# *UPDATE - not great news* Cervical length with multiples



## hopingforit

I had my regular OB appointment today and when I mentioned to her that I spotted a little bit last night, she gave me a pelvic exam and sent me for an u/s. I do get a cervix check every 2 weeks but they just tell me it's long and closed. When she checked it, she said it felt normal and was closed from the outside. The u/s tech said there is no funneling and she said the length was good but I'm a bit worried about it. 3 weeks ago via an abdominal u/s, it was measuring 4cm which I was told today could have been inaccurate. Today it was measuring between 2.6 and 3.1 depending on if she was pressing or not. She measured it about 4 times and gave me a number of 2.9cm. Should I be worried about this? IC is a huge fear for me even though my only risk factor is being pregnant with twins. Did anyone else here have a cervix measurement like that and if so, what did your Dr do? My Dr said that it was completely fine and didn't recommend anything though the u/s tech said I should take it easy. I have my growth scan next week so they will check my cervix again then but I'm just worried that being only 21 weeks with twins, this is too short? What do you think?


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## san fran shan

That sounds like a good number to me. I think it depends on who measures it and how they measure. Plus it can change...get longer and shorter, then longer again throughout pregnancy. I had one doc last week tell me 4 cm and then a couple days later a doc say 3 cm. The 1st was a vaginal u/s and the 2nd was over the tummy.

I have no idea how long it is when you aren't pregnant or pregnant with one baby. But if the docs aren't concerned, you shouldn't be! The advice to take it easy is always good advice. I think you got good news at your scan and can relax!


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## 1948LC

My cervical length stayed around 3cm but I stopped having it checked at 24 weeks so have no idea what it was after that. Here in the UK cervical length is not routinely checked, the only reason I did was due to me having surgery on my cervix were I had a fair amount of it removed. I carried my twins until my panned c section at 37+2. My Doctor was completey happy with my measurement thats why they stopped checking at 24 weeks. x


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## drsquid

the most accurate measurement is by transvaginal or translabial ultrasound. i got paranoid the other day (i had a leep too, and i was feeling pressure) and it was 3.5 cm... and baby a had her head jammed against it and b was sitting on her head. sigh. if your doc isnt concerned and there is no funneling even with pressure. i wouldnt worry about it. a dynamic (ie funneling) cervix is far more worrisome


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## hopingforit

Thanks for the responses. I'm glad my Dr gave me the okay but she didn't 100% give it which sort of made the good news of the scan kind of worrisome. She said my cervix is fine for now but that if it goes to 2.5, they will take action. She told me to look out for more back pain or more frequent BH as I'm already having both of them. Her explanation was that the weight of carrying 2 babies is making it go short but the most alarming was that it was 4 (or so depending because of the abdominal u/s) and has gone down by 1cm in 3 weeks. I actually don't know how they do things here either because checking cervical length isn't routine, I guess. I know they only check to make sure mine is closed every 2 weeks. This was a different situation as I had spotting last night and this morning with twins so she was concerned. I need to make sure I keep an eye on these things as I will be going 9 hours away from home by car at 26 weeks and want to make sure I'm not jeopardizing the babies for my shower. On the plus side, the babies are very active today so I knew they were okay before I even went into the Dr. :thumbup: They are such good babies. Lol.


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## drsquid

well i wouldnt worry about the "change". measurements of the cervix are variable at the best of times. (im a radiologist and read ob scans). unless they are focused on a problem or it looks super short or is funneled etc then it is more of a "gross" number. if you are getting 3 or 4 or more cm then you arent gonna be as strict on the measurement (or likely to repeat it a few times to look for variability). as far as the drive/// heck a reclined seat in a car is about similar to what youd be on "bedrest" anyway, i doubt many people lie completely flat.


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## hopingforit

drsquid said:


> well i wouldnt worry about the "change". measurements of the cervix are variable at the best of times. (im a radiologist and read ob scans). unless they are focused on a problem or it looks super short or is funneled etc then it is more of a "gross" number. if you are getting 3 or 4 or more cm then you arent gonna be as strict on the measurement (or likely to repeat it a few times to look for variability). as far as the drive/// heck a reclined seat in a car is about similar to what youd be on "bedrest" anyway, i doubt many people lie completely flat.

