Short Cervix - should I insist on a stitch (discovered after red degeneration fibroid)

[Lola39]

Hi all, first time poster here. I am currently 21+4 and it’s been a bit a journey to get here (3 miscarriages pre 12 weeks) and years of trying…but it finally happened for us. I’m 39 and will be 40 when the baby hopefully arrives healthy.

Reason I say hopefully, is I ended up in hospital recently with a red degeneration fibroid - the pain was crazy! I’ve never felt so poorly. 10 days later I finally was allowed home but during the process of determining what was going on with me, they discovered a short cervix that went from 1.9 on first scan to 1.2 4 days later…

We were terrified and they started talking preterm, survival etc so I was highly emotional, especially as I was in severe pain (morphine didn’t even help) after bed rest and cyclogest 400mg (twice a day) for 5 days it’s increased back to 1.8.

I am currently under a preterm clinic and still in the cyclogest, I had a scan last week at 2.1 so it’s going in right direction. Given I’m finally not in pain I can start to think straight and more positively.

I know I’m far from out of the woods, it’s still causing me endless anxiety and I’m also terrified to move. I am just so worried.

The stitch wasn’t offered when I was in pain and the risks but given pain has now subsided I thought that they would offer me the stitch now but they feel if the cyclogest is working we carry on. Maybe I should trust the process but after week 24 they won’t offer the stitch so I feel when I go back this week for my follow up if it’s not moved from 2.1 should I insist…

I am so scared to be in this situation given my history but I feel totally overwhelmed with knowing what’s for the best. Any stories out there that could help me make my decision or push for the stitch .. the consultant said some women have a short cervix and they don’t know and go full term.. really, how would they know that after birth..

sorry for mammoth post, it’s been a traumatic time x thank you x

I'm so sorry you've endured all this stress, do you have another length scan booked in to check on it? If you do (and assuming it's soon) if it's getting better I'd probably rely on the progesterone only. If it's got worse, or not got better I'd push for the stitch, or at the very least get them to justify why you wouldn't benefit from the sitch. Anything below 2.5 is considered short and requires treatment, if it's not lengthening to an acceptable level with just progesterone then as far as I know guidelines are you should have the stitch.

This all being said, they may have a genuine medical reason with the fibroid why a stitch wouldn't be appropriate in this circumstance. But if that's the case they need to explain that to you.

Let us know how you get on x

Thank you so much for your reply @LavenderSweetPea really helpful - are you a midwife, you sound very informed.

yes I have a cervical length scan this Thursday and will be 22 weeks at this point. Praying for an improvement so I know baby is going to be ok and my quality of life can improve. Feeling so bloody miserable as don’t feel I can do much apart from sit and worry. I usually exercise which I enjoy but I’ve had to stop it all, I’m like a recluse so I really hope it’s all worth it .

I certainly will update 🙏🏻 thanks again x

@Lola39 I'm not a midwife, I work in a really boring office job! Im 26w myself and had cervical surgery a few years ago. Because of that I've also needed regular checks on cervical length so I got myself clued up in case I needed to advocate to have the stitch as well. Fortunately in my case progesterone worked and length stayed above that 2.5 cut off so I didn't have it. Lots of people on this board have had the stitch though, it's surprisingly common so if you do end up needing it and have questions about the procedure/recovery there's plenty of people here who would be able to answer questions about it.

Knowledge is power @LavenderSweetPea!! I am pleased you have maintained, the cervix is so important and it amazed me it wasn’t going to be measured but only so as these fibroid issues.

I hope you are having an enjoyable pregnancy, you must be due Feb 🩷🩵 it will whip by now especially after Christmas!

I would push for a stitch. I was offered one (and had) one at 21 weeks as my cervix was under 25mm - still only made it to 29 weeks but the doctor was of the opinion I wouldn't have made it that far. Have you had fetal fibronectin testing - it can give a good indicator of how likely you are to give birth shortly? I did a lot of research into the cervical stitch and it does seem to statistically significantly increase your chances of holding on for longer.

Thanks so much @GingerKombucha - I haven’t had any fetal fibronectin testing, I will ask on Thursday when I go back. Nobody has mentioned it.
i feel they are trying to suggest 2.1 is progress but from research it still appears so short…
may I ask was it your first baby and how you discovered you had a short cervix? They told me If I get to 28 weeks baby should be ok?
xxx

If born at 28 weeks, your baby will very probably survive and eventually be fine but will have a significant amount of time in NICU, have breathing problems when both and an increased risk of many long term conditions. I now have a healthy 2 year old born at 29 weeks but she's both lucky and has had quite a few health problems linked to prematurity over the last two years. You definitely want to get as far along as you can. It was my first baby but I had previous LLETZ surgery on my cervix so was under the pre-term team from the start.

Thank you @GingerKombucha, i am so pleased to hear you have a healthy 2 year old. I can imagine you have been through it x

I haven’t had any surgery or anything so it was fluke they found it.
i will speak to them Thursday, I think the benefits of the stitch out way the possible risks they told me.

