Pregnancy and previous LLETZ

[Ohmydreams]

Hey I know I've asked about lletz before.

I am pregnant and found out my lleyz was 20mm deep which is high risk. They are going to measure it at 18weeks. Did anyone else have this level of depth and have a healthy pregancy (with or without a stitch)

Really looking for reassurance thanks

Hello, yes I had an A1A carcinoma and 2 x Lletz procedures to remove it (I'm not sure of the depth of the removal, but apparently the back of my cervix is pretty much non-existent.

During my first pregnancy the pre-term labour team were unsure how my cervix would hold. Initially it held well (I was scanned fortnightly from 16 weeks) but at 22 weeks they saw such a dramatic shortening that I needed an emergency rescue stitch which went in at 23 weeks. The follow up care will depend on the hospital, but I had quite a few restrictions. The stitch was then removed at 37 weeks and my cervix held until 40 weeks (completely surprising my consultant). I was induced at 40+1 (IVF pregnancy) and I laboured incredibly well (9 hours in total in the pool) and left without a tear. Not sure if that was all to do with the short cervix, but it does have its major benefits!

So long as you're under the care of the pre-term labour team and you're being scanned regularly you'll be fine as theres a tight procol for this. If you want any further info about any of the above just shout! I'm on pregnancy number 2 now (22 weeks) and I have a cerclage again put in much earlier at 14 weeks. All good so far.

Good luck 🤍🙏🏻

Aw thank you for coming back to me and I'm.glad yours went ok. And good luck for this pregnancy too.

I have my first scan at 18 weeks to check the length. Tempted to go private at 16 weeks,don't know why they aren't doing it at 16.

Mine is also an ivf pregnancy.

Good luck!

Thanks,I have booked a private cervical length scan for 16 weeks,mine isn't until 18 weeks. I'm so nervous 😓 i really don't want to put any pressure on my cervix !

When I had my daughter they found (by chance) at around 17 weeks that I had a short cervix but I can't quite remember the measurements. I'd had previous lletz treatments which they knew about but the plan was to just check the length at my 20 week scan.

I had the arabin pessary fitted (an alternative treatment to the stitch) at around 18 weeks, it was done very quickly after they realised my cervix was short. After it was fitted I went back every week for a while to just check it was working.

The pessary came out at 36 weeks and my waters went at 37 +4, and everything was fine ☺️

I'm pregnant again now and they tried to say they'd just measure it at 20 weeks but I've pushed and now in the pre term clinic on Monday for a review and I'll be 14 weeks.

If you can I'd push to be seen earlier xx

Hey I gpt seen this week atm all ok,just over 4cm. How did you get on? Hope everything went OK

How did you find out how much of your cervix was removed, may I ask? I had a lletz a few years ago and then my son was born at 31+2. I wasn't being offered additional scans of my cervix, I didn't get a stitch or hormones etc. It was just never picked up until it was too late and I was in labour. I'm now pregnant with my second (only 12dpo, testing positive since 8dpo) but wondering if there's a way I can find out if I have a short cervix early to be prepared? Lletz was never confirmed as my reason for premature labour so I'm a little anxious with the unknown.

Best of luck to you BTW! X

I told my midwife at booking appointment,she put me on the shared care pathway and I seen a consultant for my 12 week scan,they had my medical records there and were able to see what was recorded etc. They recorded it in my notes and told me I'd be seen at 18 weeks.

I ended up getting it checked this week and atm all looking ad it should. I'm getting it privately checked at 16 weeks too.

Was it never mentioned in your last pregnancy ? They might look into noq when they see you had lletz and went into labour at that stage. Best of luck to you

@Ohmydreams 4cm is great! I don't remember mine ever being that thick.

@HRHXO I followed the same protocol as above but I didn't have my medical notes (I've moved around the UK) and had to apply for them from the hospital where I had the LLETZ. I'd do that ASAP as it can take 4 weeks. This will be where youll find what they removed etc.

Good luck!

I don't know anyone in real life so I can only Google lol.

Did you have to get a stitch or pessary again last week or are you ok ? 🤞

Was this for me @Ohmydreams ? Yes both pregnancies I've had a stitch and will do again if I have any more.

First pregnancy - rescue stitch at 23 weeks and it was removed at 37 weeks (cervix then held until my due date which was pretty remarkable) and I had a really positive birth 🤍

Second pregnancy (I'm now 24 weeks) stitch was a preventative stitch put in as early as possible (14 weeks) but that's based on my history. They wouldn't have acted so quickly if I hadn't had quite a lot of intervention with pregnancy 1.

It's quite a worrying process, but as long as you're under consultant care with the Pre-term labour team you'll be fine. So many research reports on how well the stitch performs as a antidote to short/weakened cervixes.

Hi!
congrats on your pregnancy. I found this stage the absolute worst as I two was really worried about my cervix post lletz for both.
just wanted to offer a reassuring story as I scoured the internet for reassurance but found you mainly find the scary stories.

I was diagnosed with cin3 in 2018 and required a lletz under general anaesthetic. It was a large excision with 18mm removed.
i have had two completely healthy pregnancies since then. First was an ivf pregnancy and I delivered her at 37 weeks exactly after my waters went a few days before- I obviously assumed early delivery was due to lletz but I’m currently sat here at 40 weeks pregnant and baby seems very comfy in there. Delivery was very straightforward last time, very quick.

i had my cervix measured both pregnancies. First time was really anxious so self referred Tommy’s and had about 4 scans. Lowest measurement was 31mm. This time had my cervix measured privately at 18 weeks and was 27mm, cue massive panic but had gone to 30mm 2 weeks later so I decided to trust my body and it’s all been fine. Make sure you get the cervix scans but I hope this offers some reassurance that a large lletz doesn’t always mean issues in pregnancy.