It's good to get an opinion from someone else who is in the medical community. Like I said, the u/s tech said anything over 2cm is good and the Dr said anything over 2.5cm is good and I'm sure with their experience, they both know more than me. I just can't imagine what it will be like once the babies get here. I am sure that I will be constantly worried all the time. It's one of the things that come with being a mother, I suppose. :flower:


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## lizziedripping

Hi hun. Anything between 2.5 and 4 is considered normal in either a twin or singleton pregnancy. Twins do exert more pressure on the cervix and sometimes carrying two does create a cervical issue in women who otherwise would carry one baby with no problem at all. It isn't so much the baseline length, but any significant reduction in length over a short space of time which needs monitoring, which it sounds like they're doing. Doctors are super cautious with twins and kind of preempt this as an issue which isn't a bad thing.

At the moment there isn't immediate cause for alarm, but it is vital to check where youre at on a regular basis. I don't want you to be any more anxious than you already are, but cervixes can and do change (sometimes quickly), but there are plenty of things you can do to rescue the situation before it is too late so long as you are vigilant and being checked. 

Many docs believe stitching is pointless in multiple pregnancy because they can deliver early for so many unrelated reasons that cerclages might only add to any potential complications. I on the other hand am a firm believer in them, and mine got me safely to 38+wks with only some mild funneling from 25wks (and my babies were huge). 

You're not at the point where a stitch is necessary, but if there is further shortening in coming weeks I do urge you to push for one honey. On the otehr hand, Women in your position can and do proceed to term with a shorter than average but perfectly strong cervix, whilst others need extra help and that isn't unusual with twins. 

It could well be that 3 is normal for you and your cervix is shortening naturally as pregnancy progresses as it does in all women. It could simply be that the twins are encouraging it to shorten more rapidly than usual, but this doesn't mean your cervix will open too. If all women were scanned routinely there would be a huge variation in length, and most of those ladies make it to term regardless. That said, being aware and having this knowledge isn't a bad thing and means action can be taken if necessary - I would definitely rather that than be taken by surprise by a funneling cervix.

As the other ladies have said, cl measurements can vary hour by hour, day by day and each sonographer tends to measure slightly differently. Accuracy therefore is variable - certainly pressing down whilst she measured is good because this mimics the strain on your cervix when you're moving around and gives a better impression of how it is behaving under strain.

Take the advice of the technician and rest as much as possible. Monitor symptoms and look out for any cramps, lower back ache, increased discharge or bleeding. Don't hesitate to get checked whenever you feel the need and try not to worry. You're in good hands and are aware, the best possible place to be!

Above all, remember that genuine cervical incompetency is rare hun accounting for 1% of all premature births. This is still far more likely to be harmless than not sweet.

I delivered my second singleton at 24wks due to IC, so had a cervical stitch placed in my third, twin pregnancy at 12wks. There isn't really anything I don't know about cervixes and/or incompetence as a result, so please pm me if you need any further advice :)


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## hopingforit

My Dr did mention that it getting shorter is probably caused by the weight of carrying 2 babies. Also, both babies were head down and my girl's head was very close to my cervix though I'm not sure if she was actually pressing on it or not. It's been feeling like she is jamming her head into my cervix sometimes...like a kick type feeling but I know it's her head. So, maybe she is pushing my cervix a little more than if she weren't head down and her brother is right next to her so he might be putting a little more pressure than normal too.

I'm going to mention at my growth scan next week about my cervix length this week to see if they will do a tvu instead of abdominal one to check the length. I go to a special u/s place even though my Dr has an ultrasound tech with the equipment in office and it's sort of frustrating how they work. My Dr office doesn't send any information to the u/s place (My Dr scheduled me for an u/s there at 12 weeks and when I went in, they were very shocked to learn I was having twins since my Dr office didn't mention it) and the people who do the u/s take forever to get the results to the Dr. If they won't do a tvu at the growth scan, I'll request one the next week at my regular appointment. Hopefully a cerclage doesn't become necessary. I'm hoping that since I'm already almost 22 weeks that my cervix is just normally shorter (even with the 4cm reading at 18 weeks) and that it doesn't start to funnel or open.