Out of interest @GingerKombucha did you just have the stitch, or were you using progesterone as well? Also, did they continue to check your cervix after 24w? I've got a growth scan in a couple of weeks and I was wondering if they would check my cervix then as well. I know it'll be too late for a stitch but it would be great for my peace of mind if I knew it was still over 2.5

Let us know how you get on at your appointment @Lola39

Not as short, but with DD1 my cervix went from 3.4 to 2.4 in a week, they didn't do a stitch as I had already has a slow leak from my hind waters and the stitch at 23 weeks would have been risky and could have possibly ruptured the membranes, so I would have had to be admitted on bed rest for the rest of the pregnancy. I had progesterone pessaries, regular check ups and at 31 weeks was signed off and put on bed rest until I reached term as she was engaged and cervix soft. Stopped the pessaries at 36 weeks, in that week I dilated to 1cm, then she stayed put right up to 40+5. I got some good advice from a website called keep em cooking. If they don't want to do the stitch ask them to tell you why, what are the benefits of not doing it etc

Was on progesterone from the very start of my pregnancy and was monitored weekly after the stitch and on bed rest.

Thank you for your response @annlee3817

Wow, just shows you that you can still go all the way.

How did you find out you had a short cervix if you don’t mind me asking?

I’ve been on bed rest but I’m getting so restless and bored! Im usually very active so its driving me nuts!

Thanks for the advice, it’s appreciated and helpful xxx

This is a really interesting post so thank you for posting this @Lola39 . I am sorry to hear you are not having the best of support and like others if I was you I would ask all the questions as to if a stitch is possible sooner rather than later. I have had 3 different procedures on my cervix in the last year and my doctor told me to mention to midwife next time I was pregnant (previous miscarriage at 7 weeks) my midwife was not concerned but I urged her to refer me. She has but has said appointment could be from 16 weeks - 22 weeks (I am currently 16 and half weeks). I feel like others, petrified to leave the house, walk etc. Can I please ask anyone with cervix issues when did you have your first appointment to measured etc? I have a midwife appointment tomorrow and was going to bring this up as my mental health is really suffering so any advice would be really appreciated!

I would push for an appointment, I had fortnightly appointments from 14 weeks.

Thank you @GingerKombucha I will chase this up tomorrow.

I had cervical length scans due to having lletz 9 months prior to falling pregnant. Then I had some bleeding plus the leaking of waters so I had more scans off the back off that which is how they picked up that it was shortening

Hi All,
My midwife has chased this up with the consultant and they have said I do not need to be seen due to my lletz only being 10mm whatever that means and they look at anything above 15mm. They are not worried about the fact my coil had to be removed from cervix wall after this due to dislodgement as doesn’t think this would cause any issues.
Would you be happy with this?

@Emilyj13 10mm isn't a large lletz - I know that research suggests 10mm and under doesn't put you at any increased risk so from that alone I'd say you probably don't need to worry. But you said previously you'd had 3 procedures, was that 2 lletz and this coil removal?

If you've had more than 1 lletz at any size I wouldn't be happy without a follow up scan. If it's just the 1 at 10mm I'd leave it. I dunno anything about a coil removal, but I assume they can't have removed any of your cervix with that procedure?

@LavenderSweetPea thank you for your response.
The other two were 2 procedures under general to try to remove the coil which eventually they did so at the time they just mentioned that the cervix had received a lot of prodding in the last year and may be effected and when I then miscarriage 2 months later my doctor told me to inform midwife of all of this if I was to get pregnant again.

@Emilyj13 I'm sorry about your losses. I know it can cause so much additional stress. Weak cervixes from my understanding tend to contribute to late miscarriage (after 14 weeks at least) and preterm labour because the cervix basically isn't strong enough to hold baby in. If this sounds like your previous loss then not a chance in hell would I go without regular cervical checks. If the losses were early I would guess it's unrelated to your procedures but if I'm honest after what you'd been through I'd just want the checks anyway for my mental well-being as much as anything.

If the consultant has already reviewed your situation after the midwife referral and said the checks are not required (assuming they have the details of not just your lletz but also the coil removal and the previous losses) then they probably aren't from a physical point of view and I doubt they'll budge on that but you can press it with your midwife again. Is there any chance you can get yourself to a private scan place? Some of the ultrasound direct clinics offer cervical length scans - I went for one private one between NHS appointments and it was all very professional, it might give you some confidence that everything is fine (or if it's not you'll be fast tracked back to the NHS for treatment).

@LavenderSweetPea thank you, you have reassured my worrying brain.
My last miscarriage was at 7 weeks so I don’t think related.
I will see if I can get anywhere private as I did say to my midwife my mental health isn’t good as I’m worrying so much after the last loss but that hasn’t seemed to make any difference.

Thought I would share an update, I had a scan and saw the consultant this week. My cervix has remained at 2.1 which they say is stable as there is no funnelling. Whilst I was happy it hasn’t gone backwards I was really praying for better news.

I asked about fetal fibronectin testing. They aren’t willing to do at this stage, said that given they feel I’m stable, there isn’t any other indicators why we should do it.

The stitch still isn’t an option, they feel the risks are too high as I now have increased severe fibroid pain from another fibroid that has increased from 3.5 to 8cm.

I’ve been prescribed co-dydramol for the pain and been told if it doesn’t ease, I need to go back into hospital for observations - I really am hoping these meds do the trick as the thought of a hospital stay again is causing me serious anxiety.

I’m back for follow up screening cervix in 2 weeks…

So it’s another 2 weeks of praying and resting 🙏🏻❤️