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.

Don’t stop your pessaries now - I think they’re the right thing for you. Vaginal is normal, you can’t do damage with them. If you get bleeding or cramping perhaps don’t take them and get assessed, otherwise you’re doing the right thing.
Where I am the consuktants draw a lovely picture of a uterus/cervix/placenta/membranes and go through the process of labour and how various factors can kick off preterm labour. All tying back to inflammation in one way or other. I think it really helps to be able to put things in context a little bit, and understand where each check/test/treatment can help.
Did want to mention - it’s super normal to have high anxiety with any previous preterm birth history, and some PTB clinics have counselors attached to them and extra support available. Not sure if this is done in the UK but it might help to access some counselling? Even just give you some techniques for calming your thoughts?

Thank you all for your messages, so sorry for my delayed reply, it has been a busy day in the heat.... anyone else struggle in the heat being pregnant 😫

@islandislandisland I am definitely giving my hands a good scrub before I insert the pessary, I’m even paranoid about the littlest piece of fluff from the towel after I’ve dried my hands. The pessaries don’t seem to irritate me, I just feel a bit off down there after I’ve put it in, but once I’ve fallen asleep and I wake up in the night I can’t feel a thing. I had constipation during the first trimester but now I’m quite regular 😆 I think it’s where my nausea has passed and I’m back to eating normally. I was quite relieved at first when I was scanned on Monday and they said it hadn’t changed from the week before, and they said they won’t need to scan me for another two weeks, rather than a week. But then the next day I was like I can’t wait two weeks 😫 but I guess it’s a good sign. And I hate those scans. I really am trying to trust the consultant but you can’t help question. The consultant just goes on statistics and percentages, but I treat it as I could be in that 10% that go in to labour before 30 weeks. I wish I wasn’t so negative.

@198435years Thank you for sharing your story. So sorry to hear you are also experiencing all the worries that a short cervix brings. I’m glad you are being closely monitored! And so early. I didn’t get to see specialist and have scan till 20 weeks. So you are in the best place right now. Have you asked If there is any chance that your placenta may move in the next few weeks just incase you need a stitch? However you have time to see if the progesterone pessaries work in the meantime. If your measurements stay static for a while then you will have good chances of all being ok. Just keep resting and take things easy!

@TenThousandSpoons0 Thank you for your reassurance xx the pessaries don’t seem to be causing me any side effects so in that respect I’m happy to keep using them, I was just paranoid about infection after reading some comments. I didn’t want to end up blaming myself for increasing the risk of infection. I really do think my consultant or rather consultants as there are two of them in the room when I go, have not given me much information at all. Except a handout on cerclage. I would feel so much better knowing what they are thinking and also the facts were on my condition and the treatment and risks. I’ve done lots of googling however. I will have all my questions ready for Monday! I’m actually meant to be having some cognitive behavioural therapy so hoping it will help. I’ve previously had miscarriage counselling, prior to this pregnancy, but I found it quite emotionally draining. Hopefully my CBT counselling helps. COVID certainly didn’t help things at the beginning for me.

I definitely can't handle the heat like before. They've said the placenta still has chance to move with it being early which is a good point actually because then they might feel happier about me having the stitch if it comes to that. A friend of a friend who works as a sonographer also mentioned that having a full bladder can effect the measurements of the cervix as well as different people doing it. I didn't empty my bladder last time but definitely will next time. I've been googling too which I know I shouldn't but can't help it. There's lots of positive stories and treatments. It's a worrying time but I'm sure we are in good hands and they probably deal with it a lot and have good outcomes x

Yeah I think Covid just generally makes everything worse right, kind of magnifies whatever else is going on as well as being a genuine concern of its own. Hopefully your CBT is helpful for you :)
Putting the pessary in won’t increase risk of infection at this stage - just wash hands but don’t worry otherwise. If it’s doing it’s job it will prevent further shortening and reduce any risk of infection. Hope my talking about infection hasn’t made you more worried about that, it wasn’t my intention!
Good luck for next scan and next discussion :)

