Stitch in cervix after LLETZ

[Casander]

I had grade 3 CIN around 3 years ago and had part of my cervix removed. I was told at the time I would need a stitch if I ever got pregnant.

I made them aware at my booking in appointment that I have been told I’ll need a stitch and I’m currently 25 weeks pregnant and haven’t heard anything. I’ve only seen the midwife at my booking in appointment and then very quickly at 16 weeks. I’m due to see her at 28 weeks. I’m waiting on a call back but just wondered if this was normal and at what stage other people had had this done?

Hi, I was under consultant care at the hospital due to previous issues and they flagged me up for checks there for having had a loop biopsy years ago. They gave me multiple cervical scans from 12 weeks and when it became obvious there was a weakening they put an emergency stitch in at 23 + 5. They told me that after 24 weeks the baby is classed as 'viable' so they don't put in a stitch after 24 weeks, so at this point they wouldn't be assessing you to put one in. Mine was put in very late as an emergency measure - most people seem to have them earlier on. It's strange they didn't monitor you at your hospital- the only thing I can think of is that maybe the amount of cervix you had removed fell below the threshold that would concern them? They only checked me because my records were so old that they were not in the digital hospital system so that had no idea. I would think if they had any concerns they would have contacted you? So all must be presumed to be ok?

Hi, I was under consultant care at the hospital due to previous issues and they flagged me up for checks there for having had a loop biopsy years ago. They gave me multiple cervical scans from 12 weeks and when it became obvious there was a weakening they put an emergency stitch in at 23 + 5. They told me that after 24 weeks the baby is classed as 'viable' so they don't put in a stitch after 24 weeks, so at this point they wouldn't be assessing you to put one in. Mine was put in very late as an emergency measure - most people seem to have them earlier on. It's strange they didn't monitor you at your hospital- the only thing I can think of is that maybe the amount of cervix you had removed fell below the threshold that would concern them? They only checked me because my records were so old that they were not in the digital hospital system so that had no idea. I would think if they had any concerns they would have contacted you? So all must be presumed to be ok?

Hi, I was under consultant care at the hospital due to previous issues and they flagged me up for checks there for having had a loop biopsy years ago. They gave me multiple cervical scans from 12 weeks and when it became obvious there was a weakening they put an emergency stitch in at 23 + 5. They told me that after 24 weeks the baby is classed as 'viable' so they don't put in a stitch after 24 weeks, so at this point they wouldn't be assessing you to put one in. Mine was put in very late as an emergency measure - most people seem to have them earlier on. It's strange they didn't monitor you at your hospital- the only thing I can think of is that maybe the amount of cervix you had removed fell below the threshold that would concern them? They only checked me because my records were so old that they were not in the digital hospital system so that had no idea. I would think if they had any concerns they would have contacted you? So all must be presumed to be ok?

Hi, I was under consultant care at the hospital due to previous issues and they flagged me up for checks there for having had a loop biopsy years ago. They gave me multiple cervical scans from 12 weeks and when it became obvious there was a weakening they put an emergency stitch in at 23 + 5. They told me that after 24 weeks the baby is classed as 'viable' so they don't put in a stitch after 24 weeks, so at this point they wouldn't be assessing you to put one in. Mine was put in very late as an emergency measure - most people seem to have them earlier on. It's strange they didn't monitor you at your hospital- the only thing I can think of is that maybe the amount of cervix you had removed fell below the threshold that would concern them? They only checked me because my records were so old that they were not in the digital hospital system so that had no idea. I would think if they had any concerns they would have contacted you? So all must be presumed to be ok?

I'm so sorry for multiple posts!! Internet problems!!

I researched this quite extensively as I was convinced I’d need one due to a very large polyp removal (was told at the time). The stitch can only be performed before 24 weeks and is only considered when there is evidence of shortening. I think it may be too late for you to get the stitch now (and you probably don’t need it - only 20% of women with a short cervix go into preterm labour!) but as you are past the point of viability you should be offered extra monitoring. Suggest you pay for a private cervical length scan (Baby Bond / Ultrasound Direct are associated with Mothercare and do offer these) and then use the result to get a direct consultant referral from your GP.