I will keep an eye out for any changes because I did start having lower back pain last week and had a bit of spotting twice, both of which my Dr knows about. If I have any issues, I'll be sure to call the Dr office right away as I'm sure they would want to get me in to be seen. I've been resting on my couch which has reclining seats and I've been propping my knees up a bit so I'm hoping that will help.

I'm glad your daughter was healthy! I can't imagine going through what you went through with a 24 week baby. I looked at your ticker and your twins were the size of singleton babies. Wow! That cerclage must have worked great! I'll definitely PM you if I have any concerns. Hopefully everything will go great at my scan next week and my cervix will have gone up. Thank you for taking the time to respond. :hugs:


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## wondertwins

Just to echo what the other ladies have already said... the measurement can vary greatly from hour to hour and also from sonographer to sonographer. Between 30 and 32 weeks, my cervix shortened from 4 to 2.4. There was no funneling and no dilation, so the doctor was not too concerned. However, at 32 weeks, I started having pre-term labor (contractions every 3 minutes). I was admitted to the hospital and put heavy duty drugs to stop the contractions. At that point, my cervix was measuring just below 2 via transvaginal ultrasound (all from the same sonographer), and I was a fingertip dilated. After a few days on hospital bedrest, a different sonographer measured me because the regular gal was unavailable. She could find 0 cervix left. Within 20 minutes of everyone freaking out, they got the regular gal down and she was able to re-measure it at 1.9 knowing that my cervix is posterior. All of that is to say... the way they hold the wand can make a big difference in the measurement. FYI... in the end, my water never broke and the length of my cervix never shortened beyond that point. I had a scheduled C at 35 + 4 due to Baby B not thriving.


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## drsquid

i checked mine the other day cause i was feeling pressure.. A has her head crammed against it and B was sitting on her head.. well that explains that


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## hopingforit

drsquid said:


> i checked mine the other day cause i was feeling pressure.. A has her head crammed against it and B was sitting on her head.. well that explains that

Are you saying that them being head down close to my cervix could have caused it to be shorter? The u/s tech and Dr never mentioned that being a cause. I just saw it on the screen and the tech explained how they were positioned (in a v with both heads making up the bottom part of the v) and just thought maybe that could cause it.


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## drsquid

the length shouldnt really change regardless of where their heads are but.. just like i can feel the boy pushing out on the one side sometimes. i was feeling pressure cause they were both pushing on it.. but it hadnt shortened at all. it can be harder to measure though if the heads are right there cause you get shadow from the skull. i was just worried about the length cause of the pressure i was feeling


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## lizziedripping

Hey Hun, am I right in thinking then that they didn't measure using a TVU? I hadn't realised that whenI posted before. If so, they cannot get an accurate cl measurement unless they do a TVU. Usually your bladder is full for a transabdo scan, but needs to be empty for an accurate TVU otherwise this too can obscure the results. It's very hard to get a full cervical length view unless done with an internal probe and I'm surprised they haven't done one, particularly if they're concerned. It's definitely worth asking for one sweet.

As for baby head being low down and on your cervix, unless your cervix is weak it really shouldn't make a difference. For the record my bigger boy had his jammed low down on my cervix for weeks but it didn't affect my cervix any further, and mine is almost completely atonal and totally incompetent. 

Don't worry about baby position increasing the strain, it is thought to be uterine stretching/expansion rather than baby weight/position which places strain on a potentially weak cervix. With two babies the uterus can be over-distended from quite early on - I was full term size at 28wks. 

Get the tvu before worrying about your cl honey - its impossible to know where you're at until you do. It might actually be the case that it is much longer than first thought xxx


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## hopingforit

I did have a TVU. That's the one that revealed the shorter cervix. Before that, I had my anatomy scan where they measured my cervix from the abdominal u/s. It was 4cm on that and 2.9 with the TVU. The 4cm one was done about 15 minutes after I emptied my bladder but it was really full again by the end of the scan so I'm not sure how accurate it was. I have my growth scan next week at the same place that did my anatomy scan and I'm just worried if they only do the abdo one, it won't give the proper length. That's why I said maybe close to 3 is normal for me because my first TVU for a cervix check was yesterday. Could the abdo one be that inaccurate?