@198435years glad it’s not just me feeling useless in the heat! That’s good news, fingers crossed your placenta move well away from your cervix! I’m lucky in that sense as my placenta is towards the back of my uterus. When I had my first cervix length scan at 20 weeks I tried desperately to empty my bladder but not much was coming, when they did the scan they said it wasn’t very clear and they ended up prodding so much it hurt really bad and I screamed, I had blood straight after but the spotting spot after two days. It freaked me out. But then the second scan was the complete opposite. My bladder was nice and empty (although Strangely I still couldn’t pass much wee before) and they could see much more clearly.... although my cervix length was no different from the first scan. But it so much more pleasant I was relieved, hoping my third scan is just as easy! You’re right there are a lot of positive stories out there. Maybe after my third scan I will know where I am going with all this, it’s so hard.

@TenThousandSpoons0 I’ve continued with the pessaries don’t worry I’ve got over my initial fright haha I’ve made sense of it in my head now! I’m scrubbing my hands! It’s just my anxiety making me think it over a thousand times. Starting to read in to cerclage again so I’m ready for consultant on Monday. Now I’ve freaked myself out again reading women having had the stitch put in at 16 weeks with a cervix of 25mm.... maybe I do need it I was so ready to maybe do this with progesterone and rest. It’s hard being borderline at 25mm there’s success stories with and without the stitch. If it were very short I’d have nothing to loose with the stitch really.

The 25mm cut off for intervention is just that, they have to have some way of determining when action should be considered but it equally doesn't mean that you must have the cerclage just because you're on that border. I was offered it as a standard procedure based on dropping below that cut off but actually discussion and further monitoring turned out to be a better course of action. I'm sure lots of people have the cerclage early in the second trimester purely because they fall below 25mm but I think the decision to cerclage should be based on measurements combined with other risk factors like previous pre term birth, evidence of funnelling and so on. I've read about consultants who wouldn't consider cerclage unless they were seeing measurements under 20mm or sometimes even less. I don't think having a short cervix in itself is always an issue it's whether it shows evidence of shortening further or opening. AFAIK mine has been 24-28mm consistently since 12 weeks and hasn't caused early labour.

@islandislandisland can completely see the need for a cut off point and taken into to account other risk factors. I just wish I knew what my cervix length prior to 20 weeks
to see if it had changed much. Saying that I did get my cervix measured by my obstetrician when I was 16 weeks as I persisted to pester her, she took a measurement of 40mm so I stopped worrying. But then when the preterm clinic took it at 20 weeks they said it was 25mm and came to the conclusion that I was never 40mm at 16 weeks and that my obstetrician couldn’t have don’t it properly. I don’t know how to take that.... so I’ve just ignored that measurement. That’s when at 20 weeks I started to panic as I had originally thought I was 40mm or at least that I started off with a nice long measurement. If I did have such a dramatic change though between 16 and 20 weeks that’s big worry right? I don’t know what to believe or to think so confused.

I don't think I mentioned that at one of the scans I had between being 24mm and 28mm I was measured at 43mm which obviously made me happy that it had 'increased' but the senior consultant who did my final cervical length scan of 28mm said that it was a mis-measurement and that it could very much vary depending on who was measuring. So it's entirely possible you just got a less experienced sonographer for that one.

Glad I’m not the only one, feel less worried about that now thank you. My obstetrician who took the measurement of 40mm said the preterm clinic are the experts so maybe she sort of gave herself up at that point. Such a shame I was over the moon I was 40mm haha x

Hello everyone,

So a week later and my cervix is shorter , from 25mm to 22mm.... so have now been offered the stitch. They said I can wait till next week to decide and have another scan and see if it changes and I will be 23 weeks. Or I can email them over the next 24 hours telling them I want the stitch and I will be booked in to have the stitch put in on Friday....

I’m worried to put it off for another week just incase It’s gets even shorter by Monday. But then part of me says maybe I can get to 34 weeks without stitch.

Consultant said if I just had the preterm birth of my son at 34 weeks they would just recommend progesterone but because I have had lletz where took away 12mm they suggest the stitch. Mechanical fix for a mechanical problem.