I think this is all quite normal.

In my trust they wouldn’t even bother a consultant with queries over this a) unless you’d had multiple LLETZ, which isn’t common, and b) a bit later into pregnancy.

Cervical tissue does heal pretty quickly, and it’s just as common to have a shortened cervix from genetics as it is to have one shortened by surgery. If your GP has the notes from your procedure, the GP would know what length your cervix was on completion. And although you were told you’d need a stitch, it’s not a requirement. Nurses doing your follow up smears would have also documented cervical length, they wouldn’t think to tell you those details quite honestly.

Bottom line. LLETZ rarely leads to a stitch, it certainly isn’t a matter of course. Unless you have any other reason to doubt the professionalism of your healthcare team, I personally would trust them here.

PS. I’ve had two LLETZ, 10yrs apart. I’ve not been consulted on stitches, cervix was measured at 20w scan, no concerns.

Thanks everyone, that’s really put my mind at ease. I’d had a google (I know, I know) and then scared myself with pre-term labour stories.

I hadn’t really thought about genetics either, that’s a really good point. The nurse had made it seem like it was something that must be done but I also had no intentions of ever being pregnant again at the time so I didn’t ask any questions haha!

You should have been referred to a consultant to start cervical length scans at 16 weeks, maybe the fact you haven't been referred is a sign that your LLETZ wasn't too invasive and maybe they didn't take much tissue?

I had a LLETZ under general anaesthetic 4 years ago and was referred to a consultant at my booking appointment at 8 weeks, had cervical length scans at 15, 18, 20 and 23 all showing mine was about 10mm shorter than it should be but not in the danger zone at all.

Went back last week at 29 weeks to find out that my cervix had shortened from 34mm at 23 weeks to 8mm at 29 weeks so things can turn very serious very quickly! Looking back I wish I had insisted on a scan at 26 weeks, now too late for a stitch and not enough tissue to stitch anyway so on bedrest and pessaries. I've been told my baby could come anytime from now! If I were you I would pay for a private cervical length scan for piece of mind.

Oh god thats scary how quickly it’s changed! I think I will definitely book one, like you say even if it’s just peace of mind.

I’m seeing a consultant in a couple of weeks anyway as I have to have a section (not cervix related) but I’ll also mention it to them when I go.

I hope you’re ok too and baby stays put for a while longer!

Thank you! I'm about 2 pages deep on a short cervix thread from 2013 on here so hopefully I will learn something! Not much else to do whilst on bedrest anyway

Hi!!
I had the same cin 3 loop treatment about 9 months ago. It was noted on my booking appointment and I immediately got an appointment letter through for a consultant appointment but not for a few months (I was 16ish weeks I think).
At that appointment I thought they were going to do the scan but I just saw a doctor who said she wanted to get me in urgently for a cervical length scan the following week, then every two weeks after that until I was 24 weeks. Then at 34 weeks as a final check.
That appointment letter never came through (though the 34 week letter did!). After endless chasing and being passed from clinic to clinic (admin is not my hospitals strong point), they said they don’t normally do cervical length scans until 20 weeks so booked me in for this week.

I am still none the wiser on whether I should be worried or not...! But at least I have an appointment so should hopefully find out what’s going on.

I would push your hospital for a cervical length scan asap and start from there :)! Good luck!

Your 20 week cervical length is the most important one for predicting pre-term birth, although at 20 weeks mine was looking good but by 29 weeks it was a different story!

Only concern is if you need a stitch is it quite late but not too late, you can have one up to 24 weeks just a shame you didn't get seen earlier as if you need one then the earlier it is done the better.

Probably just routine though as you previously had a LLETZ which many ladies have had but still have a perfectly long cervix.

Good luck!

LETZ is not common. Loop diathermy is, and is a completely different procedure.

20w cervical length is almost ALWAYS significantly different from later in pregnancy. Monitoring of cervical length is ideally done well before 20w, a measurement on one day is insufficient. It needs constant monitoring.

Cervical Cerclage can be performed later than 24w. There’s no cut-off if it is indicated.

