25mm Cervix length at 20 weeks.... will I need cerclage?

[nattynoo85]

Hello all,

I’ve been told my cervix length is 25mm at 20 weeks and am worried I may need a stitch put in. I am being monitored weekly now to determine if I need a stitch.

My first born arrived 6 weeks early and since then I’ve had lletz treatment, they took 12mm away. Due to this I knew I may have a risk of another premature birth but this time even earlier, hence the cervix length scan at 20 weeks. I have not been diagnosed with an incompetent cervix yet.

Has anyone gone to term or to at least 34 weeks with a cervix as short as 25mm without needing a stitch? I’m so scared to have a stitch put it, it sounds so risky.

Or if anyone has had to have a stitch put in, how was it and did it work?

Many thanks,

Natalie.

[Figey]

Sorry, I don’t have any experience with the stitch, but am at risk of having a weakened cervix, so I’m under continued monitoring.

Have you looked into the Arabin Pessary? It’s meant to be more effective than the stitch and gaining popularity in the UK. I will be pushing for this, rather than the stitch, if I end up needing treatment.

[nattynoo85]

Thank you figey for your comment and advice. I will look in to the Arabin Pessary x

[TenThousandSpoons0]

Are you already on progesterone? That might be a good option too. Hopefully you have an appointment with a consultant to talk through your options.
And yes - plenty of people have gone to term with 25mm cervix at 20 weeks - it is not totally predictive :) however with your previous story it seems likely you’ll need some treatment. Hope all goes well for you x

[annlee3817]

Mine measured at 24mm at 24 weeks, was 34mm at 23 weeks. Consultant wanted to avoid the stitch as he was worried that it my cause prem rupture of membranes, I had progesterone pessaries instead three/four times a day (can't remember which) up until 36 weeks, as soon as I stopped the pessaries I did start to dilate, but didn't go into labour until 40+5. I had regular appointments with the consultant to check it up until 36 weeks and was signed off at 32 weeks as my cervix was very soft and DD was engaged. Fingers crossed your cervix behaves now, it's stressful isn't it

[nattynoo85]

No I’m not on progesterone yet, I feel like I should be though it’s what I keep reading... it can’t hurt can’t it. My consultant said it may not help my situation as I’ve had lletz though. I’m being checked again on Monday so hopefully there hasn’t been any change in my cervix length.

Annlee the progesterone seems to have worked for you! I would love to just take that route as I’m quite worried about having a stitch put in, sounds so risky eg that it could cause infection, damage cervix for future pregnancies and of course rupture membranes early which is obviously the point of the whole procedure!

I’m hoping a miracle happens. Thank you all xx

[Hayleylou89]

Hi @nattynoo85

Iv 13+4 and had a loss at 23 weeks in feb this year due to preterm labour, id had lreviosu lletz treatment but only 9mm and they dnt refer to preterm labour until 10mm or more so sadly my I'm completely cervix was missed and i lost my baby girl in feb due to preterm labour at 23 weeks i would 100% be pushing for progesterone atleast! And im pregnant again now as i say and this time im being watched like a hawk, i went in last week at 12 weeks and my cervix was 28mm and then went in wednesday this week and it shot down to 20mm and i was immediately booked in for the stitch yesterday and had it done, it went well and iv been told to take pesseries aswell as a strong dose of omega 3 x so dnt let them fob u off please! Not to scare u but things can change so quick and the further along u go the more riskier is for the stitch but the earlier its done the more benefits it has too they have been using the stitch for over 100 years iv asked 100000 questions about it and im so glad i have it in now, it really wasnt too bad the procedure and u have spinal block to numb u, im just a bit belly achy and backachy today after getting home x x x go and atleast get measured again as like i say things can change rapidly and if ur waters go before anything is placed then nothing can be done x

[Hayleylou89]

Incompetent * cervix not in completely 🤦🏽‍♀️

[nattynoo85]

Thank you so much for sharing tour experience hayleylou! I’m so sorry to hear about your loss earlier this year. But I’m so happy to hear you expecting again and that you are being looked after well!!