It’s so hard to make a decision

Really sorry to hear that was it the same person who measured it? Would they give you another scan prior to doing the op on Friday? I think it depends how much it's going to worry you going forward or whether you'd be more comfortable biting the bullet and just doing it. Did the consultant give you any sort of steer as to what they recommend you do?

Well there’s always two people there, one was the same, the other different. The usual lady scanned me but then the other lady took over towards the end and checked it too. I assume they would scan me again before they did incase I’m dilated or it’s shortened so much that they couldn’t do it.

Having the stitch causes a whole new bag of worries.... will I get an infection, will it cause my waters to break, will it bleed, will it irritate my uterus and cause contractions. Will it actually work and will it cause me to go in labour even earlier. Will it cause damage during labour? Will it cause long lasting damage cervix so much so I won’t be able to have another child? Lots of questions but most important thing is this baby though and getting them in to this world safely and at the right time. I’m sure the benefit outweighs the risk otherwise it wouldn’t be offered.

The consultant was steering towards the stitch I think although she couldn’t say what I should do... she just said if it had been a preterm birth at 34 weeks she wouldn’t have said stitch but because of lletz they’ve offered the stitch. So basically saying progesterone isn’t good enough i think. But then on the other hand she said she had seen other ladies go to 34 weeks with a cervix the same length.... so hard to tell. She said my cervix can’t be stable though if it’s changed from last week. X

@nattynoo85 It must be so hard to decide. It's almost easier if doctors made the decision for you. That's a good idea one more scan before on Friday and then make a final decision. Did they say if there were funnelling signs because if not that's another positive.

It's a tough one.. you're very nearly over the 24 week mark too which I know isn't still ideal to give birth at but with every week you stay pregnant after that the odds are better if you were to have another pre term labour. It's quite a small change in length too, would be easier if it had been really significant. I was told they wouldn't scan me pre op but would do a speculum examination to look at the exact anatomy, so you may find they don't offer you another scan. I was also told I wouldn't have any after the op either so might be worth checking that out too. Did they say if there was any funnelling?

There were no signs of funnelling thankfully, cervix is closed. Such a positive I guess. I’m going to email and see if they will scan me before the stitch... it would have made sense to but I wouldn’t assume it I guess.

@islandislandisland did you mean they wouldn’t scan you start for after or monitor it after? The consultant said they scan me two weeks later and then again every three weeks. You’re right it’s not a significant change is it.... but they don’t think it will magically lengthen by next week and they can’t say if the rate of shortening will accelerate when I’m a slightly bigger or even if it will change by next Monday. They said I have a 99% chance of the stitch being done without any complications as my cervix is long enough and not funnelling. They also said the chance of it being put in the wrong place is very slim.... thanks a bunch didn’t even think they would put it int he wrong place

@198435years no funnelling which is great but it’s still a hard decision xx

They said all monitoring would stop after I had the stitch, I think partly as they viewed it as job done and partly because of the not wanting to put anything up there that might introduce infection. My trust are quite keen not to internally scan too much though! I would definitely ask if they'll scan you pre op especially if that's a significant part of you deciding to have it, just in case they won't. I expect once you've made the decision you'll feel much better, it's just getting to the point where you feel it's the right choice.

Sorry to hear it’s got shorter - although I think the positive from that is that it’s really not much shorter at all, there’s always a little bit of variation between scans and the cervix is dynamic so a few mm one way or other can be just what your cervix is doing. It’s a shame that they’re not sure abo your 16 week scan - did your current consultant review those images? If it was truly 40mm then and 22 now then that’s more significant then if it was actually only 25 then, and I guess could help with the decision. Also how many weeks are you now exactly, and did you ask about the QUIPP and the fetal fibronectin? Because that could give some really valuable information.

In terms of rescanning - it wouldn’t be typical to scan again pre op as it shouldn’t really make a difference - if the cervix is shorter or opening then that’s all the more reason to go ahead with the stitch, and honestly scanning too close together probably won’t help with your decision. If you’re going to wait I’d wait at least a week between scans.

