cervical stitch question

[jx0x0]

Hi everyone,

I am currently pregnant through IVF. During IVF my private clinic told me that when I get pregnant I should have a cervical stitch as my cervix is very scarred from a large LLETZ procedure. They also mentioned that I'd need fortnightly follow up appointments to check for infection after the stitch was put in.

I have just heard back from my NHS midwife who said that I would only need one follow up appointment after the stitch is put in.

I am confused by this contradictory advise. Has anyone had a stitch on the NHS recently - and did you have fortnightly follow ups to check for infection after the stitch was put in?

Any experiences would be really appreciated. Also I'd love to know what week of pregnancy you had to stitch put in too.

x

So it will depend on your hospital, you need to be seen in the pre term clinic which is consultant lead, ideally they should see lady's just after 12 week scan most won't see you until 16 weeks which in my eyes is to late. I pushed to be seen at 10+5 weeks scan measured 2.6cm ( short for gestation) normally stitch placed if u measure 2.5cm ( I had previous baby at 28 weeks so they were happy to do stitch)
They started me on progesterone 400mg at 11+5 weeks and I had stitch placed at 13+5, was seen the following week for cervical scan swabs and urine test, and will be seen every two weeks until 26 weeks or so medication until 36 weeks and stitch removed at 37 weeks if al goes well. Some hospital do just put stitch in and don't do fortnightly apps after.

Great group on fb incompetent cervix uk- pregnancy related xx

Hello,

I too have had previous preterm birth due to incompetent cervix. I am now pregnant with my IFV baby.

I was advised never to go off progesterone pessaries and will take them till 32 weeks

I have had one telephone consultation at 14 weeks where they put me on two weekly scans to check for changes to cervix (till week 26) and have discussed placing a stitch if it looks needed. So far no shortening but I gave my next consultant appointment Monday.

It’s all very scary but also reassuring to have the continued checks!

How far along are you? At your booking appointment the midwife will probably decide you will be consultant lead if your clinic have suggested a stitch is needed so you should be able to discuss with your consultant between 12-14 weeks. All hospitals have different techniques and follow up so this is probably why the midwife and clinic are giving different advice - I’m sure your consultant will be able to put your mind at ease.

Good luck x

Hi

I had an emergency stitch put in at 20 weeks (cervix had funnelling and had thinned to 16mm) due to incompetent cervix. I've had no previous procedures / history which would cause it but just got lucky it was caught at my 20 week scan!

I've been on 400mg progesterone since then and now I am 27+4. I've been having check ups every 4 weeks with the preterm clinic consultant who has been checking my cervix measurements.

Posted too soon!

The same day as the stitch I was sent home and thankfully had no pains/cramps, just felt super tired after such a long day waiting for it to be done.

My experience and check ups may be different having had an emergency stitch, as my cervix was already in the process of shortening and funnelling. Not sure if they advised less check ups as yours will be a more of a preventative stitch or just that each hospital does things a bit differently.

I hope all goes well for you and its good they have given you the heads up to get the stitch in early :)

I had a stitch with my son, after knife cone biopsy a few years previously - I had scans I every two weeks but only one or two consultant apps as long as everything went fine. Has it removed at about 37 weeks, no problem, went a week over!

Thank you so much for all your replies. It's so helpful to hear other people's experiences. I have an appointment with the pre-term clinic at my hospital when I will be 13w5d so hopefully they'll be able to give me some answers re. the follow up appointments they provide.

@cervixissues Is the progesterone you were given cyclogest? I am already on x2 400mg pessaries of cyclogest a day from my IVF clinic. I am taking these up until 12 weeks but may ask to continue longer if it will support my cervix also.

@jx0x0 yes it is cyclogest. That would be a good idea! I'll be asking at my 28 week midwife appointment on Friday how long I will need to take them and will report back. I do have another check up with the prematurity clinic obstetrician at 32 weeks then stitch removal at 36 weeks, so I'm assuming at either 32 or at the latest 36 weeks they will say I don't need to continue with cyclogest any longer.

I also have cyclogest pessaries to 32 weeks, gets to be quite a struggle!

