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Old Aug 16th, 2010, 06:01 AM   1
mpg1502
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Incompetent Cervix - stitch/cerclage - threatened labour


Hi Everyone,

I know there are several threads on this but just wanted to capture any up to date advice if possible.

I am 24 weeks + 3 days with my first baby. I had a cone biopsy done in 2002 for abnormal cervical cells (cin 3).

As soon as I knew I was pregnant I told everyone who would listen that I had had this invasive op and would potentially require a cervical stitch as my cervix may be weak. But they seemed confident that I would be ok as the op had been several years ago.

However, I started bleeding at 5 weeks. This continued right up until 19 weeks. (Apologies in advance for info but it seems relevant!). Sometimes there was just light pink spotting, other times brown/red blood and sometimes bright red blood. All varying amounts but with maybe only 2 or 3 days respite in between. There was also a considerable amount of mucus/discharge at times. No pain or cramps.

I had several scans in order to check the baby was ok and these were always fine. They could find no reason for the bleed. Eventually at around 17 weeks I was sent to see obs/gyn at John Radcliffe in Oxford. They took an internal scan of my cervix which showed it was within ordinary limits but was slightly short. He suggested because of my history and in view of the bleeding that I have a colposcopy in order to check there was nothing going on. My colposcopy was performed at 19 weeks + 6 days. All went well, no abnormal cells, no bleeding. I had follow up scan the following week and they said my cervix actually looked longer than before so we were really encouraged.

My next internal scan was booked for 3 weeks later. In between I had occasional hard tummy and that pulling sensation, but I just thought this was ordinary pregnancy complaints.

I continued on but just last week at 23 weeks + 3 days, I started to have a pulling/heavy sensation in my tummy when walking (stomach felt like it weighed a ton and moving was slow and laboured) and also some uncomfortable light pains in my vagina/cervix. By nightime, my tummy was rock hard and I found it difficult to sit up, or turn over. I also mentioned to my husband that I felt "strange". Couldn't quite put my finger on it, wasn't unwell but I didn't feel right.

I was extremely restless in bed but eventually went to sleep. The next morning I woke up and felt absolutely fine. Tummy was soft again and all pains gone. Walking was back to normal.

It just so happened that I was scheduled my internal scan the next day. I drove myself to hospital alone thinking all was ok. As I was arriving I began to feel that tightening again in my tummy, a little bit like a stitch on my left side and that downwards pulling sensation too. But it wasn't too bad, just a little uncomfortable. I went in to the scan room and the doctor noted that I seemed to be uncomfortable. First up was my cord scan, to check blood flow to the uterus. This showed that the blood flow was above average i.e. my uterus was up to something! Also my amniotic fluids were less than they had been. We then went through to do the internal scan and my cervix had shortened to 2.1cm. Whilst this is still within limits it was below the 2.4cm they see as minimum. The doctor said I would need to see the consultant and off she went.

The consultant decided that in view of the uterus and shortening cervix that I was in "threatened labour" and that I should stay at the hospital for further monitoring. It was imperative that I have a stitch put in to stop the cervix shortening further but this could not be done whilst I was still having tightenings/contractions.

So I was put in a room and waited for my rather worried husband to arrive from London. The tightenings continued but did stop overnight so they were able to do the stitch the next day.

But by the time the theatre etc was organised it was already 4pm, and by the time they got in there my cervix had dramatically shortened to 1cm at the front and 0cm at the back - they sewed what they could but said it hadn't been ideal. I began medication "Indometacin" to stop contractions and "Progesterone - Cyclogest pessaries" to strengthen the cervix.

When the consultant came round she said that the next day I would be given a steroid injection "Dexamethasone" which would help mature the babys lungs. A second dose would be given 24 hours later. This would give the baby the best chance if its arrival was imminent.

Luckily the stitch and medications have stopped the contractions. I was kept in for two days after the stitch was put in and am now on bed rest at home.

Basically it is imperative to keep the baby in for long enough for her lungs to mature (with the help of the steroids), so if we can get to the end of the week that is great.

However, it is obviously still much much too early for this baby to arrive. If we can just get another 4 weeks even that would increase our chances so much.

Its so scary. I just don't know what to think and there's so little information given to you.

