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.

I didn't worry too much as long as it was in there! If you can feel it slipping out then it's not in properly, if you can't feel it at all then it's in. I had cyclogest too, 400mg at night. Good luck!

Hmmm They’ve only given me 200mg. They’ve no doubt given me the lowest dose possible as they said it won’t do much for me. Typical xx

Good news about cervix length :) the dose is correct, don’t worry (either 100mg or 200mg used in the studies, 200mg routine where I am). And yep you just have to get them in vaginally, just as deep as your index finger - key is that it doesn’t fall out. As pp said can be messy! Last thing at night is easiest.

TenthousandSpoons thank you so much for your message. That sounds much better, as deep as my index finger... the consultant told me I had to make sure the pessary touched my cervix and I thought wow how do I know and what I’d I can’t reach it!

Wish me luck i’m going to try it in a bit before I go to bed! X

Ahh I don’t think I inserted the pessary deep enough in I couldn’t get much of my finger in and it felt like it couldn’t go any further, when I tried to find it to push it further I couldn’t find it. I’ve been laying down in bed for half an hour and it hadn’t come back out.... hoping it does it’s job, I worry it’s no where near my cervix

Down below feels strange half hour on, not crampy but just different a bit tingly could it be the pessary? Anyone else feel sensations after inserting pessary?

Can’t comment on sensations from the pessary but I’m sure the rummaging looking for it could cause some sensations itself?! One of the other PPs might be able to comment on that.
I reckon a fair proportion of pregnant women wouldn’t be able to reach their cervix so really wouldn’t worry at all. In the US the progesterone is mostly given as an intramuscular injection weekly (thigh or arm) so I don’t think it has to be right next to the cervix to work!!

I'm almost certain it doesn't have to be 'by your cervix' to work, I was told I could use it rectally if I wanted to. Basically once the pessary is in the waxy outer will melt away in about twenty minutes and the progesterone is absorbed, so when I say about it falling out, I mean you will be able to feel the whole pessary slip into your vagina. So sometimes I would insert it then almost immediately feel it slip back down. It's very obvious when this has happened as its uncomfy and you just need to give it a shove further in. I would try not to over think it. As long as it went in and stayed in, it'll be doing the job. Sorry for the endless TMI in this post, but hope it helps!

Well I doubt I got it past my vagina and to the cervix, but it didn’t feel uncomfortable. Once I took my finger out as I couldn’t get it any further and then went to go back in to give it another push I couldn’t find it.

Hopefully I have better luck tonight!

After about an hour of laying in bed worrying about it, I fell asleep and woke up at 3:30 to go to the toilet and as I got up the waxy coating was luckily caught by my pantyliner! I was a bit worried of the waxy coating sitting inside me for a few hours while I slept but assuming if it says to put it in at night it means before you go to sleep.... so it can’t hurt to fall asleep right and then wait a few hours before waxy coating comes out?

It does get easier the more you do. I don't think having the coating in overnight is a big deal, most of mine was gone by morning though due to the amount of times I have to get up to wee in the night! But yes they are designed to put in before sleep.

I didn’t have any coating when I woke up in the morning, I think it all must have come out when I got up to wee in the middle of the night. I just find the whole pessary thing so ancient and gruesome (and of course difficult).... I’d much rather an injection if it was an option for me.

I hope your pregnancy is going well? You must be so excited as you’re getting so close! Do you know what you are having? Xx

Yes it's pretty grim, felt like a bit of a slave to them as well by the end, having to remember them every night then be sure to have laid down long enough and so on!

Pregnancy hasn't been too bad recently, 2nd trimester was horrible with all the cervix drama though. I'm having a girl, first baby so currently panicking about labour etc! When are you due? One thing that helped me was getting a countdown timer app and setting it to 24 weeks then I could see how close I was getting , then when I got to that I'd reset it for another 2 weeks and so on, until I didn't feel so anxious. With every week that goes by it does get better.

