At risk of preterm labour due to short cervix. Anyone have any advice?

[IsItMe24]

So I had a consultant appointment today (under due to 2 previous c sections). I was just expecting to go through my birth plan but it was to assess the length of my cervix which they said was only 1cm. I’m 22 weeks. Apparently it should be more than that when you’re going into labour, so I’m high risk of going into preterm labour. I was really shocked so didn’t take it in at the time but I have to make a decision by Friday what treatment option to try. Has anyone been in this position? The options are do nothing (which I don’t think is a good idea from the way they spoke), a cervical pessary or a cervical stitch. I don’t know how I’m supposed to make this decision.

I have been in this position - Twice.
First pregnancy at 22 weeks they noticed my cervix had shortened and I had a cervical pessary which was a rubber band around my cervix. I did bed rest then from 22 weeks till 37 weeks.
I declined the stitch as it can do more harm than good and actually damage the waters as there is not much cervix left to work with.
My second pregnancy they noticed shortening much earlier and I went for progesterone pessaries which were a miracle worker for me - My cervical length grew and increased from Thursday to Monday, And was back to normal length for that gestation and stayed strong for the rest of the pregnancy.
I definitely recommend the progesterone pessaries to start straight away - I am surprised they didn't offer them to you. I was on a high dose and used x 2 a day which I think really helped.
Good luck and keep us updated 🙏🏽

I would personally try the pessary first. The stitch whilst obviously helpful, likely won't hold another 16 weeks so I'd try alternatives first.

@Lillybobs86 did you experience any spotting with the progesterone pessaries?
As sorry yes they have started me on them (one a day) but feel I should pick one of the other options alongside it (Araban pessary or stitch). Had the first pessary last night and woke up to some spotting today. So that is putting me off surgery as I feel I start to spot every time they do something down there!

I didn't have any spotting as I have found they caused me irritation vaginally (which maybe why you had spotting) So I used them rectally which is just as effective infact probably more as you don't get leak of them later on. My consultant advised that.

Sorry I meant to say I had the Araban pessary I just forgot the name of it.
I've have been it that position and I know it's so scary but if I was there again I would still decline the stitch. I did 15 weeks of bedrest which meant I had a lot of time to research this later, And when the stitch is very short it's sometimes more dangerous while putting the stitch in and they could pop the waters anyway.
I would definitely ask to up the dose of progesterone (x2) and use rectally and do some bedrest until your next scan on Friday when you have to make the decision about the stitch. You never know the length may have improved.
Obviously I'm not a professional so please follow medical advise I'm just sharing my experience and what I would do if I found myself in that situation again :)))
The higher dose of progesterone was a miracle worker for me.
Have they referred you to a preterm consultant?
They are the experts and will know the best options, As the doctor who advised you as you could take one of the options of just do nothing is extremely bad advise - Most baby's born at 22 weeks don't usually survive, and if they do then they are constantly fighting for their life with long term health conditions so I'm very surprised he gave you that advise :(
I'm not saying that to scare but just wouldn't want you to choose that option of do nothing 🙏🏽
Really hope they can support you and it all goes well. Keep us updated and good luck 🙏🏽🙏🏽

Sorry I didn’t explain myself very well, this was all new to me and very unexpected yesterday. So the appointment was with a preterm consultant. She has put me on progesterone pessary once a day and will book me in for weekly appointments now, so the next one is Wednesday next week. But she said that ideally I would come in on Friday for the procedure (stitch or Araban pessary) if I choose one of those options. So they are ringing me tomorrow if I don’t make contact before then with my decision.

She gave me info on all options but it seems very vague. No real info on whether any of them actually work that well. I felt she was empathising the stitch as being the best option in terms of keeping baby in for the longest time. But she said there is a risk of the waters breaking. I can’t find any info on the success rates of the Araban but your story is positive and good to read right now so thank you.

Ah ok glad it was with a preterm consultant:)
Yes exactly there's a risk they could put baby in danger by breaking the waters.
I forgot to add I also started dilating, And the Araban pessary held it closed till 37 weeks, Where as I read lots of stories where the stitch maybe didn't hold as well during dilation.
I really hope all goes well for you - it's such a stressful time and difficult decision.

That’s so good to hear!
I’m sure they told me the pessary would be removed at 34 weeks which is why I was unsure about it as that still seems so early. Just trying to research with very limited time and there doesn’t seem to be much info on the pessary. I am leaning more towards that though as I thought any kind of surgery at this stage is supposed to be risky

Ok that's interesting, But don't be too nervous at it being removed at 34 weeks.
Just so you know after all that mine was removed at 37 weeks and I went into spontaneous labour (waters broke just before bed) at just over 39 weeks :))
So once it was removed you don't necessarily go into labour straight away.
So mine was removed then it took a couple weeks to shorten and dilate more :)

I wasn't given the Araban as an option, but had the same and a stitch at I think also 22 weeks. I had one week with progesterone & my cervix shortened during that time.

