescanned if dr does not suggest it. Up until now I’ve been fairly easy going about things (even though I’m a born worrier!) despite constantly being told by the health professionals that carrying twins carries high risks and puts me at a higher risk of just about every possible pregnancy complication there is! But this seems to have tipped me over the edge, yet another risk factor I tick the box for. I’m hoping the maybe re check it in 2 weeks and if shorter they will do something ASAP like a stitch or pessaries / injections. My friend was simply put on “bed rest” which clearly didn’t work out. X

My first was born at 24 weeks so with my second I was given cervical length scans once a fortnight, they were always around 3cm, I had a panic when one measurement was 2.9 but they wasn't bothered unless it went under 2.5. I was given progesterone pessaries because of my history and although she wasn't full term she was born by c section at 31 weeks for reasons completely unrelated to my cervix, that held up just fine. 3.1cm sounds scary because it seems close to 2.5 but it is a normal measurement.

I'm pregnant with my third and had the cervical length scans fortnightly again, they were all fine up until my cervix was very short at 23 weeks and they put in a stitch. However from what I have read they don't tend to do stitches in twin pregnancies apparently they are not effective generally?

I would however in your position be asking to have your cervix scanned every two weeks to check for changes and ask them for progesterone (be prepared for them to say there isn't really any evidence of any benefits to progesterone).

If you are on facebook there is a group called Incompetent Cervix UK. There are lots of women on there with lots of knowledge and experience of IC that you might find helpful.

@takeasadsongandmakeitbetter thank you! I will of course take the advice of the dr (I do trust her), and I know it is always dangerous to google! But I did read a journal article on it rather than just read forums / webpages which seemed to suggest my measurements were cause for concern. Hoping the next 7 days go quickly so I can speak to dr to get her personal advice on my situation. Thanks for kind words xx.

@JuniperNarni thank you for you advice, gosh you sound like you have been through the mill with your previous pregnancies! I hope all worked out and continues to work out with your 3rd. Oh I wasn’t aware a stitch wasn’t effective for twin pregnancies - that’s helpful to know. I’ll speak to dr to find out what my options are if further scan shows further shortening - like to at least know what I’m dealing with if at all possible. I pray I’m like you and it stays stable for quite some time.
Wishing you all the best with number 3. Xx

@LydiaGrace1 Not going to lie I've been extremely anxious this time but feeling better now that i'm over 28 weeks.

Don't completely take my word for it about the stitches and twins, i've never had a multiple pregnancy but i'm sure i've read somewhere that doctors are reluctant to do stitches with multiples. I did read somewhere that they don't do stitches when you have a uterine abnormality as well though and clearly they do because here I am.

I hope you've got a good doctor though that will talk it through with you and settle your mind a bit and keep up with some good monitoring. Hopefully it's all good and you have a long, uneventful pregnancy. Thankyou, wishing you all the best too. Good luck at the appointment, my only advice is to make sure you are quite firm (but polite obviously) with what reassurance you need and what you are expecting, it is shocking what some doctors will say is fine and normal and send me on my way with monthly gaps between scans, even with my history. I had to request to see my consultant directly.

@JuniperNarni thank you. Oh I’ll be making sure (politely) that I’m monitored as much as possible- I do get good vibes from my consultant so I think she’ll take my concerns seriously. Will find out next week I guess. Thanks again for the advice. X

I forgot to say my dr said that they wouldnt do anything unless my cervix went down to 2.5.x

@Angelinthenightx Thanks - my worry is that’s only 6mm from what I am now at such an early stage of pregnancy- but I know option for a stitch are not possible in the second half of pregnancy as it may induce labour - so don’t want to leave it too late to be able to do anything about it (if I can). Will see what doc says. It’s so hard not to worry! X

They are usually happy with a measurement over 3mm. Obviously it’s impossible to predict the future but it’s not an alarming measurement. They usually aren’t keen to suture too early anyway and you’ll likely have another scan before the point at which they’d make the decision anyway. The first one is mostly a baseline.

There are different ranges for different treatments. If your cervical length goes below 3 then with your medical history they may prescribe progesterone and for most women that usually works. If it goes below 2.5 they may then consider the stitch even for twins - just be aware that the stitch can’t be performed after 24-26 weeks.