Aww congratulations, a baby girl! How lovely! I have a boy already who turns 4 next month and another boy on the way . I’d have loved a little girl but as long as this baby is healthy that’s all that matters.... it will be a hell of a lot cheaper for me having another boy! No need to buy clothes or toys haha. I’m due on 15th December which seems ages away but I’m in no rush for this baby to come! Please please stay in!

Thank you for your tip, i can see how that would make it easier, taking a week or two at a time, otherwise it is just scary thinking will my cervix hold out for another 20 weeks! But yes your right each week that passes I feel a bit better. I bet you are so much more relaxed now that you are passed the 30 week mark. Although like you say labour is now on your mind!!

I remember with my son I was completely oblivious to cervix issues etc, I was low risk and he surprised me by popping out in a hurry at 34 weeks. He’s completely fine now but was in hospital for two weeks as he needed help with his breathing and then his feeding. But because it was so sudden and such a rush I didn’t have time to worry about labour, it was over in a flash.

I hope your labour goes to plan (if you have one) although when it comes down to it, it’s just about getting baby out safely and mum getting over it in one piece! Everyone’s story is so different so try not to read too much in to labour and other people’s stories! Xx

@nattynoo85 sorry iv taken ages to reply i dnt get notifications.

No bleeding after the stitch and the pains stopped after a few days im just doing the bare minimum with everything until my next cervical scan on weds and see where its at then ill be jist over 15 weeks then.

Pessaries seem to cause alot more discharge have u found? They are with me.

I was only prescribed the 200mg dose too. But will be asking them about the stronger dose on weds and they dnt need to be by ur cervix. Im terrified of feeling my stitches so just push it in say half way up my finger then it seems to disappear anyway 😂.

The worry is terrible isnt it, even with the stitch im still worrying my waters will somehow go early and they will need to remove it...i like @islandislandisland idea of the countdown though my biggest first step is 24 weeks 🙏 i NEED these next 9 weeks to fly by 🙄

What gestation are u now? X

@Hayleylou89 don’t be silly! I get notifications but have so much spam I sometimes miss them myself. Thank you for replying

Wow no bleeding that’s good, I bleed at the slightest as my cervix is so sensitive, I bleed after my cervix length scan a couple of weeks ago .

Yes make sure you take it easy!! I’ve been doing the bare minimum as I’m scared to affect my cervix in anyway. Especially as I have no stitch yet. I feel as fragile as a china doll haha.

Yes I have found my discharge is different already with the pessaries and I’ve only taken them for three nights now. So I’m hoping this means they are doing something or at least I’ve put them somewhere where they are actually being processed by my body. Exactly the same, I put them in and they just disappear after half a finger! I don’t know how I could push them any further! I’m glad it’s not just me . I just had a response from my preterm consultant about taking more than 200mg and she said that higher doses showed no benefit.... so I guess that’s a no to more for me! Make sure you push for more if you feel you need it. I’ve read lots of women being on higher doses. It can’t hurt to try.

Although I was told on Monday I don’t need to have another scan for two weeks (which would bring me to 23 weeks) I was concerned that if My cervix does change for the worse and I did need a stitch at that point then I would be so close to 24 weeks which is normally the cut off point for a stitch. They have asked me to come in Monday now to discuss my options, so hopefully I will get another scan.

I know how you feel with the worry, everything I do I thing I do or every little feeling or knock I think my waters are going to break. But it must be so worrying for you especially having had a second trimester loss.... I can’t imagine the heart break. Wishing you all the best in this pregnancy and that at some point you can relax and enjoy the pregnancy xxxx

A count down is a great idea isn’t it, Just small steps! Thinking of surviving to 40 weeks is just crazy.