I had some tightenings/contractions yesterday but the pills stopped them again and I have been fine so far today. But I want to know, what signs should I really be looking out for? Afterall my cervix had shortened overnight from 2.1cm to practically nothing and I had hardly any symptoms/pain. What happens if labour starts properly whilst the stitch is in? There have been no signs of "show" or waters breaking but I understand this doesn't always happen or can happen when you go to the loo so you might not realise.

Also the baby has definitely stopped being as active as she was, she used to kick and move all the time but she is only moving lightly and far less active than before.

Whilst I don't want to overeact and be at the hospital every 5 mins in a panic I also don't want to be so brave that I put myself and my unborn baby at risk.

If anybody has been through this any advice would be so greatly welcomed.

Thank you in advance.
M



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Old Aug 16th, 2010, 12:01 PM   2
lizziedripping
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Hi hun. I have been exactly where you are, and hopefully can offer some help and support at what is a terrifying time

Firstly, you had the stitch placed before your cervix had opened/funelled - that is a good thing. It is likely that the tightenings you felt were having an effect on your cervix - something which should be happening after 36wks, and not at 24.

It is also likely that your previous surgery on your cervix meant it was shorter than normal before you conceived and possibly made it incompetent - I have found however that hospitals always operate a "wait and see" policy in a first pregnancy, which makes me really angry

I had a normal first pregnancy, and delivered a 9Ib son at 39wks. His labour weakened my cervix, and as a result I presented at 23wks in my second pregnancy with a dilated cervix and bulging membranes We were horrified. An emergency cerclage was put in, but unfortunately I began to contract after the surgery and our daughter was born 1 week later - she is now a happy, healthy 6yr old tho

THe only symptoms I had were a feeling of pressure, and extra vaginal discharge. I did have contractions which were painful and tight, but only after the stitch had gone in.

In my third (twin) pregnancy I had a stitch placed at 12wks and carried 9 and 7Ib 3oz boys to 38wks. Proving that the stitch can and does work, despite the weight of 16Ibs of baby. My cervix funelled in that pregnancy at 25wks, but the stitch prevented it from opening any further.

In the twin pregnancy I had constant pressure, tightenings and cramps from the moment the stitch was put in. It was really frightening hun, and I spent the duration on partial bed rest. If I walked around my tummy tightened, and I felt like the babies were falling out. I felt everything I had felt after the stitch went in with my daughter. I had proper full-blown contractions with her tho, something which didn't happen in the twin pregnancy.

My point about all this is that the symptoms you describe can be absolutely normal after a stitch, since the op itself irritates the uterus. That said, your cervix has obviously changed, and your uterus has been contracting. You have done the right thing by getting a stitch put in, and it is now imperative that you rest completely and take the weight entirely off your cervix. Drinking water, and plenty of it also really important.

There are no guarantees hun, but there have been many women in your position that have gone on to atleast 30wks and beyond. The progesterone supposotories are supposed to be brilliant in preventing preterm labour, and I remember when I had indomethicin that it was really effective so you are having everything possible to help.

THe tightenings you describe may well settle down as you recover from the op. Really what you need to look out for are increasingly painful tightenings which become regular (every 10-15mins) and increase in intensity. Any extra bleeding or waters breaking are also warning signs. You will know if you are in full blown labour hun, but bear in mind that I was labouring for a week with the stitch in and it didn't damage my cervix, so try not to worry too much about that.

THe stitch will not prevent you going into labour, but it can stop your cervix opening further if that is the problem. I know this is an awful time for you hun, and my thoughts really are with you. Please keep in touch, and if you need anything at all then PM me and I'll do my best to help xxx



 
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Old Aug 18th, 2010, 05:09 AM   3
mpg1502
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Dearest Lizzie,

What an angel you are. I can't thank you enough for your comforting and informative reply.

I'm so sorry my message was ridiculously long but you know when you feel every bit of information is so important.

I am now on 6 days after stiitch and little bump is still in there. We will be 25 weeks this Friday so fngers crossed. Check up is Friday too so that will be comforting too to see how things are going in there.

I've had a couple of scares but both have settled down so hoping they are just irritable uterus afetr all thats gone on rather than things progressing. Am still finding moving around uncomfortable, hanging on to my tum when walking but I can rest all day so As you said I just have to listen to my own body.

I will keep ypu posted but meantime, thank you again from my husband and I, you have really helped us.