At this point I’d say to you that maybe a stitch is a better option for you - it will put your mind at rest much more. It’s not that it’s necessarily the only option but I think you might go a bit crazy over the next 12 weeks or so if you don’t have it? And your cervix is unlikely to get longer than 25mm from now so you may find it very difficult to get through a few months knowing that, even if everything will be fine.

It is just about impossible to get in the wrong place or to break waters while doing it if it’s done at this stage - different story of course if the cervix is already open. Usually they give medications pre op to calm contractions, and most often you can choose between a spinal anaesthetic or a general (may be different where you are). Infection is possible but uncommon - v common to have changed discharge and some spotting afterward. As for damaging the cervix, that’s a consideration and would mean you need to go to hospital straight away if/when you do start contracting, but it’s not common. Typically the stitch would be removed at about 36 weeks anyway to avoid that possibility.

@islandislandisland my consultant confirmed that I wouldn’t be rescanned before the procedure . Wish I knew what to do for the best. But you’re right once a decision has been I will feel better. Or at least know what to focus on.

@TenThousandSpoons0 my consultant didn’t know what QUIPP was I asked about FFN and they said they don’t check anymore... they said it’s not reliable, they used to test for it a few years ago but their studies showed it was misleading. I’m not sure if my consultant actually saw the scan images but they were pretty confident that wasn’t the size at week 16.

I’m not sure if I should wait till Monday for another scan, the consultant said I will be right near the cut off when the procedure was done, 23 weeks +3 days and the risk increases. Like you say my measurements are not a great deal different, but am just thinking about what will happen when I get to 26/27 weeks when your cervix naturally shortens in pregnancy due to the weight.... what situation will I be in then if I don’t have the stitch. No one knows. I don’t know if I want to take that risk. I will probably go mad if I don’t have the stitch done. But on the other hand I will be constantly worrying about something going wrong with the stitch and how labour is going to turn out.

I thought I would get some wise words from my partner that would sway me towards one route but all I got was three words..... ‘I don’t know’ oh and ‘well it’s your body it’s your decision’ I just wanted some input. I know no one wants to make the decision as it’s such a big decision to make. But Even to just say how he is feeling about it all and to go over the pros and cons with someone would have been nice.

I wonder what happens to the baby when a spinal is given..... I wonder if the baby can still move around etc or if the spinal had an affect on the baby. Another worry of mine.

Monday is only 2 days from when they want to do the procedure, but I guess if you said you wanted it on Monday it might take a while to book it in? I suppose what you have to think is what will I do if come Monday my cervix is the same or shorter, if you'd have the stitch then I would just do it now. Or you could hold off on the stitch and ask for precautionary steroid injections at 24/25 weeks just in case baby did come?
Sorry your partner isn't being more helpful, mine was similar, I could tell he didn't want to tell me what to do with my body and also didn't want to be responsible for what might happen if he gave an opinion either way. Have you got anyone else you could discuss it with?

@islandislandisland that’s a very good point... what would I do come Monday it is stayed the same. I would probably be feeling the same as I do now but worse. Although I’m one week nearer to getting where I want to be I will be thinking god if I really do need that stitch baby is even bigger now and risk is increased. I guess I need to bite the bullet. I’m just so worried about the labour too and the baby being early with a stitch in place, I’m not sure how that would affect baby. I know I need to get to hospital quick to have them out but what if it’s not quick enough and that’s if I get advance warning. What if I don’t realise my cervix has dilated int he meantime between scan checkups? all these what ifs...... but then there’s still what ifs either way.

I’ve discussed it with my parents and my sister.... my sister says to get it done, she’s thinking about a very premature baby coming out with lots of health problems, which would be devastating and I would just end up blaming myself. My Dad won’t give me his view and doesn’t like to influence me. My mums just seems put out and worried about my Son through this, about his care while I’m in hospital and for the rest of the pregnancy. I have so much guilt when it comes to my son as it seems I’m not focusing on him. My mums put so much guilt on me for having another child.... especially as she knew I’d have trouble with this pregnancy (so she says) yes it was a risk but I wanted to take it. So many women do. It’s natural to want more children. My mum eventually said we’ll do I really have much of a choice? I’m ultimately going to need it.... my mum can be tough.

