Severely shortened cervix

[Nosejug]

Hello, bit of background. TTC 4.5 years. One MMc, one ectopic, 4 failed rounds of IVF and one current 16+2 pregnancy which was going swimmingly.

I had an intense lletz 2 years ago, 3x10mm passes and another unmeasured. I also had a massive haemorrhage two weeks later involving 4 transfusions plus platelets, still getting over it.

anyway, went for my first cervical scan today thinking the worst it would be is nearing their cut off (25mm) but it’s 11mm. It’s closed. She’s asked me to come back in tomorrow to attempt the stitch (but might not be enough cervix to stitch). I included my backstory to emphasise that this is likely the only close to successful pregnancy I’ll achieve. I’m a little numb/can’t believe it/crying intermittently. So sad to be back in a hole instead of the shiny enjoyment.

can anyone give me stories of success (which I would deem reaching 31 weeks, or similar)? I just feel so sad and scared.

Im sorry for your losses, and congrats on your pregnancy! I don’t have any experience on this myself but I literally read a woman on here the other day who was in a very similar situation to you with her cervix, she had her stitch and it worked! So I hope she’ll be along soon to reassure you, I didn’t just want to read and run. Sending hugs

Also short cervix after loop excision and went on to have a healthy pregnancy. An appointment was arranged to see if I needed a stitch and they decided against it and all went well.

Well I was in hospital all day waiting for my legs to wake back up after spinal block.

unfortunately I don’t even have enough cervix left to do the cerclage.

everyone in the ward was so kind and caring, so even with bad news it wasn’t a horrible day.

I’m so sorry to hear that they couldn’t do the procedure. That must have been very, very difficult to hear. Thinking of you

Have progesterone pessaries been suggested for you?

Oh I’m sorry OP. That’s so difficult. Have they told you the next steps?

I'm so sorry OP. There is an alternative called an Arabian Pessary. I don't know if it would be helpful in your situation.

Hi OP, I’m sorry to read that they couldn’t do the cerclage. There are other options so ask about whether these are available at your trust, if not then you always have the option to transfer care. Have you started progesterone pessaries? If not then you need those ASAP

Hey everyone thanks for your support. Yes started on 200mg progesterone straight away.

Doc has requested my case be looked at by a specialist at a larger hospital as a potential candidate for Trans Abdominal Cerclage, but it is risky, normally done before pregnancy, or up to 14 weeks, and with previous cervical incompetance (late losses), which altough mine is extremely short isn't yet opening. But as it's likely the last pregnancy I'll achieve (just reached 40, 4ish years to get this far) I can't really accept waiting for it to fail. TAC later on is more dangerous and carries greater risks of rupturing membranes, so would only (maybe) be considered if my cervix starts to show funnelling/opening.

She said because of the lletx surgery there's hope its stenotic (firm from scar tissue) and that she had a patient just like me who carried to term just a few weeks ago with progesterone only. I've found a great reddit group for short cervix, but as circumstances range, its hard to find the stories that are like mine.

We treated ourselves yesterday to finding out the gender (I wasn't sure I wanted to know, but it was disclosed in my NIPT results) so I can bond and show as much love as possible to my little creature while they're with me.

Please keep us updated OP. Sending you love.

There is really good evidence for the progesterone in general, so great you're on it. The NHS at one point were trialling an app that looked at the likelihood of delivery in the next week based on a range of factors (I think the cervix length was one)+ being in active labour. I think sometimes they do look at this with short cervix and the assumption is that if you're not in active labour the percentage is lower than what it spits out. I found this quite reassuring as it was a lot lower than I had felt it would be. I think if the chance is even 5% or so you get admitted to hospital etc. Was so hard to find information though!

So sorry you're going through this - so stressful!!! Are you able to get signed off work (if that would help)?

Fingers crossed for you xx

@ChocolateLemons yes, well im self employed but as my job entails lots of volitile/toxic substances and carrying/lugging heavy things, going up ladders in busy environments, so I've stayed away during pregnancy! I've been a compulsive saver since I was little so I'm ok for money -- exactly the rainy day I was waiting for. downside is that I have lots of time to research, but maybe that's ok, finding stories of very premie babies that are doing well, and someone who had same as me at 19 weeks and is currently 28 weeks on progesterone only (which they say is a significant milestone for preterm babes.) and yes one of the midwives very kindly printed me off some research that showed progesterone really can help.