Best wishes
M



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Old Aug 18th, 2010, 15:24 PM   4
LoisW
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Thank you both for sharing your experiences. I am in the 31 week and went to the doctor today for routine check. Was told that my cervix is short and smooth which is not good at the stage. Has been instructed for bed-rest until my next visit one week from now. My husband and I just moved to Germany less than 2 weeks and our German is little. The doctor did not say my current condition is incompetent cervix. This took me by surprise coz the pregnancy has been smooth with no major discomfort. When reached home, went straight to google the symptoms .... hopefully everything will be all right.



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Old Aug 18th, 2010, 16:23 PM   5
lizziedripping
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Hi M - I'm so glad to hear from you, was getting a bit worried in your absence from the forum

That you have gone 6days post stitch and nothing has progressed is a great sign. After my daughter things were kicking off properly within 3/4 days. Even if the very worst happened now and you did give birth at 25wks, your baby has had a week more in the womb than mine did, and has had the steroids which is key to her overall outcome.

Just look at my daughter in the avatar - that is how a 24wker can turn out. Distressing and far from ideal as it is, giving birth that early does not have to be a tragedy. Please keep that in mind.

All that said, you are still pregnant, your cervix was not dilated, and you have a stitch - all positive. The need to hold your tummy as you walk around was very normal for me in the twin pregnancy, and I lived in total fear for the pregnancy because of it. Just keep resting tho, and take it as a sign that you need to do so hun.

I wish you loads of luck, and please let me know how Friday goes x

Lois - at 31 wks that fact that your cervix is short does not mean it is incompetent. If it were, your cervix would have shortened anywhere from 15wks onwards, and your baby would have delivered by 26wks. Your cervix has so far carried the weight of a baby up to 31wks so is competent. The doctor is concerned because it is shorter than normal at this stage in the pregnancy, and this can indicate that your body may be preparing for labour earlier than expected.

Now you are at 31wks, the baby is too big just to 'fall thru' a weak cervix anyway, you would have to go into labour to deliver the baby. If all women were scanned after 30wks there would be many who had naturally short cervixes, it isn't necessarily cause for concern at this stage. It may be that yours has softened and shortened ahead of time, but you will still deliver at term.

It is wise to keep an eye on you tho, since it is still a little too early to deliver your baby. Again it might be worth resting and drinking plenty of water to prevent any potential premature labour, but at this stage incompetent cervix is no longer an issue or concern for you hun. Preterm labour is the concern - a very different thing. I have every belief that you can go to term tho, it may simply be that your cervix is preparing itself earlier than expected.

You know where I am if you need any advice - best wishes x



 
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Old Aug 18th, 2010, 17:05 PM   6
MikaylasMummy
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hi there..its so good we all have eachother to reassure ourselves!all you ladies have been of great help to me so ill try and pass it on and be helpful to op..

at 19 weeks i had an episode for about an hour before work where i had very painful period like cramps that came and went..from then especially standing at work i felt like something was going to fall out of me and i was very heavy like u described..i didnt think too much of it but luckily had my 20 week scan a few days later where they discovered in the abdominal that my membranes were funneling(she discovered this as she was checking the placenta which she wouldnt see properly either as it was very low)
she did an internal scan straight away and found that my cervix was 28mm..still normal but the fact my membranes were funneling down indicated my cervix was actually shortening..the big bummer for me was that i had a complete previa as well and the placenta was actually dipping down into the opening cervix along with the membranes.
i was ordered on bed rest straight away and had an emergency appointment with my ob 2days later..
unfortunatly for me due to the position of my placenta a stitch is not an option as the risk of infection is far too high.so he put me on nifedipine (blood pressure medication which stops uterine contraction) and progesterone pesseries twice daily to strengthen my cervix..as well as two lots of antibiotics incase of infection and bed rest.
two weeks later after lots of rest and medication i had another scan to check my cervix length and it had lengthened to 3.3mm with no apparent funneling of the membranes..so it just goes to show the medication and bed rest alone can go a long way..and with a stitch in place i think you have a very good chance of making it another four weeks if you REALLY rest and rest means lying down as sitting still allows the baby to put pressure on your cervix..
i have now made it to 24+4 weeks and had an abdominal scan on tuesday which still indicicated everything was stable and have an internal scan in two weeks to check the length of the cervix..my dr is going to give me the course of steroids at 33 weeks as he has no idea how long my cervix will hold out and wants to be prepared and for a full dose to be administered incase he does come early..and a csection which was already scheduled will be done at 39 weeks however if my placenta does not move far enough it will probably be done at 36-37 weeks as the risk of going into labour with the placenta where it is is very dangerous..
hope this gives you some reassurance that you may make it further than u think..best of luck and i will follow how you are going.xox



 
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Old Aug 20th, 2010, 09:42 AM   7
mpg1502
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Hello everyone,

Just thought I'd update you.