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## lizziedripping

Sorry Hun, misunderstood - was reading your posts late last night :)

The abdo scan be inaccurate, and is more of an estimate. It could well be then that your cervix has always been around 3, and is normal for you or it could be that it was slightly longer before and has shortened but you can't rely on the abdo scan to say for definite either way. I would press for the tvu when you see them again, it is the only way to be sure. Good luck and take care xx


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## 1948LC

Abdminal cervical measurements are definatley inaccurate. When I had a abdominal scan done at 9 weeks the Sonographer said my cervix looked long at around 5cm. Then I had a internal cervical scan at 12 weeks and my cervix measured 2.7cm, thats why they monitored me until 24 weeks. I'm sure it would have changed that much in 3 weeks. x


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## BellaDonna818

As all the ladies have said, you really don't have anything to worry about. My understanding is that the average cervical length of a woman who is not pregnant is somewhere around 4cm. 

At 22 weeks, my cervix was something like 2.5cm, & around 23 weeks, I was told I had a shortened cervix (1.7cm), but that it was definitely still closed. My Dr's all recommended bed rest at home & definitely no sex. :winkwink: About 3 weeks later I had another TVU done, and my cervix measured at 1.5cm, so not much of a change. None of my Dr's seemed too surprised, and were all pretty pleased that there hadn't been much of a change in 3 weeks. Of course, I'm having triplets, so I'm more likely to have a shortened cervix than women carrying one or two babies. :winkwink:

And as other ladies have said, the only way to get an accurate measurement is through TVU. Also, I had an ultrasound technician tell me that the measurements can be inaccurate if you've just released your bladder due to you contracting your muscles.


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## hopingforit

1948LC said:


> Abdminal cervical measurements are definatley inaccurate. When I had a abdominal scan done at 9 weeks the Sonographer said my cervix looked long at around 5cm. Then I had a internal cervical scan at 12 weeks and my cervix measured 2.7cm, thats why they monitored me until 24 weeks. I'm sure it would have changed that much in 3 weeks. x

That is a huge difference in just 3 weeks and I assume that it stayed the same length after that with the TVU? If so, those abdominal u/s are really inaccurate. Did you have to go on bed rest or anything or did it remain stable throughout the whole pregnancy?



BellaDonna818 said:


> As all the ladies have said, you really don't have anything to worry about. My understanding is that the average cervical length of a woman who is not pregnant is somewhere around 4cm.
> 
> At 22 weeks, my cervix was something like 2.5cm, & around 23 weeks, I was told I had a shortened cervix (1.7cm), but that it was definitely still closed. My Dr's all recommended bed rest at home & definitely no sex. :winkwink: About 3 weeks later I had another TVU done, and my cervix measured at 1.5cm, so not much of a change. None of my Dr's seemed too surprised, and were all pretty pleased that there hadn't been much of a change in 3 weeks. Of course, I'm having triplets, so I'm more likely to have a shortened cervix than women carrying one or two babies. :winkwink:
> 
> And as other ladies have said, the only way to get an accurate measurement is through TVU. Also, I had an ultrasound technician tell me that the measurements can be inaccurate if you've just released your bladder due to you contracting your muscles.

Oh my goodness! Triplets! Congratulations. :flower:

I guess one good thing is my sex drive is absolutely zero. I haven't DTD with my DH since the week before my BFP because of that and I just don't feel comfortable with it. So, that part isn't a problem for me. I can't say the same for my DH. :haha: It's good to know that even with 3 babies and a short cervix, it is holding strong. I have since done some research on shortening cervix and they say that your risk of preterm birth is higher with a cervical length of <25mm but even then it's only like a 15-20% chance of preterm birth, which is reassuring. 

With the TVU, they require that you empty your bladder right before the exam. They did the measurement literally 1 minute after I did.


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## 1948LC

Hi no I didn't go on bed rest it was never mentioned by my Doctors, but I did take it easy and drink plenty of water. 

I found mentally I really struggled as I was so worried i woud get IC at some point, it was very very stressful.