Unfortunately I didn’t read too much in to cervix scans etc until I was just passed 13 weeks and realised I should have been monitored much earlier. I knew I would have a cervix check at 20 weeks but I kept pushing for an earlier scan as I had read your cervix should be checked at least at 14-16 weeks. I also knew things can change drastically without knowing so I was beyond myself with worry as I did know the state of cervix before I fell pregnant all I knew is that I had high chances of an early birth. I got a scan at 16 weeks which showed my cervix was 40mm however at my 20 scan it was 25mm.... the preterm clinic said I probably wasn’t 40mm at 16 weeks and that the scan was likely done wrong by my obstetrician. Anyway it was 25mm in Monday and I’m hoping Monday coming it hasn’t change or has magically lengthened!

My obstetrician says I may not need a stitch at all and I’m not on progesterone yet.... the preterm said it probably won’t help in my case... but I’d still like to have the progesterone, anything to help!

You have put me more at ease in regards to the stitch. I have been freaking out. Reading the risks did not help. And I was worried about having a spinal with bump.

Did you have bleeding after the stitch? I get paranoid seeing blood during pregnancy.... after they did my cervix scan I bled straight away and spotted for two days after, I found it so painful. But I know the scan was important and the stitch even more important. I’m also aware I’m 21 weeks on Tuesday and need the stitch put in before 24 weeks.... so I’m panicking.

I’m worried to do anything, lift anything, walk anywhere for a long time, stand, etc. It’s been so stressful just worrying.

I wish you all the best for this pregnancy. Thank you so much for sharing it helps so much xxx

[TenThousandSpoons0]

Hi again - sorry you’re panicking, pretty natural when you’re worried about your baby! I still think it’s worth asking for progesterone if your cervix remains around 25mm (if a lot shorter then cerclage May be better) - the thinking often is that if you have something that has “mechanically” weakened your cervix (eg having a LLETZ) then the treatment should be also “mechanical” (ie stitch); and if you have possibly more of a hormonal reason for shortening cervix and labouring early then sometimes progesterone is a better option. There’s overlap between the options though. You have both those reasons - because your previous preterm birth was prior to the LLETZ. So I think there’s still a possible role for progesterone. Where I am people can commonly avoid the need for cerclage with an approach of trialing progesterone for 1-2 weeks with careful watching - it often seems to hold things stable.
In terms of only having until 24 weeks to have the stitch - try not to feel time pressure because of that. If it’s not done before 24 weeks that will be because it wasn’t needed - and that’s a good thing. you and the consultant need to be sure it’s the right option for you, and no need to rush to a decision.
Also wanted to try to reassure you - even though a PP had a fairly dramatic story of cervix shortening very very quickly, that’s not often the case - more commonly it’s a slower process over weeks. Still pay attention to symptoms in the mean time obviously.

Good luck! I hope all is lovely and stable (or longer) on Monday:

[AllBellyandBoobs]

Hi, I had lletz followed by a cone biopsy and didn't need a stitch for either of my pregnancies following these procedures. In fact, I went over my due date with both. I had regular scans that showed my cervix lengthened during the pregnancy. First pregnancy they monitored me to 34 weeks I think, 2nd they stopped at 25 weeks.

[nattynoo85]

Thank you so much for all your comments and reassurance. These threads really do help me even it is just for my sanity.

Tenthousandspoons- I really don’t want to rush anything but do feel pressured for time. I wish I had been put on progesterone last week. I would have had enough time to see how it went for two weeks then.... but I will push for it Monday, it can’t hurt to have it. Even if it just calms my nerves. I’ve read so many horror stories and I just want to make sure I do everything I can so it doesn’t happen. It’s so hard to know how everything is going to go especially as it could be hormonal or mechanical. If my son had been full term I wouldn’t worry so much or vice Versa I hadn’t had the lletz!

