Cervical cerclage/stitch advice please

[ZxrH888]

Hi ladies
Really hoping for some advice as I'm feeling out of my depth.
In January of this year I had a second trimester loss at 16 weeks - I had to be induced to pass baby and baby had died in the womb shortly after my 12 week scan. I was seen by recurrent MC clinic shortly after and now that im pregnant again been put on aspirin, clexane (for abnormal TEG results) and progesterone for spotting.
Given my last loss I was seen my prematurity team and the consultant basically said to me theres isn't strong evidence my cervix was the issue but if I want a cerclage hes more than happy to do it.

My worries regarding the cervix is due to

1. there wasnt a lot of fluid around my baby when they discovered the loss - so potential painless rupture of membranes
2. Despite the induction - I had a painless dilation.

I know those two things can point towards an incompetent cervix. But I also feel torn on what to do as nothing is 100% and I just dont know if its worth doing it if I'm not 100% sure the cervix was the issue.

Has anyone had any similar experiences? The consultants essentially offering to do the procedure or wait and watch (of course that comes with its own risks)

Any advice would be appreciated!

I’m sorry for your loss. How far along are you now?

Honestly it doesn’t sound like a primary cervical issue last time - if you needed induction at 16 weeks when baby had passed a few weeks prior, then it would not have been the cervix that caused the loss. The low fluid is common to see when baby has passed, and also doesn’t mean there has been a leak/cervical incompetence.

Available evidence would say a stitch in your situation won’t make a difference - you already have a very high chance of everything being fine this time round. There is also good evidence to say that a “watch and wait” approach is equally as safe as a stitch, with the benefit of avoiding surgery in most cases. That would usually mean cervix length check at around 12-14 weeks and again 2 weekly from 16-24 weeks. If the cervix was shown to shorten <25mm then you have a good reason for a stitch.

Hope that helps and all the best.

Thank you so much for replying!
Im currently 11+4, I guess the anxiety of the what if's is really getting to me and making me think to just do it to have that possibility covered - but your right it doesn't sound like a cervical issue and avoiding unnecessary surgery would be ideal😫

I had similar but different reasons (basically knew cervix wasnt the problem but wanted a stitch anyway). Went under oxford preterm team and was strongly advised to do a watch and wait approach with cervical scans every fortnight. In the end my cervix was fine, actually lovely and long on the progesterone and baby was evicted for pre-eclampsia with no signs of shortening at 34 weeks. I'd watch and wait in your case x

Ah thank you! Thats very reassuring to hear so glad it worked out for you😊

My mum had this with her first pregnancy -- she lost the baby at 19 weeks. She did have to be induced despite being diagnosed with cervical incompetence. She then had a cerclage for both me and my younger sister and both pregnancies went perfectly. I do think there is more reason to do it for peace of mind than not do it.

Hi I had a loss at 19 weeks in my last pregnancy. I had been bleeding which caused my waters to go but no actual cause for the loss was found. I'm now 16 weeks and I'm having consultant appointments every 4 weeks where they scan my cervix to check the length. Has this been suggested to you? It's called the pre term prevention clinic. I completely understand the anxiety, I've now hit the point things started going wrong last time so I'm an anxious mess!! Really hope we both have successful outcomes this time 🤞🏼

I guess this is why there are trials on this topic though - because for your mum you don’t know whether she would have also been fine without a cerclage. Used to be that lots of cerclages were placed but actually they’re not necessary a lot of the time - even when the one previous loss seems to be definitely due to cervical insufficiency, you need to place 6 cerclages in order to help prevent one preterm birth; and when comparing head to head either elective cerclage (based on history alone) vs surveillance with cervical length, equally as safe to just watch and only place stitch if cervix shortens, with benefit of saving unnecessary surgery.

PRoM can happen due to cervix opening prematurely causing an infection. That's where was suspected in my case. However a 12 week loss is unlikely to be due to incompetent cervix.
In my case after my first loss at 20 weeks, my cervix was measured at 14 weeks, was borderline (24mm) so they went ahead with cerclage.
I was very grateful to have the cerclage, it put my mind at ease. I have a friend whose doctor waited till 16 weeks to check and the cervix had really shortened by then

Hi
Im so sorry for your loss,
Yes I was referred to pre term clinic and they basically said to me they are going to keep a close eye with cervical length scans and are happy to do the stitch too if I feel that will give me peace of mind - so long as NIPT results come back fine
Fingers crossed for a good outcome this time🤞🏼

Hi
So sorry for your loss
I went through similar (21 week) and I was told probably not IC due to history etc. Also as tested positive for blood factors. Put on Clexane etc. Hospital agreed to monitor cervix weekly from 16 weeks and I did indeed turn out to have an incompetent service as it was opening from 21 weeks when pressure put on the scan. I had an emergency cerclage and made it to almost fullterm.
With my loss I had leaking of membranes for a while before I think and I ended up with sepsis and chorioamnioitis.
With hindsight i would take the stitch as I think it is riskier done late on. Wishing you all the best.

I had a loss at 20 weeks when I was ironically 200 miles from home at a family funeral. My waters broke. Cause was unclear.

With my daughter I was being scanned every 2 weeks just in case to check cervix length. At 20 weeks all seemed fine. Went back 2 weeks later and was dilated, bulging membranes etc. had an emergency cerclage. My consultant made clear it wouldn't hold for long as he had had mm to work with and had done what he could.

Fast forward 2 weeks to the day, I had my daughter at 24 weeks. Unfortunately despite having had antibiotics when having the cervical cerclage put in place my daughter and I both had sepsis (she is a strapping 3 yr old now).

Post pregnancy I was strongly advised to have an abdominal cerclage if I was thinking of another child. That held and I had my son earlier this year at full term.

Perhaps in your case you could wait (have bi weekly scans) and see. But keep in mind there is a risk things could move quickly further down the line.

Hi,
Thank you so much for sharing and so sorry for
your loss. I do think having it done earlier as precaution would give me some peace of mind as otherwise i'll just be anxiously waiting for something to go wrong😩