There is limited evidence that Cerclage is actually effective in preventing pre-term birth. There are other effective measures as well as this. It is thought that a stitch helps in about 30-50% of cases....

LLETZ*

Hi, first baby here. I had the same, cin3 4 years ago and was told I may need a stitch. Brought this up at my booking app and was told straight away due to this I would be consultant led until min 24 weeks. There was no checking of historical notes at this point. Had my first transvag scan of cervical length at 16 weeks then 17+4 which showed a big drop and boarderline measurements and then again at 18 at which point they kept me in for a stitch. Now taking it super easy + on daily progesterone.
For peace of mind I would want to get checked, especially with previous cin3 as potentially there was more of the cervix affected/removed than a lower grade. You may still have a really strong cervix but it is mechanical so losing a bit can weaken it. If you have shortened they are able to monitor and help you and baby, especially now you are past 24 weeks. Good luck, keep baking and keep us posted xx

I'd push to see a consultant sooner personally, I had lletz nine months before I fell pregnant (unplanned) it was only CIN2 and not too much tissue removed, however I did have problems with spotting on and off, had been booked in to see a consultant at 21 weeks for a cervical length check, but ended up seeing one earlier due to other issues. He decided to monitor me. At 23 weeks my cervix measured 3.4cm, then at 24 weeks it measured 2.4, I had steroid injections and progesterone pessaries, and was monitored every couple of weeks. Signed off and made to rest from 32 weeks as she was engaged. All was well in the end, but I was relieved that it had all been picked up and addressed

Meant to add that as well as it shortening my cervix was very soft, which is why he was concerned

Finally seen the consultant today at 26 weeks! Basically she had already seen it in my notes before I mentioned it and said they've made a massive error and I should have been monitored as previous posters have, but for some reason despite it being in my notes I've completely fell off the radar.

Consultant said now I'm 26 weeks they would be hesitant to put a stitch in incase they broke my waters, and as the risk of not having a stitch is premature labour it's kind of a catch 22.

She was going to check my notes from my LLETZ to see how much they removed and to see if there's any record of my cervical length but basically I've just got to see how things go. I'm having her by section at 38 weeks anyway and she said if I go earlier it'll just mean an earlier section (although obviously not ideal!)

I'm not one to complain but not sure if it's worth mentioning (although not sure who to!) just because it clearly shouldn't have been able to happen!

You aren’t being massively disadvantaged by not having a stitch. Cerclage is old-fashioned, outdated treatment and it is found to be very ineffective in preventing pre-term birth. So don’t worry about that.

Steroids are actually the slightly more effective treatment, but as the consultant indicated, it would have needed monitoring earlier to detect whether steroids (which aren’t ideal at any stage of pregnancy) would be indicated.

Have you been given further appointments? And have you asked for a second opinion? Because given the anxiety you’ve been caused (granted, you are probably still pretty low risk), you should ask for both. Just for peace of mind.

@Casander I'm so sorry they haven't picked this up. I would insist on a transvag scan to measure your cervix asap and at minimum discuss progesterone pessaries and reducing your activity to delay preterm birth. I would not accept anything else.
If they refuse, get a second opinion and a private scan and use that to get referred. There is a specialist at guys and st Thomas in London (Dr Shennan) you could probably call and talk your options over with one of his team at the pre term
Clinic in the mean time, all NHS. There is also a really good Facebook group with loads of ladies all going through the same thing if you search for Incompetent Cervix Uk - pregnancy related and request to join. Hoping you get what you need but please fight for it, it seems we need to at some hospitals xx

I agree with shamyloo, I'd be asking to see if they'd check the length by TV scan and look to see whether progesterone pessaries are needed. As said, I started the pessaries at 24 weeks, certainly wasn't given a wait and see. Sorry you weren't checked out sooner, but hope all goes well

Agree with @shamyloo I can't believe they didn't scan you to measure the cervical length, my scan at 29 weeks was an absolute game changer - why wouldn't they check?!

Insist on a scan and depending on the result progesterone pessaries as a minimum which as many people have pointed out and based on my own research, pessaries and bedrest can be as effective as a cerclage.