Cervical cerclage

[Iggilypiggily]

Hi there - any one other have any experience of a cervical cerclage? And if so, what was your experience of getting it?

I have had two previous cervical surgeries so my cervix is shortened and I was told I have increased risk of miscarriage. The only issue is that I also have fertility issues and am doing IVF.

What I’ve read online suggests they will wait to see if your cervix holds up and then if experiencing miscarriages they will then consider it, but I have low AMH and am doing IVF so I feel I don’t really have the option to wait and see. I appreciate no one wants to experience a miscarriage, but it will be a miracle if I’m pregnant once never mind trying to consider it a second time.

Any one got any info or experience with this?

I had two premature births and for my third pregnancy i had my cervix measured at various points, had cerclage (stitch) put in at around 21 weeks at it was seen to be shortening . Had to weigh up risk of the procedure though as there is a risk in the procedure itself. DD arrived at 36 weeks though and all was fine . Worth discussing as soon as you are pregnant especially with your history . For me there was no ‘wait and see’ approach & no previous miscarriages .

Thank you! That’s really helpful. I appreciate the response. That’s good to know - Dr Google seemed to give the impression it would be something I had to fight for and may not get without a history of things going awry first.

How did you find the cerclage itself? I mean, I am in the middle of IVF so I’m sure I’ll be and to handle it! I’m poked and prodded every day as it is.

Thanks again for getting back to me!

It was ok, a little nerve wracking given the risk, but they did it with an epidural so I didn’t actually feel much at all. So the procedure itself was straightforward. It’s doesn’t seem very common (I’ve never met anyone else who had one) but I do feeling it’s worth asking for if you or anyone else reading thinks they need it . I do think it helped baby stay in for longer than they would have without it !

Hi OP, can totally understand where you're coming from, you want to treat any possible pregnancy as conservatively as possible. It's not exactly correct that if you experience miscarriages they'll only help you then. It's more that in cases of recurrent miscarriage, one of the investigations might be to check cervical length. If an issue is found with cervical length or competency then they can treat it.
However, if you already know you have a cervical length/competency issue, then the approach is different.
You should flag it early on with your care provider and should be referred to a special clinic, often called preterm birth clinic or something similar. That's how it works in my hospital anyway. They do serial cervical length measurements and if it shortens to a certain level then a cerclage is recommended.

When I filled in the booking in form one of the questions was whether you had any risk factors for premature birth and some types of cervical surgery were one of the boxes you could tick. I got referred to the pre-term birth clinic for another reason and will also be getting cervical length measured as described above.

Thank you so much everyone! That is so reassuring and helpful.

@Lavenderandlemons that makes a lot of sense why I misinterpreted what I read online, so thank you for clarifying that. That’s definitely useful to know. And @wishIwasonholiday10 thank you also. You have no idea how things are done when you haven’t experienced it before so that would also make a lot of sense that they would check for it! And I hope all goes well with your risks too and you don’t need it.

@Nicflowers82 thanks for that - very unhelpfully my YouTube decided to bring up a video of an epidural needle on my for you page, no idea why anyone would want to see that before they might be getting one! But I guess I’ve got to get through the IVF and fingers crossed that works first and then I’ll cross that hurdle!

Much appreciated everyone x

I currently have a cerclage, though not due to previous surgery on my cervix. If you have any questions, feel free to ask.

You will only need one if your cervix begins to shorten, it’s not an automatic procedure for anyone who has had previous surgery unless you have virtually no cervix left.

When you self refer or refer via GP (however it works in or area) you put info about any risk factors you have - there’s usually a question about previous pre-term births or cervical procedures. You put the details in there. They will then determine your risk factor and book you in for cervical length scans from 16 weeks. Those usually happen every 2 weeks. If they notice significant shortening and/or measure you below 25mm at any point, they may discuss progesterone and/or cerclage.

The procedure itself was unpleasant for me, my body had trouble accepting the spinal, and I found the catheterisation painful and uncomfortable, but it’s nothing to the comparison of losing a baby. I lost my last baby at 19 weeks due to premature labour starting for unknown reasons. It wasn’t classic cervical failure because I didn’t have painless dilation, but they told me to try again and that it was unlikely to repeat. I got to 16 weeks in this pregnancy and started having the same symptoms as last time. No doctor in the country can see to find out what’s wrong, so they’ve tried a stitch as a last attempt.

Surgery whilst pregnant sounds scary (and it is) but if your cervix is short, I can guarantee the alternative is scarier. Good luck.

Thanks for that really informative response! I was told at the point of my second surgery that I would be significantly at risk as it was essentially halved and they did mention cerclage to me at the point of my second surgery (when I was in my early twenties and wasn’t thinking about any of this) so I do think I would need to be considered.

As I’m doing IVF I’ll be on progesterone anyway and I have had enough catheters and things shoved in and out to date to know I’ll probably not get along with it very much at all, so that’s useful to know that your experience wasn’t pleasant. I’ve been told enough times that I’ll feel something and felt nothing but excruciating pain when having scans and saline scans and catheters inserted through the cervix so that is helpful to know that it can be pretty horrible so I’m mentally prepared! But just got to actually manage to get pregnant first, quite a few hurdles! It’s like I’m not supposed to be a parent!

cerclage is more usually done with a spinal type block (lowish dose or 'saddle' block) rather than an epidural and the block should be checked before the surgeons get to start - it would be normal to feel something is happening, but it shouldn't be painful if the spinal is working. Epidural needles and spinal needles are not the same. (doi: anaesthetist)

Hi

I had short cervix and did IVF.

