Need urgent advice please on incompetant cervix

[GeorgieM]

I had DD when I was living in New York and was treated by American docs throughout pg. Had cervical stitch put in at 13 weeks and then told to go on strict bed rest (22 hours a day - yawn) from 26 - 36 weeks. DD born slap bang on due date in 2001.

Am now 18+5 with second pg and finding UK docs to be really, really uncaring about whole situation.

Had stitch put in at 15 weeks at Kingston. Slighty traumatic as went into pre-term labour afterwards and doc that was 'looking after me' was totally unsympathetic. They finally managed to control labour and booked me in for check up three weeks later. Check up consisted of doc asking if I was feeling Ok and whether I'd had any bleeding or discharge...... no scan to see what cervix was doing which I found strange as I'd had hours of pre-term labour and I'd been told that his could shorten my cervix.

Whilst I understand that American docs where VERY over zealous in their apporach to keeping DD inside me, I'm finding it v hard to understand UK docs take on things. I've been told that I don't need bed rest (in fact they don't recommend at all) and that there's really nothing I can do to keep pg safe. Seems to be very reactive over here rather than proactive. Everything that I've read in books or on medical internet sites has said different things.

Has anyone else had a similiar experiece? Am finding it very hard to trust what UK docs are saying to me as it's 180 degrees from what US docs told me. Am very confused, upset and worried that I'll lose this baby because I'm not being given the right advice.

Sorry, long missive but would be so grateful if anyone has got any advice.

hi, can you see a different consultant or even go to a different hospital? Sounds like the care you're recieving isn't making you happy one bit.

Not very clued up to ic and hopefully someone else will come with good advice.

I've found when I've done my own research into my own obstetric issues that you can find as many opinions as consultants sometimes. Professor Lesley Regan (of the recurrent miscarriage clinic at St Mary's in Paddington) in her book on miscarriage doesn't seem to set much store by the notion of an incompetent cervix: she suggests that it isn't the cervix 'letting it out', but some fundamental problem with the pregnancy such as antiphospholipid antibody syndrome (a clotting disorder commonly causing growth retardation and calcification of the placenta) - and that a stitch can create more problems than it solves. On the other hand, I read a paper by some other consultant (in Leeds or somewhere) who positively recommends a cervical stitch for his patients. My approach is to do as much research as I can and question the consultant as to why certain things are or are not applicable - and go with my gut instinct as to what sounds credible to me. (I've certainly learnt a lot about haematology in the last few months.) I suspect that sometimes there's a fair bit of empire-building going on.

Re the bed rest - this was recommended to my mother when she was having problems in the 70s, but I think it's felt now not to have much material impact (that is, if it's going to go, it's going to go - and fighting gravity isn't going to do anything about it). It certainly didn't have any impact on the miscarriages she had subsequent to my birth.

As to the different approach of doctors in the UK, if you're seeing them on the NHS that might be one reason why you're finding them reactive rather than proactive - the different method of funding. I don't know if you are aware, for instance, that you have to have three consecutive miscarriages in this country to 'qualify' as a recurrent miscarrier and for investigations to then start: unfortunate as one miscarriage might be, it's rather seen in medical terms as no unusual event.

Can I ask what problem with the first pregnancy prompted the stitch and bed rest advice initially?

Hope all goes ok with the rest of the pregnancy.

I was diagnosed with an incompetant cervix and had a stitch put in on both occasions. As I did have some bleeding after the stitch on both occasions I was on bedrest (6 weeks first pg, a week in the 2nd). My consultant also scanned the cervix afterwards to make sure that there was no tunnelling and the cervix was fine.

My consultant (Mr Michael Booker) covers South London. He is very hands on and does his own scans etc. He is a believer in bed rest under certain circumstances (most of his twin pgs are on bedrest between 28 and 32 weeks)

Ladymuck: can I ask what criteria your consultant has for diagnosing an incompetent cervix...? I'm just curious - although it's not something that has been suggested with regard to myself. I did know someone once whose consultant routinely suggested a stitch for all pregnant women over a certain age - which seemed a little like overkill to me. Particularly since the age at which your cervix was deemed to be flaccid and geriatric was something like 33...

(Sorry - slight hijack...)

No, he doesn't do it as a matter of routine!

He was fairly familiar with my cervix by the time I was pg with ds1 (I had had over 3 years of infertility tests/treatment). Before this I had had comments that my cervix appeared to be weak from nurses etc doing smears, but certainly in a round of other fertility treatment it was added to my medical notes. I had a number of transvaginal scans where he was measuring the length of the cervix, and was looking for tunnelling. But I'm not a medical expert, so couldn't give you the exact method of diagnosis - it seemed to be from inspection, and I was told I was lucky as it is usually only picked up after a second trimester miscarriage.