@Pud90 40 weeks, congratulations! It seems we've had a really similar experience and also great to hear that you birthed so well with your first! Please keep in touch about your current pregnancy's labour, i really want to feel confident going into labour (currently 24 weeks) but i keep thinking my first quick labour was a fluke, and not a benefit (probably the only one!) of having a short cervix!

I also found it really difficult with pregnancy 1 to find similar women in the same boat. There's quite a good US Facebook group @Ohmydreams if you want the daily comradery, but be warned, showing pictures of premature babies seems to be quite common practice which can be a but upsetting when you're heavily pregnant. Also a lot of support / cheerleading, so each to their own!

@CreativethinkersTequiladrinkers thanks for sharing thats reassuring. Don't know if I couls join that group or not I so get anxious about things maybe later on in my pregnancy I will.

@Pud90 thanks for the update I also had mine under general and 20mm removed so just slightly more than yours,did you ever get a stitch?

Do they measure up to 24 weeks does anyone know ?

Nope didn’t need a stitch for either pregnancy luckily. It depends on the policy in your area. The saving baby’s life’s guidance puts lletz as “intermediate risk” and recommends “at least one cervical length scan between 18-22 weeks”. So where I am they offer only that, one scan over those weeks and if it’s short they will monitor more frequently. The majority of people who have even had a large lletz like us dont end up needing a stitch- I’m a doctor and did obs and gynae for a bit and never saw someone with a stitch, it just feels like it happens all the time when you look on forums because the people who don’t need it tend not to post about it. But obviously amazing that the monitoring is there and there is a treatment if needed!

Hey @Pud90 hope everything went well for you and baby.

Juat thought I'd update this encase anyone else searched like me.

I was measured at 4cm,4 weeks later I was 2.9cm so I've been put on progesterone due to the reduction.

I'm 21 weeks and will be on it to 34 so just hoping everything goes ok. I haven't been giving any guidance or anything. We have decided no sex encase it would cause any issue.

So glad that you are being looked after and that everything looks ok. I found 18-24 weeks the hardest time. Hopefully once you get to 24 weeks you can breathe more easily and start to enjoy the pregnancy more. My first pregnancy I felt once I got to 30 weeks I really just relaxed and finally accepted that hopefully this was it for me!
2.9cm is a really good length still though. I was 2.7cm this time and baby didn’t come until 40+3! And that was with no progesterone or stitch. Are they measuring you again? Hopefully it will stay that length and if so you can take great comfort in that length for rest of pregnancy.

update from me- ended up going overdue , had a sweep at 40+3 where I was 4cm dilated with bulging waters. Unfortunately admitted from there as blood pressure high. Was in hospital whole next day waiting to be induced but didn’t need in the end as when they examined me 24 hours post sweep I was 8cm dilated. 2 hours later was 10cm and baby arrived soon after. Barely had any consistent contractions at all before 10cm so once again a very quick and relatively pain free labour which I like to think is due to having a shorter cervix which dilates more easily! So maybe all the worry during the second trimester pays off for
me during delivery! She was 8lb 1oz so clearly cervix strong enough to hold quite a big baby- which I think is a good example of just because your cervix is shorter than average doesn’t mean it’s not strong.
i really hope the rest of your pregnancy is joyful and relaxed and that in 18-20 weeks time you are holding your besutiful baby and all of this worry will be behind you.

Hey, your measurements are nearly identical to mine. I am currently 21 weeks 6 days and measured 29mm. At 18 weeks my cervix was also over 4. How did you get on?
I haven’t been offered progesterone or any other scans, but wondering if i should push for it.

thanks x

hi

2.9cm at that gestation is a good and normal reading. They only start worrying if it gets to 2.5cm and even then they usually don’t act straight away they tend to watch and wait. That measurement is similar to mine in both my pregnancies at the same gestation and I went to 37 weeks first time and 40+3 second time. Cervix was actuslly shorter second time round but I went overdue. Just because the cervix is a bit shorter post lletz doesn’t mean it isn’t strong.
I wudnt be pushing for treatment at that level as progesterone vaginally can be irritating and there isn’t really any evidence for using it after a lletz (the treatment tends to be a stitch as it’s thought to be a mechanical cause and therefore a mechanical fix). If you’re anxious I would ring them again and ask if it’s possible to have another scan in a week. The cut off for any stitch is 24 weeks and you’re almost there so they likely won’t offer scanning after that. If your in London there is a tommys clinic at st Thomas’. You can get referred via your gp or you can just call up the Tommy’s midwives for advice if feeling anxious- at that level though I think they will reassure you.

as for the reduction since 18 weeks- was it the same person who did the scan and were they both internal with empty bladder? It’s a very difficult scan and there is a lot of discrepancy between different clinicians. The cervix is also dynamic and can change in length often, so it doesn’t necessarily mean it has dropped from 4cm to 2.9cm and that it will continue to go down. The strongest evidence for preterm delivery is cervical length 20 -22weeks and most centres consider above 2.5cm at this gestation as perfectly normal and adequate and would discharge .

trust your body and know that the majority of people have perfectly normal and health pregnancies after a lletz.