I’m currently 21 weeks + 2 days, I will feel better when I’m nearer 30 weeks and will be able to relax a bit more. I’m meant to be going to a short caravan break in September when I will be about 26 weeks..... I’m thinking I may have to pass what do you think? Xx

I really struggled in the second trimester, felt just like you, like any movement might trigger labour, hobbled round doubled over half the time, in and out of triage.. but as time went on and I got past 24 weeks the anxiety really wore off and I haven't felt worried since about 26 weeks really, it's such a relief to feel able to move around freely (although I'm so big now that isn't too easy either!) I'm sure you will both get to that point too. @nattynoo85 I would be prepared for them to put the decision to you when you go in and have a think about what you might want in different scenarios. Did they mention when they will stop monitoring your cervix?

@islandislandisland I can’t wait to get past 24 weeks... I hope I get there. I really am walking with a hobble and a waddle frightened to do anything. When I go to the toilet I dread it too. With my son, I’d gone to the toilet in the middle of the night and when I went back in to bed my waters broke, god it was scary, I was 6 weeks early and it’s funny as I would be happy enough with that this time round!

I bet you’re so happy you’re past the second trimester!

They didn’t mention to me when they would stop monitoring my cervix.... I will ask that, that’s a good question. I hope they don’t stop I will be so worried without observation. I will just have to keep pestering my obstetrician and maternity assessment if needs be.

I’m really stuck at making a decision... in a way I wish they would just make it for me but I do want what’s right for me. At first I though I must have the stitch, this was before any scan as I just went in to panic mode at about 15 weeks when I read more in to incompetent cervix’s, but then reading more in to the stitch and it becoming almost reality I’m scared of the risks. It’s so hard being 25mm because I could go near to full term or on the other hand anything could just change. If my cervix was very short I’d definitely want the stitch as highly likely the worst could happen if I didn’t.

Yes my cervix was 25mm at 14 weeks right up to about 27 weeks when it then started to weaken, I was on projesterone injections from 20 weeks, didn't need a cerclage and got to 35 weeks before I laboured with my second dd. My waters broke on my first dd at 32 weeks and had her a week later but as I had no prior knowledge of a weak cervix I hadn't been monitored so I'm not sure what it was but it's absolutely possible you will get well into 3rd trimester. Best of luck 🤞

I was told in no uncertain terms that cervical length scans would stop once I reached 24 weeks and they wouldn't do them more frequently than fortnightly during the monitoring period because apparently it increases the likelihood of infection etc, they really didn't want to examine me too often. I wanted them at least weekly but they weren't having any of it. Hopefully they'll give you more of a steer in the right direction than they did with me. The risks of having the cerclage are very low I believe but as the consultant said to me statistics mean nothing if you're that 1/100 that has the negative outcome. The cerclage is also not a guarantee and I was told it wouldn't prevent labour starting if it was going to, kind of made me wonder what the bloody point of it was then! There are a lot of studies available online about its effectiveness which are worth a read.

@Travellingmotherhood thank you for sharing your experience xx

Wow so your second DD was born later than your first, I’m assuming progesterone helped! I’m hoping it does the same for me although my preterm consultant doesn’t think it will help me I’m not sure why though.

I was the same with my DS, waters broke at 34 weeks and I had no signs or previous history with cervix. I was low risk for everything. No monitoring so as with you I have no clue why it happened. Now I’m being monitored they’ve found my cervix is short but it may just be down to lletz or a mix of that a weak cervix. Who knows.

I’m worried that possibly with my DS my cervix began to weaken towards the end of the second trimester Hence the early birth however as this time I’ve had lletz, if it starts to weaken again this baby will be even earlier. So frightened.