I'd love to know my risk in %, but mostly i'm told they really cant predict the ones that will just stay closed and the ones that wont. If I can make it to 24 weeks, I will celebrate every second (maybe week actually...) that passes. They did say that if my risk increases when I'm reaching viability (24) that I could end up on bedrest. for the moment, yes, im not funnelling or in labour, so I'll just take it week by week. just taking some time to digest the news.

Just to add that our previous neighbour had a very premature baby after many miscarriages and the baby is now a toddler and completely healthy with no developmental issues whatsoever.

Hi, on the statistical risk point, my consultant showed me the stats on when I was likely to go into pre-term labour using an app called QUIPP - my cervix shortened to 14mm at 22w and I had a history of LLETZ and a previous PPROM and pre-term birth, and we were weighing up the risk of placing a stitch at that point given the real chance of inducing labour from the procedure itself.
I've just run through example numbers on the app with your cervix measurement and the earliest gestation date available (18w), and assuming no current labour symptoms/history, the risk of labouring in next 4 weeks is only 5%. If it helps provide any reassurance, this is lower than my risk was when we calculated the likelihood within 4 weeks (11%) at the point my shortening was identified (mine was higher due to history and I think due to later stage!). Maybe worth speaking to your consultant about whether they use the same app and what the results mean for you?
I'm currently 31w and still pregnant, on both progesterone and cerclage. I've heard lots of positive stories that progesterone alone can be as effective as cerclage in many cases so definitely worth following up if you're not already on this. Wishing you lots of luck and hope, keep taking it day by day.

Hi, I'm sorry you're going through this 😞 I have no experience of the cervix issue but just wanted to say - I'm on 400mg cyclogest (progesterone) twice a day due to a previous second trimester loss. 200mg sounds a bit low to me given your situation. Can you find out if they would give you a higher dose? It's very effective, I'm on it until 34 weeks (currently 32 weeks) and I believe it to be one of the reasons I've stayed pregnant this time. Good luck, I really hope it all works out for you 🤞🏼

I didn’t have cervical issues, but other problems which might have led to preterm birth. What helped me is only ever focusing on the next milestone I set for myself - 20 week scan/ 22 weeks which is when she would have a chance if she came / 25 weeks when most of them pull through… right up to 37 weeks when she arrived!

I couldn’t cope with thinking of the acres of time before my actual due date, breaking it up was much more manageable. Good luck x

@Nosejug I feel compelled to write to you because I've experienced similar and know how scary it is and I want to offer some hope. I'm currently pregnant with my 4th baby. I've had a short cervix in each of my pregnancies and each time I have delivered at term (or 1 week early due to planned c sections).
With my first baby they found a cervical length of 1.1cm at my 20 week scan (unexplained as I had no previous surgery). I still remember the look on their faces when they saw it.
At the time I was living in London and was seen at the fetal medical centre there which was considered at the cutting edge of research in this area. They advised that progesterone is often the best and safest form of treatment and decided against a stitch. I was given 200mg of progesterone daily.

Each pregnancy has been the same, but my cervix has never got as short as 1.1 since that first pregnancy as I've always started progesterone early. It's currently 2cm. This hospital are giving me 800mg a day of progesterone. I've never had a stitch.

I really hope and pray that it works out ok for you. I remember counting down each week and just praying to get to a safe stage.
Any questions please ask, sending lots of love!

Just to add, similar to a PP, I am on 800mg. It might be worth enquiring about dosage. I was told advice has changed since my first pregnancy and now a higher dose is often recommended. But different hospitals have different approaches.

Hi @NosejugI was so sad to find this thread after watching the other thread for so long ❤️

What specialist are you being referred to? Obvs been here in a similar situation myself and highly, highly encourage you to reach out to either Prof Simpson in Leeds or Prof Shennan in London. They are the two best specialists for cerclage and preterm birth in the country. Without Prof Shennan and his incredible team little boy wouldn’t be here.