@Teddybear45 thank you for advice. I’ve just read a journal article reviewing the evidence for treatment for cervical shortening in twins and I have to admit it’s freaked me out even more. It concludes that not only does a stitch or progesterone injections / pessaries not work in twin/ multiples pregnancies, there’s evidence to suggest it actually increases the chance of preterm labour. So whilst these treatment can be effective in singletons it’s looking like there are no treatment options for twins. I know I’m doing myself no favours doing my own research / reading!! I’ve promised myself I won’t read anything else until I’ve seen doc next week. It would still be nice to hear some positive stories on here though, people that have had similar experiences and now have healthy babies to cuddle! (I know I need to try to stop stressing as it’s not something I have any control of, it’s just easier said than done!). Thanks to everyone for their replies so far though. I really appreciate it. Xx

In the UK and US women with multiple pregnancies do get the stitch and progesterone pessaries. I suggest you not read anything from the internet and speak directly with your consultant who will do a proper assessment.

@LydiaGrace1 I'm also 16w, although with a singleton, and just had my first cervical length scan this week. Result was 3.1 same as you and they were happy with that.

I will be rescanned every two weeks and they have given me a chart which they will plot the results on. If I can work out how to I will upload a photo as i think you'll find it useful and hopefully reassuring.

The measurement they are working to is 2.5 thereabouts to consider a stitch but it does change slightly as the weeks progress, and I'm afraid I don't know whether they also make adjustments for twins.

They also said, as others have mentioned, that topical progesterone support will be provided if they don't opt for the stitch, although this can have other effects such as actually softening the cervical tissue and making it more prone to bleeding apparently, so I don't think it's necessarily a fix all.

I had a cone biopsy in March this year, literally weeks before falling pregnant, so am slightly on edge about my cervix holding up given the recency.

@Botanica thank you, that’s really helpful. X

Mine was measured at 2.8 at 20 weeks. I was told to take it easy (not bed rest but no more dancing!) I was very worried but my twins were actually born by csection at 36 weeks (for other reasons). Keep it monitored but don't panic!

@timeforakinderworld Ah now that’s the kind of story I was hoping for!! Wow, can’t tell you how reassuring that is - my goal is to get to 35wks so to get to 36wks would be fantastic! Thank you - you’ve made my day!

@LydiaGrace1 Here is the chart I mentioned earlier that they use to track how close the cervical length is to the threshold for a stitch.

@Botanica thank you!

@LydiaGrace1 Hey, I know this thread is old so chances are you may not see this at all! I am really worried too in the same boat as you! I am in the UK and my cervical length was measured at 3.9 3 weeks ago and now at 19 weeks it's just over 3 ! They told me not to worry and this is fine and they will not need to monitor. Did you go on to have a healthy pregnancy in the end without any stitches etc ? I have been googling and it has not helped anxiety levels! Just wondered how it turned out for you?

Thanks

@Smartiex Hi - please don’t stress! I did go on to have a normal pregnancy and delivered twin boys at 37 weeks! They’re now 5m and thriving! I think it’s common for their to be initial shortening but then for it to stay stable at the same length for the rest of the pregnancy. I had no treatment at all. Looking back I stressed far too much about various things in my pregnancy, I wish I’d relaxed and enjoyed it more! Wishing you a happy healthy pregnancy and birth - congratulations!

@LydiaGrace1 Ahh thank you for replying! That is brilliant news ! 😊 congratulations on your baby boys!!

Thank you so much nice to hear a positive out of this! Did you get checked any further after your 16 week one or just leave it ? The hospital told me they will not need to do anymore but may go private just for reassurance xx

No, I didn’t have any more check ups. Did they check for funnelling (I think that’s what they called it) At the time I had my cervix measured they also put pressure on my bump from the outside to check for funnelling which basically meant did it getting even shorter when pressure was put on that area. As there was no funnelling present she said I shouldn’t worry as it was unlikely that my cervix would shorten much more (the consultant explained this at my appt with her following the procedure a week later). If this was done and they weren’t concerned (if it wasn’t mentioned check your maternity notes as it should be documented in there) then I honestly wouldn’t worry. I think you just have to put your faith in the professionals (easier said than done in know!) as they would monitor it closely if it was likely to get worse and they could do something about it. They’re very much into preventative medicine where possible as it’s much less of a resource for them than looking after you and a very prem baby, so try take comfort from that - they would offer more monitoring if you were high risk of complications because of it. Are you expecting one or multiples? I had double the weight in me compared to my 2 previous pregnancies and my cervix still held so I’m sure you’ll be just fine!! Try not to stress. Xx