Help, consultant appt at 19 wks for previous section at full dilation-why?

[yoghurtmap]

I have been given an appointment with a consultant obstetrician at 19 weeks and I don't know what it's for! Wondering if any midwives, DRs or women who have had similar can advise?

The appointment letter doesn't say what it's for, I asked my community midwife and she didn't know. Have rung hospital twice to enquire and was put through to a midwife on one of those occasions. Was told the referral is due to previous c section at full dilation (which is correct re my history). Admin staff member said there will be a scan (although was also told by the midwife a separate letter should come through if there is to be a scan, which it hasn't). Midwife couldn't tell me what the appointment is for, just what the referral note said.

I have the standard abnormality scan appointment booked at 20 weeks.

Community midwife said I would have appointment to choose between elective c section and vbac at 36 weeks - I have that appointment booked also (and the letter includes vbac information so is clearly for that). She wasn't expecting me to have any other consultant appointment.

Why would I be getting a scan and consultant appointment at 19 weeks due to previous emergency c section- what will they be looking for?

Thanks

Above probably not clear- it was the hospital midwife who told me what the referral note said - the reason the appointment has been made. But couldn't say what the appointment is actually for.

I was consultant-led for DS after an EMCS with DD. But I had the appointment straight after my 20 week scan, not separately.

I think it's standard to be consultant-led after a previous c-section. No idea about the extra scan though!

I’ve just had this. It’s a new thing they’ve just introduced. My midwife didn’t know about it either. It’s to check your risk for going in to labour prematurely. I think the new thinking is having a c section at full dilation can affect cervical length. You have an internal scan, then a thing that’s a bit like a smear, then you have a urine sample done. They put all the information into a programme which gives you an estimated risk. If your risk is low you go back and have the exact same done 2 weeks later. If it’s low again you’re discharged. If it’s high you get closer monitoring.

Oh, that's quite fascinating!

Oh crikey I'm glad I asked on here, rather than turn up and be surprised by an internal scan and smear-like procedure!

I guess this information would have been in the second letter, which has gone awol (appointment is very soon).

@Fueledwithfairydustandgin do you remember if there were specific instructions for the internal scan, in terms of bladder fullness? Or any other preparations or instructions I should be aware of? Don't have much confidence in getting anything sensible out of hospital if I try to ring again.

Thanks so much for the info

Anyone with a previous cesarean is automatically referred to the consultants. If there are no other factors that make you high risk they will put you back under midwife led care.
I have my appointment booked to see the consultant 4 weeks after my dating scan, letters are all electronic at my hospital so have come through fast. I've been under consultant led care in my last 3 pregnancies for 2 large babies and then twins, it just means you have all your appointments at the hospital rather than what can be multiple locations with the midwife team.

Yes you need to go with a full bladder for the scan and you have to do some big coughs while they’re scanning you which is a risky business 😳😂😂 I think that was the only instruction

I forgot you also get an extra scan while you’re there too which is a nice bonus

I had the same, it’s to check your cervical length and if there was any damage to your cervix during the section which could mean having a preterm labour. No instructions were given re: bladder etc. I didn’t know what the appointment was for either until I turned up. I wasn’t seen again as everything was fine. They also took a swab to check for infection.

Thanks all. I had no idea c section at full dilation risked damage to cervix and pre term labour ... interesting. It was a difficult section delivery as DC's head was strongly impacted- it took ages and DH said obstetrician was panting at the end of it (I did not notice this but I was really not with it to put it mildly)... so perhaps there could be damage.

Anyway very glad I asked rather than turn up unprepared, thanks all

I would phone ther mw and find out. But the above makes sence.

@june2007 neither my community midwife nor midwife at the hospital could say what the appointment was for. Hospital midwife was able to say why the referral was made but not what the consultant would be checking. I mainly rang to see if it could be a phone appointment rather than face to face, and midwife couldn't say either way . It does sound like it's to assess pre term labour risk, and it's reassuring to know that before hand

It’s relatively new research that has to come to light so not all midwives are aware.

I also had an EMCS but at 9cm and I've not heard of this new thing about seeing a consultant to check for cervical length. I have requested an ELCS this time due to traumatic labour, which ultimately resulted in the c-section but was told I wouldn't see consultant until 28 weeks. Is it worth me checking about this with my midwife also? I'm not sure if the difference between having a section at 9cm or 10cm makes difference to potential cervical length issues, but now I'm a bit worried.

@yoghurtmap

Thanks all. I had no idea c section at full dilation risked damage to cervix and pre term labour ... interesting. It was a difficult section delivery as DC's head was strongly impacted- it took ages and DH said obstetrician was panting at the end of it (I did not notice this but I was really not with it to put it mildly)... so perhaps there could be damage.

Anyway very glad I asked rather than turn up unprepared, thanks all

I had that issue with DD. They really struggled to get her out. Was your DC facial presentation or just wedged in general?

@NoWordForFluffy not facial no, back to back and deflexed head/neck - was trying to present through cervix at widest part of head, didn't fit and got jammed in pelvis. Now I have to decide between vbac and c section and wish there was some magic third option where baby just appears

These babies don't half make life awkward!

I'd already opted for ELCS, but I'd have had to have one anyway with DS as he was a transverse lie, so clearly uninterested in a standard exit!

Click fingers, baby appears? Sounds good to me!

Just to update as had appointment today. It was indeed to assess pre term labour risk. Assessment involved: (1) urine sample (2) vaginal swab for fetal fibronectin and (3) internal scan to measure cervix length.

Results were combined into an overall index of risk, mine was very low, apparently lower than average risk of pre term labour for a first time mother.

Doctor involved said not all trusts offer this assessment at all, some offer just one appointment if low risk, my hospital offers a further check even if low risk, so I will be invited to another appointment in about 4 weeks.

Have terrible insomnia so completely forgot to ask about two things I had intended to - (1) why c section at full dilation increases pre term labour risk and (2) Whether breastfeeding increases risk (still breastfeeding older child although DC has hugely cut back during pregnancy)

Thanks to those who responded as I would not have been keen to have an internal scan sprung on me. Good to see baby's head on scan and confirmation of heartbeat as I can't feel movements yet.