Cervical cerclage

[anotheronettc]

Hi All,
I'm currently 27 weeks and the consultant has been monitoring the length of my cervix regularly due to a previous lletz procedure.
This is my first baby.
So at 25 weeks my cervix was 26.5mm so he gave me progesterone pessaries to use every night. My 27 week scan today showed in some places my cervix was 28mm, some places ,26mm some 24mm and some 21mm. They have to take the shortest as a precaution but he didn't suggest this is urgent. There was a tiny tiny opening of my cervix but again he wasn't worried about rhat. Basically the decision has been left in my hands, have a stitch or just carry on with the progesterone. I'm not asking for anyone to tell me what to do. I'm just asking if anyone has experienced similar a what decision did they take.

Right now I'm swaying towards not having it. My midwife says I'm processing towards more and more viability and she's not even sure how much good it would do at 27 weeks given that they are normally done much earlier.

Having said this. I'm doubting myself and terrified.

Supportive positive thoughts welcome xxx

I was given this choice too, it was so so hard and it was during spring 2020 so I had to go to the appointment and decide by myself. I didnt have it- my measurement was 21mm too and I was already on progesterone. I was about 20 weeks then though so not viable if I had gone into labour. They actually stopped monitoring my cervical length once I got to 24 weeks because they said then they would be looking at prepping for a premature baby and further monitoring was pointless. I decided that I would rather do nothing and risk losing my baby than make a choice to do something that might also cause me to lose my baby. I would also have had to have a general anaesthetic for the cerclage which I wasnt keen on. I went into labour at 34 weeks and would probably make the same decision again re the cerclage. The consultant told me that the risk of it causing miscarriage was something like 1/100 but that if I was that 1 person that lost their baby I wouldn't thank him for telling me to have it. It is a really tough call though and I wasnt really given any medical opinion or advice to help me decide!

@Walesrecommendations Thank you so much for this comment. May I ask, as your baby was born at 34 weeks were there any further complications, is your baby okay? Did you deliver normally? It's such a difficult decision to make and it was quite clear that the consultant and midwives didn't want to be held responsible for any outcome which I completely understand. However as I have no medical training whatsoever it's a big decision to take on your own.

I was led to believe that most places don’t offer a stitch after 24 weeks. I had a stitch at 12 weeks, it started to fail at my 20 weeks scan as they could se funnelling. I had a second stitch the following week and it got me through to 24 weeks. It’s not been easy but my DD is doing well. There’s a Facebook group called Incompetent Cervix UK and you will get lots of great advice from very knowledgeable ladies that have gone through all this before.

She was fine, she spent 13 days in special care but didn't need help breathing or anything. Shes 18 months now and on the 91st centile so very much has caught up developmentally. I was induced after my waters broke at 34 weeks and she was born as normally as any labour goes I guess! I don't know if the cerclage would have helped in my case anyway, they said they take it out if you go into pre term labour anyway! One thing I would say is take it really easy, lots of lying down and resting. I was too active and despite people saying it would have made no difference, I think I overdid it and might have kept baby in longer if I'd sat down more!

@blueroses99 yes I'm surprised at that too, I didnt receive any further monitoring once I got past 24 weeks. I also thought the cerclage was most effective when put in early. Also OP, thinking back, is it more risky when baby is bigger? I know the consultant wont give you a steer in either direction but you can ask as much as you want to make the most informed decision you can.

@Walesrecommendations yes I think it may be riskier when the baby is bigger. I also agree that taking it easy and staying off your feet can make a difference - effect of gravity and the weight of the baby on the cervix etc. Glad everything worked out for you and your DD.

@Blueroses99 so I had it measured at my 20 week scan and it was 3.6 mm so they said will measure you again on your 24 week appointment. I then got Covid so couldn't be seen until 25 weeks which is when it was at roughly 2.6 mm so they said they'd see me again in two weeks just to check it again as it was so close to the threshold of 25mm. I've got I feel as much advice from them as I possibly can. But it's kind of an impossible decision. I think I will probably say no to the cerclage though but make sure that the consultant is happy with that. It's a really difficult one for them because it's fine in some places, over 25 mm, but in other places is it shorter

@Walesrecommendations I'm really glad to hear that and very happy for you. I guess as I'm at 27 weeks and Its not urgently short, hopefully it will not come too early. I did ask my consultant about what level of activity I should be doing and he said that from what he's seen bedrest makes it worse and to just keep your normal routine. But as my back and hip pain is so terrible im finding that I'm sitting down a lot of the time to be honest and I agree about taking it easy.

Nothing been said to me about having a big baby… I don't know maybe my local NHS does things a bit differently but they did say unless I have it this week I won't be able to have it when I'm 28 weeks. Very strange, me and my husband are trying to gauge whether they were trying to suggest Subtly that I should have it or if they were trying to say I probably won't need it. And we were both completely perplexed! Basically they have no idea what will happen as it's so borderline.

I’m feeling confused now having read this.

I’m 22.5 weeks and due to have my FIRST appointment to look at my cervix in 2 weeks at 24.5 weeks. Have also had lletz and loop diathermy but by the sounds of what I’m reading here it’ll be too late to do anything if my cervix isn’t measuring well. The name of the clinic is the preterm baby clinic… I haven’t even had the choice of the cerclage. Does it vary by trust or something? Or maybe it’s because I have already carried a baby to term post cervical procedures?

I just assumed they could put the stitch in whenever…

@anotheronettc There are other options such as progesterone and Arabian pessary which might be worth asking about. Your measurements sound OK to me. Not an expert though of course but there are lots on the group that I mentioned that report 1cm or less, which would be more worrying. It’s good that you are being monitored. (I haven’t had a LLETZ or any procedures on my cervix so I wasn’t monitored and had a second trimester loss before I had a stitch for my DD.)

The only thing I would caution is that in my experience, pre-term birth is widely minimised by healthcare professionals at all levels. Please make sure to advocate for yourself and your baby if something doesn’t feel right.

@DragonMovie they are offering me one at 27 weeks so if you need one you'll have the choice at that appointment I imagine. I think things do vary between each trust though. Each case is different etc.

@Blueroses99 thank you for this, and yes I've been taking progesterone for 2 weeks and they seem to think they are doing their job.

@DragonMovie See my comment about minimising, often the preferred approach seems to be wait and see 🤷🏽‍♀️ However many women have no issue after cervical procedures and having had a full term pregnancy so you may be considered low risk in that respect.

After my loss, I was promised a stitch at 12 weeks in my next pregnancy. However the pre-term clinic originally didn’t want to see me until 16 weeks and told me that I probably didn’t need a stitch, until my GP got involved and sorted it all out with the consultant. As the stitch didn’t even work properly (I must be some strange anomaly!) there’s no way my DD would be here at all without it.

I agree with @blueroses99, I was told when very first pregnant that I needed cervical length scans from 15/16 weeks but had to ring several times at this gestation having heard nothing, and explain to numerous midwives why I wasn't just being over anxious. I ended up finding my consultants email address online and emailing her directly, fortunately she sorted it out. This was my first pregnancy and they did say several times that progesterone or the cerclage were equally effective with no history of loss which I didn't quite understand! Anyway, if your cervix is varying lengths this could also make it harder to stitch I think? Apparently they kind of wrap thread round and tie it shut, so they need a good amount left to tie. I know they say not to do bedrest and I wouldn't go that far but no heavy lifting or ahem painting as I was doing half an hour before my waters went!