They will push limits where others are afraid to go. They also trialled me on 800mg a day of progesterone instead of 400mg a day, though it was reduced band down to 400mg as there were negative side effects for me and it actually made no difference at all in the end, though I don’t have a classic cervical issue.

Reach out as fast as possible because both profs take self referral - they just need a letter from your consultant or GP saying you’ve asked to be seen by them.

I have absolutely everything crossed for you and your precious little one.

Why only 200 progesterone a day ?!

My cervix is at 3cm and I am currently on 800 a day...
I would up your progesterone asap.

I was in this position with both my children, First born worse and I was also not able to have the stitch due to length too short, But I was given the Araban pessary so it's worth asking if there is any chance of that with remaining length.
And strict bedrest from now - I promise you that is so important but it works - stay off your feet and reduce weight off your cervix.
The bedrest is what I think got me to 39 weeks and I wasn't even given progesterone that pregnancy.
I was laying down all day on got up for wee and shower ..Keep us updated 🙏🏽

Also wanted to ask where abouts are you in the country? It really helps to have a good consultant specialist with this who has good experience with this cervical situation. I would ask for a second opinion if you don't feel confident x

@IC29173 Thanks so much for the app name and putting in my numbers :) I've now downloaded it. I see one of the people who's research created it is Professor Shennan who I see keeps coming up as the person to contact.

Thanks so much for reaching out @KittyFantastica . I actually found your own thread from when you were going through it, I had read Prof. S's name on Tommy's and then saw you yourself had been seen by him. I read a testimonial that he'd travelled up to aberdeen to save someone's pregnancy (I'm in scotland and was worried about how I'd safely get down there if things started to progress badly/if England NHS would look at Scottish patients.). One of my tasks today was to ask how you got in touch with him, so thank you very much for preempting my question! I will talk to GP/Hospital asap for a referral. I'll also try Prof Simpson in Leeds. Really thans so much for writing.

@Pennyroses @diamonds2023 @KittyFantastica and @Anothermanechange I really do get the feeling I should be upping my progesterone. I almost want to just start right away? I have 2x 400mg packets (so 28 pessaries) leftover from the start of the pregnancy. May I ask, those on more than 200, did you do 1xday or 2 doses daily to maintain a level? I read on scottish and nhs guidelines which both seem to mention 400mg for my gestation and issue (they don't separate out reasons for short cervix)...

@Anothermanechange what a wonderful message to read, I read it out to my partner (I hope thats ok) as I found it so comforting to read someone with the exact same issues who was on progesterone only, but successfully (4 times!! amazing!) I so appreicate your time in reaching out. I'll be reading everyones messages again and again over the coming wees I'm quite sure.

@diamonds2023 yes I read about the ariban pessary yesterday, I thought as my cervix is flush with vaginal cavity it wont have anything to support but I will absolutely ask. I'm in west of central Scotland. The doctor was quite adamant that I could be on my feel but careful (Im only 16+5 so I suppose the pressure is currently lower) so I'm doing my normal tasks but reclining for periods in between. I'm only on day 2 post surgery attempt so still finding my feet/acclimatising to the news.

@Slothey thats exactly how im trying to think about it right now, week to week until I know if my cervix is actively changing and then milestone to milestone. but youre so right, time is stretching out endlessly...I keep working out what date it will be when I'm X months and balking at how far away it is.

Thanks everyone so much for your inputs and well wishes. Honestly so valuable to me in many ways.

Of course it's ok to read to your partner, I'm so pleased it's of comfort to you both. I remember the desperation and fear with my first pregnancy. Reading stats and research and just filling myself with panic. It was such a relief to make each extra week and positive stories really helped.

I personally take 400mg in the morning and 400mg at night, which is what they recommended.
In my previous three pregnancies (different location and hospital) I was on 200mg night only.
Hope that helps x

Im not giving out medical advice but if I was in your position right now I would up my progesterone to max dosage and I would put myself on FULL bedrest ❤️
if you work get yourself signed off x