Hopefully I’m monitored as far as 27 weeks so I can see what’s going on.... it would be great to keep my cervix at 25mm for as long as possible 🤞🏻

@islandislandisland I can understand not wanting to scan a patient too much, I hate them myself (especially as they hurt me and I bled at the first cervix scan) my mum always says to leave well alone, but where I’m full of anxiety I just feel I need to know and that something might change within a week. But all that prodding can’t be good. I even worry with the pessaries.... I literally think, question and worry about everything. It was me who wanted the progesterone pessaries but once I had them I was googling like crazy the side effects etc and like should I be using these 🙄

Yes I’ve questioned the cerclage and read that you can still go in to early labour and that it can literally tear your cervix. However I know it’s definitely saved a lot of babies. I just think I could be that 1 in 100 like you say... I wish I could believe in the doctors and the statistics. I’ve googled so much and given myself a headache and sometimes I’m reading like a long detailed report on a study and I’m thinking you need to be a doctor to understand all of this but I still read it anyway 😆

Hi @nattynoo85 💐 Sorry to hear you’re going through all of this! It’s a bloody terrifying nightmare isn’t it!!!

I was monitored at 20 and 24 weeks because I’ve had a 10mm LLETZ and am carrying twins 😰

At 20 weeks I had 31mm and by 24 weeks I had 23mm with a big ole funnel!
It’s been absolutely horrible and everything you describe about moving around gingerly thinking “what if I’m dilating now?”, “what if my waters break tonight” is spot on how I felt too x
The main thing I would say is to not worry that you’re too anxious or that you’re asking too much of your medical team, you have a legitimate scary situation on your hands and no one can truly tell you what will happen. It’s ok to be afraid and upset and need lots of help xx

My consultant was of the opinion that the benefits of cerclage (Not including transabdominal ones done much earlier)/arabin pessary/progesterone are very limited.
I knew from my own reading that cerclage or pessary were pointless with twins but same as you I insisted on Cyclogest 👍 I have been using 200mg in the evening but I’m using it rectally as I did for my IVF lol. It works the same and doesn’t need to be in contact with the cervix. The biggest risk when you have a shortening cervix is the risk of infection, it’s that that would cause PPROM. I’ve been told not to put anything up there even a little bit, at all. Also no orgasms, no sex, avoid upset bowels (that can cause uterine contractions).

Also there is an app called QUIPP that your consultant might use to assess your risk (I’d already used it so I felt properly smug when my consultant used it at my 24wk appointment 👌)

I took the liberty of putting what I gather are your details into it, I hope this helps a little bit! Xxx

Was just coming back to say about QUIPP as well - worth asking the doctors about it. However the key to that calculation is the bit that says FFN - fetal fibronectin. I’m not sure if all places have that available in the detail needed. Where I am, it’s used at 23-24 weeks alongside the history and cervical length to give a prediction of risk. If the FFN is very low or very high then that changes the % risk dramatically, without knowing it it’s much less precise.
And just picking up on some of the comments about duration of monitoring - the reason it’s done only up to 24 weeks is really because that’s where the evidence is, and where the prematurity risks are highest. There’s not much evidence around to be able to say what counts as a “short” cervix after 24-26 weeks and even less to say whether that means someone will labour early. Generally it can create a lot of anxiety so that’s why the monitoring changes to just symptoms alone esp if things have been stable. But it’s understandable that people can feel more anxious when the monitoring just stops also... hard one!
Re cerclage not stopping labour - the idea is that the process of preterm birth is infection/inflammation. So anything that creates that increases risk of preterm labour - eg infections elsewhere in the body (UTI/dental abscess etc), bleeding behind the placenta (causes inflamation) etc. short cervix is just one way that preterm labour can be kicked off - If the cervix is shorter then there’s a higher chance of normal bugs from the vagina, getting up through the cervix and kicking off the labour process. Once the labour process has started it’s hard to stop - the cerclage aims to keep the cervix length long so the process can’t start, does that make sense?? I think it’s a pretty complicated thing that the experts don’t even really understand fully, which is why there’s not really a single quick fix for it!
OP if it helps ive known lots of people with your story do really well and get right through to full term - I think the stats say about 85% of people with One previous PTB will go full term the Next time.