Feeling like I’m about to make the biggest decision of my life so far!

Update for you all, I’ve decided to go ahead with the cerclage. It’s Thursday now rather than Friday so onto one day to prepare myself for it.... wish me luck. I’m a big bag of nerves!

My obstetrician swayed me towards this route, she said to do it, I have great odds for this working out as I have a decent amount of cervix for the stitch to be successful and no funnelling. She also said That the risk of me having a preterm birth without the stitch is higher then the risk of any complications from the stitch so it’s a no brainer I thought! X

I had half -typed a reply saying exactly this - just do it, for you a stitch is the better choice, as soon as it’s done I think you’ll feel more at peace! Glad you’ve made a decision - that must be a weight off your mind either way :)
In response to PP suggestion about steroids - Don’t ask for steroids “just in case” - the obstetricians will offer them to you if there is a need. The best effect of steroids is if given within around 48h and up to 7 days prior to delivery, after that you lose the effect. They can be repeated but you don’t get the same benefit. So you’re much better to save them for when there is a super high risk of delivery soon - you’re not in that category yet.
Re spinal - consider that almost all caesarean deliveries are done under spinal and the babies are absolutely fine. Re general - sometimes can make the baby a bit sleepy which is a consideration if baby is about to be delivered and needs to breathe on its own - not a worry for you as your placenta is doing all the “breathing” for baby anyway. The anaesthetist would talk you through whatever option they think is best for you. And they always tailor their drugs to minimise anything going to baby anyway.
Good luck for Thursday - it’s a really quick procedure, will be done before you know it and then hopefully you’ll be able to let go of some of the worries.

Re steroids I was given them by an obstetrician in her words as a precaution, she told me the benefits can last some weeks, but more effective straight away. The thinking being that if I went into labour there wouldn't be time for me to have them and for them to take effect, due to the cervix being short and labour likely faster. Can only give my actual experience, it's not a recommendation..just a suggestion based on what I've been told by my own consultant.
Well done for deciding, hope it goes well. Keep us updated!

@island definitely would depend on individual circumstances but the up to date research definitely argues against giving unless reasonably certain of delivery in the next 7 days - the effect doesn’t last longer than that. its always a judgment call! And a balance because you’re right sometimes there’s not enough time. Just don’t want OP worried she should be having them if not offered, as her obstetrician should be well familiar with when they’re required.

Hi OP

Just been reading through your thread and wanted to give you a little bit of positive info about the stitch.

I had to have a stitch put in at 15 weeks as my cervix length at 14 weeks was already 22mm. I had lletz last year and it turns out they took a lot away (I had to really push to have this length scan done as my midwife said I didn't need it!! Turns out I really did) .

I was worried about having it done but but felt it was the best option. The procedure went well and the spinal wasn't too bad at all I was moving around about 2-3 hours after and then sent home. I was quite crampy that first night and next day home and there was some spotting (I was told to expect this) but apart from that I felt fine. My consultant also wanted me to take 400mg of progesterone (sorry for TMI but these were rectally to prevent infection). He said they would help to keep the uterus calm after the procedure. I stopped these at 32 weeks.

I'm now 34 weeks and everything has gone well so far. Obviously I have been worried but getting to each milestone 20w ,24w, 28w has made me feel much calmer. I'm now waiting for my phone call to have the stitch removed.

In terms of labour etc I have had to be very aware of any symptoms and have to contact the labour ward/ assessment unit straight away. I went in twice as things didn't feel quite right, the MW's were amazing and everything was good. My consultant has said that my labour could be quick and happen as soon as my stitch is removed but also there is a possibility of dilating slowly due to scar tissue from the Lletz but there is no way of predicting which way it will go. I have been assured that the MW's will be fully aware of my situation and take it all into account once I'm labouring.

I hope everything goes well for you. If you have anymore questions feel free to ask x