All boobsandbelly- you’ve given me hope! How wonderful your two pregnancies went full term! How short was your cervix? So it actually lengthened? Did you have progesterone? Xx

[JessicaPeach]

In my trust 2.5 is when they'd start to take action, although I was told last week that they like to take an individual approach. I had an extensive lletz in 2012 and my cervix was monitored in my first pregnancy in 2014. I had scans at 16w and I think 23 or 24w. Measurements came in at 3.3 and 3.1 so I was discharged from the pre term clinic. I had a large baby after a fast and spontaneous Labour at 38+5. So not preterm but a bit of a combination. I'm expecting twins now (14+1) and I'm having a scan at 16w to check length. Midwife said it wasn't indicated but consultant said it was an easy box to tick so we know whether it's a concern or not. I think the main thing in this situation is to be being monitored so I wouldn't be too worried about what action will be taken yet because the main thing is that it's on the radar, the real problem is when it happens unexpectedly as pp have sadly said. Good luck x

[nattynoo85]

Jessicapeach- thank you so much for sharing and the reassurance x

Congratulations on your pregnancy, I hope all goes well for you! Your cervix measurements in your first pregnancy were good for having had extensive lletz! I had 12mm off, not sure if that’s a lot, but my cervix measures 25mm.... So assuming it’s not a good sign and that it’s more than my lletz that has affected the length of my cervix.

But yes I am being monitored so I’m trying not to worry. There’s a part of me that doesn’t trust the NHS. Plus I’m just worried about being told I don’t need the stitch and then something happening... I’m always thinking the worst.

But let’s see how my scan goes on Monday all could change. Xx

[AllBellyandBoobs]

My first measurement was at 14 weeks or so and it was 24mm. They told me then there was a good chance I would need cerclage, 16weeks I was 25mm and it seemed to steadily lengthen from then I spent that first pregnancy terrified about every twinge however, convinced the measurements had been wrong! I was much more relaxed second time round (mainly because I knew these twinges were part of pregnancy). I hope your scan gives you some reassurance

[nattynoo85]

Allbellyandboobs- Wow that’s great, I hope I am as lucky. Not long to wait my scan is tomorrow. Feel nervous already.

I am terrified... I was completely oblivious in my first pregnancy I was low risk, but then my son showed up 6 weeks early. I always knew the next would likely be early but having a lletz after my son has really topped that worry for me.

It would have been helpful if I had been scanned earlier so I could have seen what size my cervix started as and if there has been any changes up to 20 weeks.

Were you given progesterone?

[islandislandisland]

Hi @nattynoo85, I'm 31+4 and my cervix was 25mm at 12 weeks, then 24mm at 17 weeks, then 28mm, then back to 24mm at 22 weeks. I was put on progesterone at 17 weeks and offered the cerclage but as its my first pregnancy they told me it has as much benefit as the progesterone, and I chose not to have it. It was an awful decision to have to make, it felt like choosing between taking action and potentially losing the baby now, or leaving it and potentially losing the baby regardless. Anyway, I didn't have it and I was discharged from cervical monitoring at 22 weeks, and stopped the progesterone at 28 weeks. My cervix is short due to a uterine abnormality so not quite the same situation as you. I haven't had any signs of threatened pre term labour either (touch wood!). I think with the cerclage it's a decision best made based on previous risk, if I had had a previous loss I would definitely have had it. Hope all goes well for you.

[nattynoo85]

Thank you islandislandisland for sharing your experience, So happy to hear that your pregnancy is going well And that you didn’t need to have the stitch. You must be so relieved. I can imagine how hard it is to make that decision, this is what I worry about. However I’ve already been told progesterone won’t make much difference in my case (not too sure why) but I think should have been put on progesterone at the beginning of this pregnancy. It is probably too late now to make much difference. All I’ve heard is women having been put on it much earlier to observe. However I’ve had no treatment as such yet just one observation which worries me.

The hardest part is not knowing how ones cervix is going to behave and if it will change. I haven’t had a loss due to my cervix, but my son was 6 weeks early. Thank god he was fine and just needed help with his lungs for a week. But I could deal with another 34 week birth, its the 20-30 week birth I worry about. My miscarriages have been early, latest at 8 weeks, I couldn’t imagine a loss later in pregnancy.