I had an internal scan at 16 weeks whick showed 3.2cm, then when I was 18 weeks I felt alot of pressure so I went into hospital and they wanted to do an internal examination but I didn't let them - I don't believe in internal examinations early on, they wouldn't do an internal ultrasound as I was due to have one at just before 20 weeks. At 20 weks my cervix measured the same at 3.2, I paid for a private scan at 22 weeks and it was the same and at 24 weeks it was the same so they no longer monitored me

OH and I didn't dtd throughout my pregnancy.

Take care. x


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## mummykel1984

I had tv scan 2 weeks ago and mine was 3.8cm x


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## Lisa84

I havent had cervical length measured yet and it hasnt even been mentioned :shrug: xx


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## 1948LC

Lisa84 said:


> I havent had cervical length measured yet and it hasnt even been mentioned :shrug: xx

They don't check us here. The only reason I was checked was due to previous surgery I had on my cervix. x


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## Lisa84

O good at least im not on my own. Wonder why its not something they check here. Seems to be quite common everywhere else x


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## hopingforit

Lisa84 said:


> O good at least im not on my own. Wonder why its not something they check here. Seems to be quite common everywhere else x

They only check here at the 20 week scan for singleton pregnancies through an abdominal u/s. I get a quick cervix check done by the Dr every 2 weeks but that's just to make sure I haven't dilated any and they will check via abdominal u/s (which people have said is not accurate) at my growth scans. They only do a TVU if there is a reason (like my spotting).


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## hopingforit

I just wanted to update and ask for advice. I found out I have a yeast infection and started the meds last night but this morning I was having some cramping and the feeling that something was stuck in my vagina. I called the dr office and they sent me into labor and delivery where they put me on the toco machine and checked my cervix. I was getting some contractions so they put me on an iv drip and gave me indocin to take for the contractions. My cervix is still measuring 2.8-2.9 with no funneling but the bad part is externally, I am dialated 1cm. I have an u/s tomorrow where they will check and see if everything is okay and I'll have an appointment on Saturday. If anything changes between now and then, they'll admit me and give me steroid shots. So, now I'm really freaking out. I'm on bed rest until then. Has anyone been through this before? Now, I'm really nervous about the babies.


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## lizziedripping

Hey Hun, just typed out a lengthy reply over in 'gestational complications', hope it helps :hugs:


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## Bumblebee117

oh dear - I really hope that everything will be fine and that you won't dilate any further! 

All the best and keep us posted! :hug: xx


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## san fran shan

Oh no! Glad they have you on bed rest and you are under frequent care and monitoring. I don't have personal experience with this, but it sounds like a few ladies on here do and the outcome was positive.:hugs:


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## kcoennen

I found out at 27 weeks I was in preterm labor and was having contractions every 2 mins without knowing it. There are so many medications they can give to stop the contractions it's unbelievable. I was in the hospital for a week before they stopped the labor, then was on strict bed rest until my water broke at 34 weeks. The steroid shots helped my babies so much. Good luck, and remember you must be calm to help your babies out. I had to keep reminding myself that because it is extremely scary.


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## Wind

I have no idea what my cervical length was. I did, however, have monstrous braxton hicks and dilated to one cm fairly early on. I was near panic. I never did dilate any further though. I was still at 1 cm when they did my scheduled section at 38+3.

I hope your cervix stays as it is for awhile longer!! Hang in there!!:hugs:


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## hopingforit

Thank you everyone. I got an abdominal ultrasound and TVU yesterday at the MFM. The abdominal shower my cervix at 2.6cm and the TVU showed it at 3.1cm. I'm not quite sure if that is because my cervix length changes constantly (dynamic according to my dr) or if the abdominal on this one was also wrong (which is weird because before the abdominal showed more than the TVU and this time the abdo showed less). But, I'm seeing the MFM back in 2 weeks. They scheduled it at the office near the hospital on case they either end up admitting me before that or if they have to after the scan. I have an appointment for another TVU (seems like a lot - hopefully it doesn't affect my cervix with all these exams) on Saturday with my OB and she will decide what to do then. I'm done with my indocin as I just took the last dose and I'm hoping the contractions don't come back because I don't feel them all but they were causing change. Fingers crossed all goes well on Saturday. Thanks again for the advice and encouragement.


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