Cervical length scans

[Hildy1994]

For a bit of background… This is my 3rd Pregnancy. I had a LETTZ procedure done a few months before my first pregnancy. Because of this i had cervical length scans between 16 and 22 weeks (roughly) in pregnancies 1 & 2. I didn’t go into preterm labour with either. This pregnancy, they have changed the hospital’s policy and are now offering one one scan at 20 weeks. I was under the impression you would have at least 2 scans to not only measure the length, but to compare the measurements to see how quickly the cervix is shortening.

For my own peace of mind, i had one done privately at 18 weeks. The measurement was 41.8mm which seemed a good length. However, I’ve just had my NHS appointment and it’s now 3.4mm. To me that seems like it has shortened quite a lot in 2 weeks. They didn’t seem concerned by the length, and I don’t think I’ll be offered any additional cervical length scans. Does anyone have any experience of this?

thanks xx

I had them done at 18 and 24 weeks (slightly late) due to previous CS at full dilation. Mine had shortened significantly between the 2 and I was put on progesterone pessaries until 34 weeks- I think the measurement was 24mm but wasn't measured again. My due date is in a couple of days so not sure if the pessaries did their job or cervix would have held up anyway!

Your measurements are a lot longer than mine, and I've only had one

I had LLETZ before pregnancy and had to have a cervical scan, I was scanned at 16 weeks but that was the only time as they were happy with the length

Mine went to around 3.4 at that gestation, I had a shortening cervix in my first pregnancy and like the previous poster went down to 2.4 and ended up on progesterone pessaries until 36 weeks. I questioned that it had shortened to 3.4 from 4ish and the consultant wasn't worried and said they was a perfectly normal length for that gestation. I was given progesterone as a precaution from 14 weeks due to the first pregnancy but all was fine

It’s not so much the length that I’m worried about, but more the amount it has shortened in the space of two weeks. I have had a look on google but i can’t find anything that says if this is normal or not. I know some shortening is normal as the pregnancy progresses, but my worry is how will they know if it shortens again (and ends up too short) if they don’t do a follow up to compare? I may not need any treatment now, but I’m only 20 weeks and how will they know of that changes?

I have only had one CL scan on the NHS this time. The one two weeks ago i paid for privately. I did this because in my two previous pregnancies you were given at least 2 scans (NHS) to compare the measurements to check how quickly the cervix is shortening. The consultant at the time told me this.

When I questioned it this time, i was told they have recently changed their hospital policy. Unfortunately it’s probably to cut costs, as i can’t see how that would benefit patients in any way.

@elb1504 that’s great news that you’re close to your due date and everything is going well. It’s impossible to know isn’t it, but good that they put you on the pessaries just in case. I think 25mm or under is when they treat, so it makes sense. I’m obviously not at that stage but I won’t be offered any scans at 24 weeks so won’t know if my cervix is shortening or not 😔

That’s interesting. So you had a shortening cervix the first time but not in your second pregnancy? Do you think it shortened less the 2nd time because of the progesterone?

I think it hasn’t helped that nobody has actually explained it to me. The lady who did the scan was great but didn’t go into detail about the rate that the cervix shortens. She just said anything under 25mm is treated, anything over isn’t, and they don’t bother checking the length after 24 weeks as the baby is classed as viable.

Possibly, also I had 7 years between pregnancies, mine shortened from 3.4 to 2.4 in my first pregnancy within a week, I can't remember the timeline it did in my second, I've got pics of my notes somewhere and will try and have a look for you. Are you consultant led?

That’s what i my concerned about tbh. Mine is 3.4 now but how can anyone possibly predict how much it will shorten again?

Yes i am under a consultant because of the LETTZ and 2 previous c sections. I’m not due to see him again until March though. I don’t feel cert confident in him as he didn’t offer growth scans even though i have a history of small babies. My midwife at the GP checked my notes and wasn’t happy about it, so flagged it up and he agreed to do them from 32 weeks.

They have told me i am ‘intermediate risk’ for preterm labour, so not high or not low. I appreciate that having carried to term in my last two pregnancies is encouraging, but no pregnancy is the same. Even if the risk is small, it’s not one i feel like i should have to take with no reassurance x

Sorry to jump on your thread but can I ask what this procedure is like? I'm booked in for one in a couple of weeks and feeling a bit nervous about it.