I take 400mg once at night have been told to take until 36 weeks then stitch removal at 27 weeks

Thank you so much I am so grateful for all your answers.

For the ladies who have had stitches put in already can I ask a little bit about the procedure?

Did you have a general anaesthetic or just a spinal epidural?

Also, did you have to be on bed rest for any days after the operation?

And were you given any specific dos and don'ts for rest of the pregnancy?

It's so great to speak to people in a similar position.

Thank you so much, I feel less overwhelmed already.

I also had LLETz a couple of years ago and was simply warned that there is a risk of premature labour, albeit a small increase and that a stitch may be required to prevent this in the future.
I had my midwife booking appointment yesterday who didn't seem to know initially what to do but having sought guidance, they are referring me to a preterm birth department and a for a risk assessment.

Does everybody who has had LLETz need a stitch? I was initially quite chilled about it but now I'm flapping if it needs to be done before 16 weeks 😭👀

Is the procedure bad? 😭

So they tend to be done under spinal, they don't like giving pregnant women ga's if they can help it
The spinal is not bad at all I made the consultant do mine was all over in 3 mins ( u feel a warm feeling spread down ur bum and legs ) then ur numb and shouldn't feel pain, u can still feel touch and pressure ( I was aware they was doing something but it didn't hurt) think I was in theatre for about an hour all in all
There are different stitch's that are done most offer the mcdonald. If you look at the Tommy's website they have good info

www.tommys.org/pregnancy-information/premature-birth/cervical-incompetence

Depending on hospital u will have to stay over night but some do let u home same day.
With post operation instructions again will differ from hospital and also what job u do. My Personal experience ( I work in theatres, so very manual job on feet all day) I had two weeks off to recovery (Mainly just had a sore back for a few days and slightly sore lady's bits with slight spotting for a couple of days) then went back to work on light duty's, I have now gone on sick as it's not the right place for me to be until after baby is born. So no heavy lifting no baths no swimming no sex no long walks. So mainly at home sofa surfing.

If you have time read the nice guidelines about stitches

www.nice.org.uk/guidance/ng25

Also join incompetent cervix uk-pregnancy related on fb

And no @Twinkle1989 not every lady who's had a letz will need a stitch but should see a consultant to go though ur risk factors and for cervical scans to check length x

I had a spinal too, was very quick and easy - I was home the same evening and just took it easy for a few days, a bit of backache but otherwise fine. I didn’t take time off work (desk job) but if I have it again for this pregnancy I would take a few days as I rushed back I think.

Removal was really easy, no spinal and didn’t feel a thing!

Thanks @boymum88 ♥️
Praying to god it's not required but best to be safe!
That procedure is worse than what I thought 🙈 I naively thought it would be something like a smear done by the midwife 😂🙈 Christ I've got a lot to learn...!

@Twinkle1989 try not to worry until you have seen the consultant, take it step by step and if needed it's a far better option that having a loss or premature birth.
I personally feel it's better to have all the info so if a stitch is needed it won't come as a shock and you will atleast have a bit of of idea what they are talking about xx

@boymum88 oh certainly! I would rather know that's going on 😂 I was like that with LLETz and had to watch on the screen even though it was gross 😭

Are the scans uncomfortable? xx

This may be a long one but I thought I'd give as much detail as possible, hope it helps!

Based on no history, the Sonographer at my 20 week scan thankfully spotted my cervix was thinning (16mm) and funnelling too. Now 28 weeks and going strong!

I saw an obstetrician who confirmed this on the same day and strongly advised the stitch be put in asap. It would have been on the same day but they couldn't fit me in, so I was put on super strict bedrest until the stitch was put in 3 days later (only getting up to use the toilet or shower - luckily DH was working from home!) They also gave the 400mg Cyclogest to take from the day I had my scan and I am still taking it. I had to take the Cyclogest vaginally until the stitch, then rectally after that to minimise risk of infection.

From the night before the procedure, 2am onwards, I was told to fast, meaning no liquids or food. I had to get to the hospital for 10am and was scheduled to go for the procedure around 11am, but due to a few emergency C-Sections this got pushed to 5pm. I was starvinggggg! I did ask the midwives a couple of times if I am allowed a drink or small snack but got told I can't. The anaesthetist was a little annoyed when he came to see me before the procedure as the midwives should have popped an IV on me for the day at the very least.