Can you get your consultant to talk through the risks & benefits of both options?

I had no issues with the stitch (other than not being allowed to walk for longer than 30-45 mins for the rest of my pregnancy which was annoying!). It was taken out sometime in week 36, and my DS was born a week later.

I found an old thread on here useful for reading people's experiences - I think it was the Short Cervix Club.

Hi @IsItMe24, I was in this position twice. Cervix got short from 22 weeks, they put me on progesterone, didn’t advise stitch or even bed rest! I put on low movement , not fully bed rest myself, luckily as able to work from home. At hospital just told me be ready for early delivery.. I had weekly scans, delivered at 32w snd at 33w both of mine. They prepared the lungs I think from 30w or so as was like almost no cervix left. Progesterone didn’t make a trick for me. Both kids healthy, but it was a stressful time.
This time I corrected the septum with surgery, as niw they say most likely it was the reason, no space. And not incompetent cervix. But we will see, only 18w and for now all good. I also don’t want a stitch as it dose pose a risk.
Wishing you all the best! Xx

Not sure when it was inserted, and I’m talking 34 and 25 years ago respectively, but my mum had a stitch for both my younger siblings (I was born at 28 weeks and my mum had a baby before me at 24 weeks who didn’t survive- this was in 1980, so I know 24 weekers have a lot better chance nowadays!) and they worked and the babies arrived at 37 and 39 weeks. No idea about the pessary. Not sure if it was an option back then…

Thanks everyone. I have read a lot of positive stories about the stitch, I think the risks just put me off so I’ve opted for the Araban pessary. Still don’t know if this is the right choice but I’m having it fitted tomorrow afternoon. And I’m slightly calmer now. So I’m just hoping it works long enough for my baby girl to be ok

It's very hard to decide but good your having it today and I really hope it will help keep your cervix closed.
Definitely ask about the x2 dose of progesterone as that helped my cervix length increase and try to stay off your feet as much as you can as well :)

Thank you. It went ok and I’m back home now so hopefully it works. They said just to do the one pessary each day but I’ll question again next time if my cervix gets any worse as they will check this every week now. They’ve also signed me off work for 6 weeks so I will rest in the day. She definitely said they’ll take it out at 34 weeks though, she couldn’t say why, just that’s what they do 🤷🏻‍♀️
But at this point I’ll be happy to make it that far as I think she’ll still have a good chance if she’s born then

Hi @IsItMe24, how are you doing? 🙏

I am now in a similar situation, unfortunately the surgery I had to remove uterine septum didn’t help, my cervix last 2 weeks decreasing at a high speed. I am 26w, 21mm and funnelling under pressure. Same situation I had in my previous pregnancies.. Dr put me in bed rest, I am taking progesterone from beginning, unticontraction drugs.. On Monday she might suggest cervix pessary to insert, but she is not sure due to risk of infection. I am not in the UK this time

Hi @FlatWhiteAnyone
I’m sorry to hear that. But on a positive note, I’m doing well so far and I was only 10mm at 22 weeks with funnelling. I’m now 30weeks+3. So if you make it as long as I do baby will be a good gestation. I’m hopeful for us both! My next goal is to reach 32 weeks where Dr has said I can return to work. I’ve been resting as much as I can until now (not that easy with little ones already) and I can’t feel the Arabin pessary. Still on daily progesterone so hoping that will be enough to get me a bit further. It’s horrible though isn’t it.

Oh this is great news that you are feeling well!

Thank you @IsItMe24🙏 And glad all goes well (as much as it could do in this situation)
I will then ask the dr to put Arabin pessary. My both kids were 32-33w, so my goal to get there. Usually my cervix starts disappearing fast after 24-26w, once the baby is around 1kg. And doctors and I really hoped that removing uterus septum would help…doesn’t look like.

@FlatWhiteAnyone hoping we both reach our goals. Anything further is a bonus. I would love to go to term but I’ve heard many people not reaching viability so I’m just thankful I’ve made it this far.
I have no previous knowledge/experience with cervix issues but had a lot of time whilst resting to research. The pessary and resting seems to have worked for me and there are many success stories of women going to term with that along with progesterone, so hoping it will work for you also if that’s what you decide. I had an infection prior to getting the pessary, but haven’t since it’s been inserted.