Which procedure? The LLETZ or cervical length scan?

@Hildy1994

First of all I assume you mean 3.4cm or 34mm?

Secondly the scan pathway was changed based on evidence and research. It doesn’t actually save money as high risk women now have more scans and intermediate risk women less. It’s based on the fact that unnecessary interventions, often with risks such as premature rupture of membranes, infection etc. were being performed based on ultrasounds performed at the incorrect gestation.

It’s done at 20 weeks because this is the time that the cervix is under the most pressure from the uterus, so if the length is sufficient when under pressure it’s less likely to lead to a preterm labour.

Has anyone showed you the QUIPP app?
It’s what we use to calculate your risk of preterm labour. It’s more accurate when used with fibronectin levels but it can be used for asymptomatic cervical length scans also. Hopefully this will reassure you.

The cervical length scan

The cervical length scan is quick and painless, it’s just an internal ultrasound to get a more accurate view of the cervix x

Hi, thanks for your response. Firstly, can I ask if you are a medical professional? It sounds like you are from what you’ve said but you didn’t mention it in your post.

Yes 3.4xm/34mm (typing error)!

Surely high risk women should have more scans anyway? They shouldn’t need to reduce the care for women who are classed as intermediate risk to do this. Me having a repeat cervical length scan would in no way cause ‘unnecessary interventions’. It would either give me peace of mind, or could potentially indicate a problem that needs treatment that could be life saving for my baby.

I understand that having the scans too early can give an inaccurate indication of preterm birth, but equally many women go into labour or need treatment before 20 weeks (who have had a similar procedure to me).

I appreciate you taking the time to share this information with me. Your post does offer some reassurance. However, the hospital have a duty of care to listen to, and discuss patients’ concerns. That has not happened in this instance.

I don’t think anyone can 100% predict the risk of preterm labour as every individual case is different. Ultimately it’s me who would have to live with the consequences of something going wrong (even if the chances are small).
I don’t think a repeat scan 2 weeks later is an unreasonable request.

My situation is a bit different - I gave birth prematurely at 19 weeks in September, our baby boy obviously didn't survive. So, I'm considered very high risk for it happening again. All tests came back clear, so there is a problem with my body rather than an outside factor having caused issue.

They found blood clot on the maternal side of my placenta and bands of inflammation in the placenta as well, but can't say whether those things were there before I went into labour, or whether they were caused by labour/birth itself. I also had bladder retention that I had flagged three times, but no one believed me; it resolved as soon as I gave birth. I started experiencing Braxton Hicks contractions from 16 weeks also.

Due to these things, they've put me on cyclogest and I'll be on it until 36 weeks to try and prevent my uterus from contracting too early. They will also try aspirin from 12 weeks and start doing cervical length scans from 16 weeks fortnightly until 24 weeks. This is the NHS' 'wait and see' policy. I had a consultation with a Tommy's consultant and he has recommended cervical length scans weekly, not fortnightly, and has advised us to seek them out privately if the NHS won't provide them weekly. Sadly, they won't do a preventative Cerclage in case it wasn't a cervical issue and prefer to do one in an emergency should my cervix shorten.

I think possibly the reason they'd approach our cases differently is that you've had two successful pregnancies, neither of which appear to have been affected by the procedure you had previously? However, I also completely understand your concerns, having been through the worst possible scenario and having my life ruined by no one listening to me about my concerns what was happening to my body.

Is there a possibility for you to have a scan privately for peace of mind?

Thank you for your message. Firstly, I’m so sorry to hear that you went through such a devastating experience. Sending you lots of love. I am glad to hear that you are being closely monitored during this pregnancy. At least if you do need an emergency stitch the scans will identify this so you can receive the appropriate treatment. Although I appreciate how nerve wracking it all must be for you after a loss. Are you going to have the scans done privately in between your fortnightly NHS scans?