Trying to stay positive but I keep feeling let down by our health service and worry I should have been monitored earlier. I worry about a late stitch. Xx

[islandislandisland]

Absolutely understand, I found the second trimester so difficult and a lot of the HCPs I saw were quite laid back about it, their goal was to get me to 24 weeks after which point they were more geared up to manage a very early baby and all monitoring stopped. I can see why they do this but I didn't find it very reassuring because to me having a 24 weeker wasn't exactly an ideal outcome either!
One thing I did have at 24 weeks actually was steroids which my consultant wanted me to have just in case I did deliver very early, to help baby's lungs. Might be worth discussing that if you can for extra peace of mind. Also I'm not sure how long progesterone takes to come into effect but you could push for that as a precaution too, I don't think it's too late for it to potentially help. Hopefully your scan will give you a steer as to whether or not to have the cerclage. I would get a couple of consultant opinions if you can, the first consultant to review my scan booked me straight in for the cerclage with no real discussion about other options then when I went in for the operation I saw someone else who gave me the choice to continue monitoring and explained it all much better.

[nattynoo85]

Islandislandisland I will certainly push for progesterone today! And anything I can to get extra help! I’m hoping I get good results and that this time the scan doesn’t hurt me and make me bleed like last week . I will try to get a second opinion if I can. But I agree with you a 24 weeker is not ideal! I want to at least reach 30 weeks! And even then I’d worry.

Wish me luck, will update you all later today when I’ve had my scan and seen consultant. Thank you al for your support! Xx

[TenThousandSpoons0]

Good luck!

[Vuduvu]

Good luck! Just to add my experience - I had my cervix monitored from 19weeks in my last pregnancy as had had 2 LLETZs, 27mm at 19 weeks but it dropped to 23mm at 23 weeks so I went on progesterone pessaries and then went to 40+4. I was allocated to progesterone in a trial as they were trying to find out whether pessaries or a stitch was better.

[nattynoo85]

Thank you all so much!

Good news, my cervix scan went well! There had been no change since my scan last week, it’s still sitting at 25mm. So the preterm clinic said that they won’t see me for two weeks. Hopefully nothing changes in the next two weeks! They weren’t going to give me progesterone as they were still adamant it won’t help me but I asked for the pessaries anyway just incase and they didn’t hesitate to prescribe them to me.

Can I ask how difficult it is to put them in?..... they said the pessaries have to reach the cervix.... I’m hoping I get it in the right place! They also said Inserting the pessaries can cause spotting, has anyone had spotting with the pessaries?

Vuduvu- thank you for sharing your experience. So it seems the pessaries worked great for you especially after 2 lletz procedures! I’ve only had one but they took off 12mm. It would be lovely to reach full term. I’m hoping the pessaries help me. Xx

[islandislandisland]

Great news! Pessaries.. I just sort of shoved them in as far as I could, up and back and then laid down for at least 30 mins. A bit like a non applicator tampon. You then get a small gush of waxy stuff come out which is the covering of the actual medication, they can be quite messy. I didn't notice any side effects or bleeding. If it's hot weather they can start to melt very quickly once you're holding it, not sure if you can maybe keep them in the fridge, I never tried this. I was told that they help strengthen your cervix but also prevent your womb from contracting thus reducing the likelihood of labour starting so for that reason alone you may as well have them I reckon.

[Vuduvu]

Yep same for me, just shoved them in! I did it last thing at night. They make your underwear waxy and smell weird unfortunately, I had to throw some away! I didn't notice any other side effects but stopped having to use the laxatives I'd been using earlier in the pregnancy.

Good luck for the next scan!

[nattynoo85]

Thank you islandislandisland and Vuduvu! Will be fun trying the pessaries tonight then haha. I must sound useless but hoping I can do it right as I’ve never been one for tampons. I tried them once or twice when I was younger and never tried again!

The pessaries they have given me are called cyclogest, assuming they are all the same. I’ve been told to take just one a day, at night.

Will let you know tomorrow how it goes!

Thank you all again xxx