I went to the hospital for follow up today (25 weeks exactly). Baby is absolutely fine, scan of her heart shows it is still perfect so the Indometacin has had no effect on that (phew!). Which is good because that means I can continue on the Indometacin for the forseeable to keep from going into labour. Giving us all round much better chance.

They still think that she will probably be an early baby but we're hopeful to at least get a few more weeks baking time!

My amniotic fluid has replenished itself (amazing!) so that's also excellent news. The stitch is doing its job too and although my cervix hasn't improved, it hasn't got any worse and there was no discussion of funnelling etc. Baby is growing exceptionally well which under the circumstances is amazing news. So we just have to keep all fingers, toes and legs crossed!

So all round good news. I'm off the Extreme High Risk list and now just on High Risk.

Thank you all so much for your invaluable advice and information. It really is a credit to this site that everyone makes the effort to share and pool all this information to ensure that we are all better informed.

If anyone reading this is in the same boat, please feel free to PM me anytime if I can be of any help.

Keep you all posted.
Best wishes and long baking times to all, and special thanks again to all those who helped me through,
M xxx



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Old Aug 22nd, 2010, 13:45 PM   8
SugarKisses
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Glad things have settled down hun, really hope bubs keeps cooking for as long as possible.

Ive had 2 early labour's both in the 24 weeks mark-they were unable to stop it the 1st time with my baby girl-was 10cm by the time I got in and they stopped it for a week with my baby boy and I was given steroids too.....
this time I decided against the stitch-but have not ruled it out totally....but I am on cyclogest. Can I ask, do you think it has helped keep the labour at bay and helped maintained your cervix length? Im praying that it does work and that it will help me xxx



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Old Aug 23rd, 2010, 02:33 AM   9
mpg1502
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Hi sugarkisses,

Firstly I am so sorry about your other two little one's - you are being very brave.

Yes, am still going on the Cyclogest and Indometacin and baby is still in there. I was still having intermittant "tightenings" (threatened labour) but these seem to totally have disappeared (phew!).

The Cyclogest is particularly to strengthen the cervix and the Indometacin is what stops keeps labour at bay.

Cyclogest appears not to have any inadvertent side effects on the baby but it is only given to "strengthen" the cervix and hopefully help maintain the length you have rather than lengthen it. Because my cerclage (stitch) was so complicated as my cervix had gone to 0cm at the back and only 1cm at the front they have been unable to scan my cervix to check what length it is now as it would pose to great a threat of infection. But it certainly seems to be holding for the moment. And combined with the Indometacin it should help to stop my cervix contracting.

The Indometacin does carry a possibility of a heart defect in the baby. You are given a fetal heart scan after one week on the Indometacin to see if there has been any effect, if this does not show up within the first week then you are usually absolutely fine. My next fetal heart scan is in a couple of weeks time. So fingers crossed.

As soon as they gave me the Indometacin this helped calm down the labour. So you may suggest that to your consultant/doctor, but it does of course require careful monitoring. But it may give you a better chance of keeping baby in longer.

Keeping all crossed for you this pregnancy.
Mx



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Old Aug 23rd, 2010, 04:24 AM   10
lizziedripping
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Hi Mpg - so glad all is still ok for you my sweet. My thoughts are constantly with you

Sugarkisses - please take it easy hun. The cyclogest has proven to be very effective in firming up the cervix, and is particularly good for women who labour early with no apparent reason. Progesterone is the hormone produced throughout pregnancy to prevent a woman going into labour - it declines naturally as you approach term. SOme women don't make enough progesterone, and so labour begins too early. I wanted to have it as well as the stitch, but our hospital doesn't routinely give it yet.

Out of interest, is there a specific reason why you didn't want a stitch? Good luck xxx



 
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