Any success or unsuccessful stories of cervical cerclage following precious PPROM?

[Nonstop24]

My 1st daughter was born at term. I then had my routine smear after this with abnormal cells (CIN3) but had a successful loop diathermy . Six months after this treatment I fell pregnant with my second daughter and had PPROM at 29 weeks and she was born prematurely at 31 weeks (luckily very healthy). No-one warned me before, during or after the loop diathermy that premature birth was a risk. I even went privately before i fell pregnant with the 2nd daughter to check all was ok to get pregnant after the loop diathermy and there was no mention of it or advice that I should have my cervix length measured during the pregnancy.
We really want a 3rd baby, however have been told that it is very risky given the previous premature birth and that things like cervical cerclage don't usually work. So my question is has anyone had similar experience of a premature birth due to loop diathermy and gone on to have a subsequent full term or nearly full term birth with cervical cerclage? Thank you!

[SiouxsieSiouxStiletto]

Just bumping for you. Hopefully someone will be along soon

[Nonstop24]

😀 thank you

[northwesternskies]

Not quite the same history or reasons for the need for a cerclage as you but my second daughter was born at 28 weeks after I needed an emergency cerclage at 22 weeks. She wouldn’t be here without it. I was diagnosed at that point with an incompetent cervix as I’d suffered a late loss with my first daughter and told that I’d need a cerclage for any future pregnancies.
I’m currently 36 weeks pregnant with a preventative cerclage placed at 15 weeks and so I can tell you that they most definitely work. Of course I don’t know the ins and outs of why you were told that it wouldn’t work for you but there’s some great Facebook groups, particularly ‘Incompetent Cervix UK’ with women with all different reasons for cervical issues in pregnancy. I have seen some of these women say they were told they weren’t candidates for a cerclage but were given progesterone to take for the duration of their pregnancies to help strengthen cervix so there are definitely options if cerclage isn’t appropriate. Also possible to get a TAC placed before a pregnancy which is similar to a transvaginal cerclage but with a higher success rate due to being placed at the very top of your cervix if it’s cervical length that is your issue.
My advice would be to join a Fb group and have a search through the posts to see if you can see any stories similar to yours. From experience, a lot of obs and gynae doctors have no idea what they’re talking about when it comes to cervical issues in pregnancy but there are a select few experts in the UK that a lot of women flock to, particularly Dr Simpson in Leeds.

[Mufflette]

Also not quite the same as it was my first baby, but I had a cerclage at 23 weeks, taken out at 36 and had PROM a week later so I think it's a reasonable assumption to think there's a high chance of that happening earlier if the stitch hadn't been there! So they definitely do work.

[Nonstop24]

@northwesternskies Thank you so much for this. The doctor didn’t say the cerclage definitely wouldn’t work for me. But when I asked if there was anything I could do to help with another pregnancy she just said no not really, there are things like cervical cerclage but do they work..no not really. She was just quite negative and more or less said don’t take the risk of another baby. However since I never had cervical length measured I can’t even be 100% sure that this was the cause of the Pprom. I was working a lot- on my feet and quite a physical job at the time and was very unwell with a sinusitis for months which wouldn’t clear up so I do wonder if this had anything to do with it. But again the doctor said probably not and that even if I did bed rest for another pregnancy it doesn’t make any difference. I have obviously read and read everything I can since that appointment and I see a lot of success stories with cerclage and most sites say it is around 80% successful. They also always seem to suggest bedrest. So I don’t know why my doctor was so negative. Anyway, thank you so much for replying and helping me gather all info I can. I have also been wondering who to contact so will try Dr Simpson 🙏

[Nonstop24]

@Mufflette thank you for sharing your story. I am so happy with my 2 girls now and am so lucky that they are healthy, so as much as I’m desperate for a third and final baby it’s really such a tough decision in case things don’t go well with another. But I’m just trying to gather all info to try and help! Thanks again

[Wrongsideofpennines]

Not the same history as you but successful cerclage here.
PPROM and loss of twins at 19 weeks in 1st pregnancy. Short cervix in 2nd pregnancy but never dropped below their cut off for intervention. 3rd pregnancy cervix was 20mm at 15 weekd and needed emergency cerclage and progesterone. Had it out last week at 37 weeks and now just waiting for baby.