Hi ladies, many thanks for your advice.

To answer your questions - I was diagnosed with adno carcinoma in situ by American OBGYN and had a cold knife cone biopsy in Apr 2000. They cut out about a third, or maybe more of my cervix, hence the need for a stitch. Bed rest was recommended by my specialist OB as scans showed that cervix was shortening at 26 weeks.

I am seeing UK docs on NHS. I'm really not trying to be a whinger and I do love the fact that this country has so many excellent medical people and it's all free of charge (I'm v proud to be British!), but when it comes to your baby, all logical thought goes out of your head and you want the very, very best advice that you can get.

DP and I are looking into getting an appointment with private OB to get second opinion.

Ladymuck - forgot to ask, what hospital does Mr Booker work out of? Is he NHS or private? How can I get hold of him?!

hi (am new)

had my second babe at Kingston and got excellent care medically but v v cold care emotionally from the consultant - wonder if is same bloke?
My probs were less scary though - severe history of post natal dep and some preg induced diabetes.

Remember that being competant and being good with patients are two different things?

Sorry to ask annoying newbie Q but why are people calling their babies DDs?

doh

is it darling daughter?

Re Mr Booker, he does both NHS and private. I know he works from both Mayday (NHS) and Shirley Oaks (private), but I think he may also cover a hospital in Epsom. If you give Shirley Oaks a ring (02086555512), they may know which is the best way to get hold of him.

Hi Flr - yep, DD = dear/darling daughter. DS = dear/darling son. DP = dear/darling partner and DH = dear/darling husband. If you go to top of page and click on blue acronym list next to 'useful stuff' it'll give you a full run down.

Am sure docs at Kingston are v competant. Consultant is lovely and so is OB Registrar, but just can't help feeling it will be a case of shutting the stable door after the horse has bolted. ie if I go into pre-term labour then they'll do something, which will be too late for Beany.

Ladymuck - thanks for number. Will call tomorrow to try and get hold of him.

GeorgieM, I haven't had any direct experience with an incompetant (sp?) cervix, but a friend of mine has had.... her 1st child (dd1) was born at 30 weeks at St Marys (NHS), and was up in SCBU for 2 months or so, and is now fine. When she got pg for a 2nd time, her ds attempted to put in a v early appearance at about 20 weeks, she was ordered to rest (which she doesn't do easily, a v. driven woman running her own stressful business), and he put in an appearance at about 23 weeks and didn't make it . Before she got pg again, she decided to go private (Mr. Teoh, St Marys), who did a bit of investigative work beforehand, and looked after her the whole way through pregnancy #3. Dd2 tried threatened to put in a v. early appearance at 14 weeks or so, she was given a stitch, she threatened again at about 16 weeks, and she was then ordered to bed rest, hips higher than head, until she reached term. She did reach term, and by then had to resort to all the usual curries, pineapple etc to persuade dd2 to emerge! Both dds are healthy and fine, and my friend rates Teoh very highly indeed. I would suggest you go and find someone sympathetic to your cause, who can give you some consistency of care and advice... I beleive the private system here is similar to the US consultant led system, so you will be familiar with it already.... best of luck
ps: very abridged version of events above...

Dear Georgia, I am currently under the care of Mr Booker who is wonderful - very kind & understanding. I am 16 weeks pregnant & had a stitch inserted at 14 weeks. I was not given any advice as to how to go about the rest of the pregnancy other than to be vigilant to pain & signs of infection together with regular outpatients appts. I found the book by Ros Kane very helpful & informative although abit dated entitled 'Cervical stitch - whats it like'. This is availble through the miscarraige assoc or amazon. It is a collection of stories from women who had the stitch the outcome,advice and their recommendations for other women which I am constantly referring to as there seems to be very little other documentation avialable. I wish you the very best of luck at and hope you found this message useful. Jacquie

My Darling first grandchild Cole arrived on Wed 14th 05 at only 23 weeks only 1 lb 3 oz and did not make it. We are all totally bereft and the docs think my daughter has an incompetent cervix. She is only 21 and very healthy. She and her husband so wanted this baby and i was beside myself with excitemant that now we feel lke we have entered a black tunnel with no light. Please give me any help/advice/infoetc and what her chances of a healthy baby are. Have any of you gone on to have babies. Thanks fron very sad Coles nana

Colesnana - sorry to hear about the loss of your granddaughter. Unfortunately an incompetent cervix is usually only idientified once it is too late. But for future pregnancies there is hope - a cervical stitch can be inserted at around 12/13 weeks, and your daughter can then be monitored through her pg to check for dilation. She may need to be on bedrest (I had to give up work at around 20 weeks pg). But many women go on to have full term pregnancies - I've had 2 myself.