I opted to have the permanent cerclage which is generally placed prior to pregnancy (it involves more of a surgery as it’s placed right at the top of the cervix).

When I had recovered I then had IVF, my IVF consultant did a “mock transfer” to check that they could get past the stitch to implant the embryo, and this was fine. I was also sedated for embryo transfer to ensure I was relaxed.

I am assuming you may have a cerclage placed in pregnancy which is far more common. Usually supported by progesterone too as is the norm with IVF, but I got my GP to continue prescribing my Progesterone until the end of the pregnancy as there’s good evidence that it supports the cervix. Also if your GP prescribes your progesterone, it’s far cheaper than the IVF clinic!

My cervix was checked fortnightly during pregnancy and I was swabbed at the same time to rule of the risk of infection which can cause the cervix to open prematurely. Did this until 27 weeks.

Like you, my cervix was shortened due to previous surgeries and unfortunately I was not aware until I lost a pregnancy late on when my cervix opened prematurely. If you know that you already have this then be sure to speak to your doctor as soon as you are pregnant, if not before, to ensure this is effectively monitored in pregnancy.

I was also supported by the Tommys pre term clinic in London St Thomas’ hospital, who are very good at understanding the risks associated with short cervix in pregnancy. I self referred to them, I do believe that there’s another Dr called Dr Simpson who works in Leeds who offers the same.

oh, and my cervix held strong and I delivered healthy twins each weighing just over 5lbs! So the stitch does work! X

Good luck! XxxX

Thank you @brassbedknobs this has been the most helpful thread I’ve ever been on on here, I really appreciate it, everyone.

Sorry to hear about your loss, that must’ve been so difficult. But also really good to hear a positive outcome for your twins! I’ve always had a feeling I would have twins so perhaps our stories will be similar.

I have low AMH and thinner than normal lining so everything you’re saying is like music to my ears. Not many people on here seem to have IVF background and the short cervix issue too so that’s so good to know. I will definitely be requesting it. I did suspect if I was ever pregnant I would be a bit of a risky one. I’ll be taking all of your advice. And I’ll happily take your luck too! I am actually based in London so I will look into that if the time ever does come.

And @Greybeardy thank you for clarifying! I didn’t even think of an epidural being involved until someone mentioned it earlier on so that’s a helpful distinction to know after seeing that horrific video of the epidural needle! I can relax a little

I lost my first baby in March, he was an IVF baby, 26 weeks, he lived for 2 days. I had placental abruption but also they think a weak cervix. I’ve been told in future pregnancies I can either get preventative stitch at 12 weeks or get scanned every other and if it shows signs of shortening then get a stitch. Progesterone whole way through pregnancy x

I’m sorry for your loss @Tor410but I hope having a plan for any future pregnancies brings some comfort. I know how challenging it is to prepare yourself for another IVF cycle after a loss.

Hope you don’t mind be suggesting, but I had a pre pregnancy stitch and then when I was pregnant I pushed for injectable progesterone (lubion) as well as the cyclogest pessaries as I wanted to be sure it was being absorbed.

wishing you all the very best xx

Hello, just wanted to update.

I had a cerclage placed at 18+6 in this pregnancy after monitoring and a previous loss of our first son at 19 weeks.

My waters went one night two weeks ago, and our second little boy was born at 33+1 first week of August. We’re currently still in NICU, but we wouldn’t have made it that far without the stitch.

Sadly, his birth was very traumatic and I needed a Cat 1 EMCS under general to save our lives, so I don’t remember his birth. The surgeons afterwards said that there’s no reason we can’t go on to have more children, and recommend a preventative stitch next time to see if we can get further. I’m not sure if we’ll ever try again, but thought I’d pass on their thoughts here.

Good luck x

@KittyFantastica Hi, can I ask how many weeks you are now? I too lost a baby at 19 weeks and I'm currently pregnant again (10 weeks). There were no issues with my cervix last time, I just started bleeding one day that led to my waters going. I'm just wondering if I will need a stitch too? They couldn't find a reason for why I lost my baby, everything appeared normal. You say you experienced similar symptoms this time - what wee they? Sorry for all the questions but obviously I'm very anxious and just want to try to prevent the same happening again this time 🙏🏼

@KittyFantastica oh sorry just seen your update! Congratulations on your little boy!! So glad you made it that far and I'm sorry the birth was traumatic 😞 I hope you get your little boy home with you very soon!! x

Congratulations @KittyFantastica on the birth of your little boy, you both did very well to keep him in until 33+ weeks! I hope he gets strong enough to leave NICU soon and that you can both be home soon and start to enjoy life with him . Take care of yourself and keep posting on MN if you need any support, I know the days and nights in NICU can be so exhausting physically and emotionally ! Sending lots of love and support xx