Short cervix doesn't necessarily mean weak cervix but your history of premature birth suggests in your case it does. There is a really good Facebook group for Incompetent Cervix, and I'd also check out the Nice guidelines to see what monitoring/care you would get if you get pregnant again.

[Nonstop24]

@Wrongsideofpennines I'm so sorry to hear of your loss during your first pregnancy. I can only imagine how tough that is. I would have thought they'd have put a cerclage for your second pregnancy given the history of your first. I'm guessing your second pregnancy made it to full term? Do you have any idea if cervical length is measured routinely at the 20 week scan?
Thank you for sharing your story

[Wrongsideofpennines]

I think they often say they can't be sure the reason for the loss was an incompetent cervix so they monitored my cervix fortnightly from 14 - 24 weeks. My measurements never dropped below 30mm and their point of intervention is 25mm. Cerclage obviously comes with its own risks. I made it to full term and was induced at 40 weeks.

They don't routinely check cervix length at scans. Often it is found at a 20 week scan but usually in cases where the cervix is already dilated and there are bulging membranes. When I was in hospital for my stitch the woman in the bed opposite me had been in that situation. For me I never made it to the 20 week scan the first time. They also don't check before pregnancy because the cervix lengthens in pregnancy anyway.

But if you have had a pre-term birth then you should be seen in the preterm clinic when pregnant so it should be monitored. Also depending on the amount of cervix you had removed there are guidelines they should have followed for you in terms of how often they will check. It may be worth trying to find out how much was removed.

[MomFightPPROM]

For expectants don't know PPROM, I urge you to learn something about it try search on Qiagen.com and Parsagendx.com. You might not know that there are test for PPROM.

[worktired]

In your shoes I would go for a pre-pregnancy trans-abdominal cerclage.

I had a premature birth (22w) where we lost our babies. I had a preventative trans-vaginal cerclage at 14-15 weeks which only held until 22-24 weeks (it was looking like it was about to fail at 22w, then was completely gone at 24w during birth).

There are only a few places that do the trans abdominal cerclage (Liverpool, London and Leeds are those I know of), but remove the risk of PPROM during/after a preventative or emergency cerclage.

Good luck with whatever you choose.

[Nonstop24]

@Wrongsideofpennines it’s weird how you didn’t need the cerclage for your second pregnancy but have for your third. But thts great news that you’ve made it to full term! I called the doctors the other day and I had a medium excision - it didn’t say how many mm but from what I’ve read medium is normally 10-15mm. I have a referral to an obstetrician now so will see what he says. Given the previous preterm birth I think that id almost feel more comfortable having a preventative cerclage rather than monitoring and having to maybe have an emergency one later on. But like you said cerclage comes with its risks as well I guess. Thank you for this and good luck with the rest of your pregnancy

[Nonstop24]

@MomFightPPROM thank you. @worktired I’m so sorry to hear of your loss and that the cerclage didn’t hold up. I actually didn’t think they did cerclage for more than singleton pregnancies. Did they do the cerclage due to history of lletz or previous preterm birth? I have read a bit about the TAC and that it holds up better. Thank you - I will see what the obstetrician says.

[MakesMeFeelSad]

I had an emergency cerclage at 18 weeks with my 4th pregnancy due to incompetent cervix but the stitch failed

I had a preventative stitch at 14 weeks during my next pregnancy that was taken out at 35 weeks, he was born by elcs at 37 weeks

[ninadust17]

@Nonstop24 hey, I'm so sorry to hear this happened but so glad your baby was born healthy. What a relief!

I hope you don't mind me jumping on, I'm in a very similar situation to you! Cin3 treatment, 12mm removed and fallen pregnant 6 months later. Did they say afterwards that the rupture was down to the cervix length or another reason? X

[Nonstop24]

Hi @ninadust17 I found out that I had 8mm removed so better than I thought. I also found that my placenta was sent for analysis and I had chorioamnionitis at the time of birth. But we will never know if the awful sinusitis I had caused the chorioamnionitis and the subsequent pprom. Or whether the pprom happened due to maybe IC and the chorioamnionitis happened by ascending infection after the waters breaking.
Congrats on your pregnancy. Is this your first? Do you have plans to get cervical length scans?