I had a private cervical length scan at 18 weeks (as I had in my previous 2 pregnancies through the NHS). Unfortunately, the hospital have disregarded it completely, saying they don’t take the results of the private scans into consideration. I have actually booked to have one done privately at 22 weeks (in 5 days time), which will be two weeks after my NHS one at 20 weeks. If the scan result is reassuring then great, but if there is cause for concern, I am terrified that I won’t be listened to by the hospital which will leave me with no options.

It’s definitely encouraging that I have carried to pregnancies to term, which puts me at intermediate risk rather than high risk. However, even if the risks are small, in my eyes it isn’t a risk worth taking for the sake of an extra 2 minute scan. There have been no discussions with me about my care going forward despite me raising concerns. It just shows a total lack of compassion and patient care. I’m really disappointed with the hospital and am seriously considering changing to a different one. I will be having my 3rd c section, which I am sightly nervous about, and have really lost faith in this hospital.

Thank you @Hildy1994 It has been the worst time of our lives, and we will never be the same. I wouldn't wish it on anyone.

I totally get your concerns, I'm sorry I must have missed the bit about the private scans earlier. It's infuriating how different one hospital or trust can be from the next. My hospital don't love it, but they will take private scans into consideration depending on the situation. For example, in my last pregnancy, I was measuring quite a bit ahead than my dates given by LMP and they'd booked my 12 week scan for when I'd have been past 14 weeks. I had a private scan that showed this as 10 weeks and called the hospital to let them know I was measuring ahead via private scan and they'd booked were happy to book me a new scan date based on those results.

I think if a new hospital can provide you with the care you want/need vs the care your current hospital see as adequate, then it's definitely something to consider. Of course you want to feel safe and listened to. You could also consider a PALS complaint as they may be willing to reassess as part of the improvement plan.

I have just been discharged from the pre term birth team. As 3 cervix checks transvaginal have all come back normal. I'm now 23 weeks. Could you get a private scan at a private hospital, that way you take the results to your consultant?

I understand that the hospital would have to do their own checks, but to disregard a private scan is just ridiculous. If i had received the correct level of care from the NHS (like i did in my other pregnancies) I wouldn’t have needed to have one in the first place.

My GP midwife had emailed the consultant directly so I will see of anything comes of that. She has been fantastic and has picked up on a few other things that my consultant missed. I am seriously considering changing hospitals, but I will be 22 weeks next Friday so can’t see myself getting a scan at a new hospital within 5 days. It all feels like an unnecessary stress atm.

I sent an email to PALS this morning, but again, I’m not holding out much hope for a resolution within the amount of time I should be having the scan.

Thank you for sharing your experience, I can imagine it must have been difficult to talk about. I appreciate your advice. Wishing you all the best in your pregnancy xx

May I ask what your cervical length measurements were and why you had been referred to the pre term clinic? Did the length shorten between scans or were the measurements all pretty similar?

There aren’t any consultant lead clinics locally to me that I know of unfortunately. The clinic that I go to is owned by an specialist sonographer who worked at a nearby hospital (for over 20 years) in the preterm labour clinic doing these scans day in day out. So for her measurements to be totally disregarded is ridiculous.

I can't remember measurements sorry. Just mine were within normal range and hadn't moved. My uterus is a certain shape so at risk. But both my previous children were not born early, planned c-sections so that was a factor.

Hey I would push for a second scan. My cervix was 3cm at 19 weeks and went down to 1cm at 21 weeks and I needed an emergency suture. Things change a lot between 18-21 weeks xx

This is my concern, especially with it already shortening between 18 and 20 weeks. I am pushing for it as much as I can but I’ve been told no twice. I’m finding the whole thing really stressful and feel like I’m banging my brick wall

Agree with this. Also unfortunately I could have written @KittyFantastica's post. Lost a girl at 20w.

Then when pregnant with my daughter length was fine at 20w5d, exactly 2 weeks later literally a few min, dilated and membranes bulging through. Emergency cervical cerclage bought me another 2 weeks. But unfortunately in that 2 weeks despite having had antibiotics to reduce risk of infection from cerclage I did get an infection and both baby and I had sepsis. By some miracle she survived and is doing well.

Current pregnancy I had a trans abdominal cerclage put in before getting pregnant. I am checked weekly albeit privately.

In your shoes definitely keep pushing but for your own peace of mind I'd get private scans in the meantime if you can as things can change very quickly.