So the anaesthetist talked me through his side of things, how I would be having a spinal block and that the most common side effect is a bad headache the next day. He also emphasised the backaches that are commonly mentioned are usually due to having to stay still for so long not due to the spinal.

Once I'd got my gown etc, I was taken to the theatre. Spinal was fine, I did feel a little prick but really was nothing to be scared of (I was expecting it to be quite painful!) He did have to fiddle around a little as I did feel multiple little jabs but it really wasn't a big deal. Not long after I had pins and needles/numbing feeling in my bum then legs. He used a cold spray to check if I was totally numb before anything happened. A midwife was present and even pinched my leg quite hard to show me just how numb I am compared to my arm. I felt her doing it but no pain in my leg.

The rest of the theatre "crew" came in - must have been around 10-ish people all with their own jobs. I didn't feel super exposed and they did pop up a sheet below my chest so I could only really see the anaesthetist, who was monitoring and syringing into my cannula when needed. I did get the shakes which were odd but fine!

Felt a little bit of tugging but barely, and literally no pain at all. Once the procedure was done they showed me a quick ultrasound of baby and I was moved to recovery. The whole thing must have taken 45min - an hour max, the procedure itself around 15-20 mins.

Once I was taken to recovery they just monitored me every 15 mins and all was well. A Catheter was put in during the procedure which I didn't feel at all. It was removed in recovery and just felt a bit odd but again no pain. They wanted me to eat, try to walk about and be able to release at least 150ml from my bladder - this all happened within 3 hours and I could go home (10pm). So although I was there all day, technically from the procedure to being discharged was 5 hours.

I was told to continue with bedrest, cyclogest (rectally), no sex, nothing going into the vagina. I have had 2 follow up checks by obstetrician (every 4 weeks) and the stitch has been holding up so far with cervix being at around 19-20mm.

After my 27 week check up I was told I can just have sofa rest and take it easy, no heavy cleaning/ minimise stairs / only carry light stuff around. The rest of the no sex etc still holds unfortunately!

I would advise drinking loadssss of water - I've been aiming for 3 L per day and found I didn't get any headaches, cramps or constipation during the strict bedrest and it is also good to keep up fluids anyway during pregnancy!

Each experience is completely different and advice will of course be tailored to your individual situation. Hopefully you won't have to do bedrest (it is a hotly debated subject but I followed the consultant's advice and it was an emergency/rescue stitch rather than preventative).

@Twinkle1989 not really can be a little bit uncomfortable when the probe goes in but is fine after and the scan doesn't take very long 5-10 mins on the plus side u tend to get a Wee peak at baby to

Thank you so much to you all, especially @cervixissues for your super detailed account. So helpful!

I have my stitch booked in for the 8th January and feeling more confident now I've heard your stories.

No problem! Hope everything goes well and happy to help if you have any other questions

Hi everyone,

I have recently had my cervical stitch put in. All went well and seems to have healed nicely.

My mind is beginning to turn to my birthing plan. I am trying to decide between vaginal birth and planned c section. Would love to hear what other ladies with cervical stitches think on the matter. Have you been advised either way on this?

I would also love to hear any post stitch birth experiences.

Thank you

Glad it all went well x
My consultant hasn't really talked about a c section. Had a quick chat about taking the stitch out at 37 weeks and then basically ur like a normal pregnant women and can either have baby in midwife birth unit or up on consultant lead unit.
Think she will go into more info the next time I see her and get a date booked in for the stitch removal
No right or wrong have to do what u feel is best for u and ur family, but I would rather have a vaginal birth due to the recovery as c section is major surgery and not something I would personal pick 1st, if it's midwife lead or consultant lead I'm undecided xx

Thank you so much for your reply @boymum88. It's good to hear from someone who is a few months ahead!

I would also want to have a vaginal delivery but was wondering if anyone had been advised against it following a stitch? I am probably being over cautious but I just wanted to check in with this group as it is so helpful to hear stories / experiences from other women.