@FlashesOfRage yes it’s a big nightmare! Never felt so out of control of anything in my life! Im doing all I can I hope to not cause any further risk.

Wow twins, congratulations! But I can imagine the worry you had/have with the weight of carrying two on your cervix! IVF is stressful enough and then having to worry about your cervix.... you must have been so worried.

If you don’t mind me asking how far along are you now? I hope is going well?

Thank you so much for putting my information in to QUIPP! The odds are not looking too bad for me...... but it is hard to rely on an app if you know what I mean. But if consultants are using the same then there’s got to be some truth in it. I will get the app and also talk about it with my consultant on Monday.

I feel like an idiot now for using the pessaries...... it was me who demanded them. I’m putting in the pessaries vaginally so am worried I could have done more damages than good now! I asked if I could take them rectally and the consultant said no and that they had to touch my cervix to work 😫 maybe I should stop them all together?

Sex is certainly off the table and in terms of my bowels, they have recently gone from being constipated to loose.... so have been a little bit worried. I ate a whole punnet of tomatoes last night (roasted with my dinner) I’m sure it won’t help my bowels 😫. Literally am worried about everything I’m doing!

@TenThousandSpoons0 thank you again- I think they have tested for presence of FFN in my swab last week, I will double check on Monday with my consultant.

Thank you so much for the info on monitoring up to 24 weeks.... it’s very interesting! I just thought it had something to with being out of a danger area ie if all ok up to then likely to carry to nearer 30 weeks or that the elective stitch can only be put in up to 24 weeks. Naive me. But yes can see why monitoring stops as it can cause panic and reliance on scans that won’t really help later in pregnancy.

I didn’t really know that infection was the cause of premature labour, I knew it was a cause but I didn’t know that’s the main concern when having a short cervix.... why didn’t my consultant tell me this? I just thought your cervix can shorten for a few reasons but that it was purely the cervix getting shorter and causing PPROM/labour. I didn’t realise the key factor was infection as such. The consultant said I have a nice closed cervix so hoping all is ok to date. They did an infection test last week, and I think I will have another at 23 weeks. Maybe I should stop the pessaries? Freaking out once again here.

Thank you so much for your support and reassurance, I hope i’m worrying over nothing I really do and I hope I reach past 30 weeks 🤞🏻I always think the worst and what if I’m one of the unfortunate ones. My consultant must hate all my questions and lack of trust 😆

I would keep up the pessaries, just make sure you wash your hands well before inserting which I'm sure you do, they didn't do me any harm. My consultant told me to avoid getting constipated so no straining on the loo and to avoid getting a UTI, and to have frequent lie downs to take the weight off your pelvis. I knocked sex on the head too, not that I was in any mood for it! I think whether your cervix is closed or not is important, mine never showed any signs of funnelling and that seemed to be the second factor for real concern. Try to relax! Theres every possibility that you will stay pregnant. My consultant stopped my scans at 22 weeks saying she was confident there wasn't a risk and that she thought more scans would only cause more anxiety, I was really put out at the time but she was right, once I didn't have any appointments to build up to I felt a whole load better, and really it's empty reassurance having a scan unless your cervix has lengthened and even then you'd probably still be worrying it might change. Just take each day at a time, it's one day closer to term!

Hi,

I'm 18 weeks and have been having ultrasounds to check the length of the cervix because of previous lletz and dilation surgery on the cervix. It's gone from measuring 35mm to 28mm in just a couple of weeks so they have prescribed progesterone pessaries too. The doctor also said because the placenta is slightly covering the cervix opening they would want to avoid the stitch. I'm also super anxious and worry about it already shortening at 18 weeks and the amount it's shortened by in just a couple of weeks and the fear of going preterm. Scared to be even a little active but then this doesn't help and I dwell on things. I appreciate that I'm being really closely monitored and just have everything crossed it goes as full term as possible and try and dwell on the positives also. Let us know how you get on.