Monitoring cervical length ‘wait and see approach’

[Dixie17]

I had lletz treatment 6 years ago. Mentioned this to my midwife who booked extra scans to monitor the length of my cervix.

Had my first appointment and went in totally unprepared. I measured 27mm and was told this was absolutely fine and come back in two weeks.

Cue furious researching (Googling) and 27mm is actually borderline needing treatment (stitch or progesterone)

Wondering if anyone has had similar experience?

@Dixie17 I can’t share my experience, but I’m worried about similar, only I was told my cervix was ‘most likely’ long enough and they wouldn’t even check! I had a LETZ 5 years ago and really feel like it should at least be checked once 😕 I’ve got my 16 week appointment on Friday so maybe I’ll try and bring it up again and ask to be checked. Great they are being so thorough with you, hopefully you won’t need any treatment but at least if you do you know baby will be nice and safe in there x

Hi @MintGreenLife I’m turning 16 weeks this week too.

Care seems so different hospital to hospital. From what I can see 1 lletz is unlikely to be too much of a risk unless they took more than 10mm...I’m note sure how much I had taken off but to have 27mm left does seem very short...

It is in the nice guidelines to offer monitoring so you could raise this if you want to push for a scan.

I’m wondering if short cervix= incompetence. Or if I’m likely to need a stitch at some stage...I’d rather just have it now!

Who did the scans? I had my cervical length scans done by the consultant, have you been referred to a consultant? It's good that they're doing it again in two weeks. I had my first cervical length scan at 21 weeks and was 3.4, when I went back the following week it had shortened to 2.4, I was then on progesterone pessaries and had weekly scans up until 29 weeks then fortnightly after that, signed off at 32 weeks as DD was engaged and cervix was soft and released back to midwife care at 36 weeks, pessaries worked for me.

My lletz was done 9 months before I fell pregnant and I had around 1cm removed

Hi @annlee3817

That’s really interesting, thank you. Seems it can shorten so quickly! I’m glad to hear it worked for you...and a less invasive treatment.

It was a sonographer who saw me, not had chance to speak to anyone about it yet. I’m just really surprised she said it looked absolutely fine..another 2mm and the guidelines say offer stitch/progesterone. Counting down days to go back for my next scan and see if I can speak to someone about treatment

Hi I've not had lletz but I'm having my cervix monitored because of my last birth and cervix damage from that.

How often are they scanning you? You cant have cerclage after 24weeks so try and push for another scan in advance of this.

Mine is fine at the moment and I'm 25weeks on wednesday but it's been nothing but worry so far. I'm counting the days to get to 30 weeks where I will feel safer

I have incompetent cervix but no LLETZ or prior cervical procedure. 2.7 is definitely borderline and I would recommend a stitch over monitoring because cervical length can change very quickly. A preventative stitch has a better success rate than a rescue stitch.

If you are on Facebook please join Incompetent Cervix UK - a group of very knowledgeable women. Sadly I found them after losing my DS but I’m not sure my rainbow DD would be here without their advise and handholding.

@Dixie17 thanks for replying. Apparently I only had 7mm off, so maybe it’s not necessary to have it checked. Hope you continue to get good results from your follow up scans, but at least if you do need treatment it’ll be the right thing to do for you and baby x

@Dixie17 I'm 35 weeks now and they took the same approach as you. My doctor said they wouldn't see the impact of the baby until 20 weeks and that left 4 weeks for them to use a Stitch if needed.

Alsoooooooooo she said Lletz around the time we had it was the lowest risk - it's if you had it the old school way it was even more key.

Google can scare us!

P.s no stitch and they were always happy as long as it was more that 2.5

I would push for a stitch - it's just not worth the risk of stillbirth/late miscarriage for the sake of a stitch in my opinion. I'd even consider going private for that if I was in your situation - I had a friend lose a baby quite late in the pregnancy that could have been avoided with a simple stitch and it was devastating. Sometimes (especially with public healthcare) you have to be a bit demanding and advocate for yourself, and this is one of those times I think it is worth it.

I was found to have an incompetent cervix after some spotting and a few appointments. I also had Lletz treatment 5 years ago, and only happened to mention it in passing to my midwife at my first app, she actually wasn't too worried but made a note of it.

It was only after going to EPU with some spotting that I I was referred to a consultant as I was 19mm so much lower than they'd like, I had the choice of either the stitch or the arabin pessary (a plastic pessary that sits over the cervix to keep in it place).

I went for the arabin pessary (also with daily cyclogest pessarys), and two weeks after having it fitted my cervix had gone from 19 to 23. I'm now being monitored every 2 weeks to make sure all is okay.

I'd definitely push for the scan and measure, it's much better to treat as early as you can. But mine wasn't put in until I was 20 weeks. I'd never even heard of it before all of this, but it's more common than I thought x

I had lletz years ago then had ivf. It was noted during my ivf that I had a short cervix. Every appointment I went to I mentioned it and was told it was fine ect. They told me they would measure at 20 weeks. Got to 15 weeks and decided I wasn't happy with that so called midwife who emailed the consultant who agreed to see me. Got measured by the sonographer who measured it at 2.3 so I had to wait and speak to the on call dr. She was very unconcerned about it and wanted to wait until 20 weeks but I pushed for progesterone which she agreed to. I now go back on Friday to be remeasured at 20 weeks and will take it from there.

Thanks for all your replies ladies.
I had my first scan at 14 weeks and have my next one coming up at 16 weeks followed by a midwife appointment so hopefully plenty of chance to ask questions.
I do find it scary how care changes so much from trust to trust..so much better going in armed with a bit of knowledge. So thank you for sharing your experiences.
Really have freaked myself out thinking I’m going to have a late loss..At least I have a bit of time act..the next scan might give me some answers 🙏🏼

Push for the stitch 2.7 is very close to the threshold of 2.5 and things can change very quickly with incompetent cervix.
I had my 1st son at 28 week due to undiagnosed ic, he came very quickly and was very poorly. this time i made then see me at 10+5 weeks was 2.6 so had a stitch placed at 13+5 and put on progesterone, cervix then went up to 3.2 and was looking fab until 28weeks, I have now started to funnel down the the stitch with a length of 2cm. If I had not had stitch put in then baby would have been here.
Do not let them fob you off it's ur body and baby. Preventive stitches work a lot better than emergency stitch and are less risky.
Sadly hospital and consultant care is widely different. Some are really on top of it some don't seem to give to shits and and happy for lady's to loose baby's before they will be proactive.
They should ideally be doing two scans one at 16 weeks another two weeks later ( I do feel these should be done sooner)
Like other pp said join the fb group, so supportive and knowledgeable

Incompetent cervix is hugely minimised by HCPs in my experience. Even after having had a loss at 21+4, I was told many times in my next pregnancy that it wouldn’t happen again (guess what, it did - but because I was aware of what could go wrong, I pushed and pushed and thankfully did not have another loss).

Just because in most cases it’s fine doesn’t mean that all cases are fine and I didn’t want to be one of the unlucky ones that fell into that gap when preventative precautions could have been taken.

Good luck OP x

I had lletz 6 years ago. Mentioned to midwife. Had scan and internal scan at 22weeks and it was 24.2mm and they wanted 25 mm (I think). They put a stitch in just after 23 weeks and I've had it removed today at 36+5