funnelling cervix

[bek74]

Hi ladies I need some advice please.

At my 19wk scan it showed my cervix was 34mm (3.4cm) in length and all ok. Hubby and I went in for an extra private scan on Wednesday 31st March and I was 23wks pregnant and it showed my cervix is funnelled with a 18mm (1.8cm) opening and my cervix length now only 15mm (1.5cm) long. They rung my OB and he sent me straight to the hospital where I was put into theatre and a stitch put in that afternoon.

I am now on bed rest and only getting up to pee and have a quick shower, for the rest of the time I am just laying down.

I am scared, I am expecting twins and am 36yrs old. I heard of cases where they give injections to mature the babies or even progesterone support, I wasn't given anything, is that normal?

My OB wasn't going to see me again till the 15th but I rung this afternoon to be squeezed in, any questions I should ask him?

Any advice, success stories, anything to help ease my mind please.

 

[lizziedripping]

Hi hun - just posted a message to you over in twins and multiples.

I have a stitch, placed at 12wks due to my last pregnancy ending at 24wks due to incompetent cervix.

I am also prego with twins, but have reached 35/36 wks with relatively few problems. My cervix at 12wks was floppy with absolutely zero tone, and consultant had never seen such a weak cervix so early on

I am testament to the fact that the stitch does work if placed in time. From what you have said, your cervix had begun to funnel, but it was closed at the bottom, and your membranes were not bulging thru the gap. This means you have every chance of making it atleast several more weeks, if not to term.

As for steroids - they don't give them unless labour looks imminent. They work best if administered within a week of delivery, after which they aren't of huge benefit. It is likely that they will have a chance to give them if you begin to show signs of further cervical changes - because I'm guessing your cervix will now be checked regularly?

Progesterone has shown to be of benefit to women at risk of prem labour. In the case of incompetent cervix, this isn't prem labour as such, rather a "silent opening" of the cervix due to weakness - two different things. That said, if you have a doc who is happy to try it, then go for it, it certainly won't do any harm. Here in the UK they don't yet routinely give it, but in the States they do. It can't hurt to ask.

The other thing is to push for regular internal scans. I have had them every 2-3wks in this pregnancy. I began to funnel to the stitch at 25wks, but it remained that way to date due tot he stitch. Don't be worried if you remain funneled - this is to be expected. That is the point of having the stitch placed hun - so long as you don't dilate thru the stitch you should be ok.

As I said in the other thread, the stitch often creates an overall tension to the cervix, and in many cases it lengthens it again. If not, I have known women with virtually no cervix left, and the stitch is holding the babies in - they still make it to term.

The stitch didn't work for me in my last pregnancy, but by the time I went to hospital, my cervix was 3cms dilated, and membranes were bulging. This allowed infection into my uterus which in turn triggered labour. YOu were a long way from this, and so have every chance of making it.

Please get in touch with any questions hun - you are not alone

 

[bek74]

Oh Lizie you have no idea how comforting your post is to me. Thankyou so much hun.

 

[lizziedripping]

Any time hun - seriously. I know how scary IC can be

 

[Sherri81]

Progesterone support is usually only given in the 1st trimester, as the placenta is supposed to be producing adequate amounts of progesterone by weeks 12. So I wouldn't think they would give you any of this now as it probably wouldn't make a difference to the pregnancy. Progesterone support is pretty hotly debated anyways, with some Drs finding no reason to use it as they believe the pregnancy will survive if it should and progesterone may only prolong a 'doomed' pregnancy. I am fortunate that my Dr will use it though, and am currently on the suppositories at the moment.

As for shots to mature the babies, I was under the impression that if there was ANY danger of going pre-term, that they would do it. The fact that your cervix has funneled would seem to put you in that category, so I would definately be asking the Dr for them.

After bleeding at 24 weeks 2 days, with my 3rd pregnancy, I had an u/s which showed that my cervix had thinned/funneled, and I was sent 800kms sounth to a hospital that had a NICU. They said I was in imminent danger of going into labour. I was obviously placed on bedrest, and they did do the steroid shots for me. I did give birth at 25 weeks exactly, and he is now 6 and healthy. They did say that in any subsequent pregnancies (if I ever make it to 20 weeks....) they will start giving me steroid shots to prepare the baby for an early delivery. They said there would be no harm to giving it for 20 weeks (as they don't think I will make it anyways), but that the benefits would be in our favour if the shots were started at 20 weeks, and there was a pre-term delivery.

 

[bek74]

Progesterone support is usually only given in the 1st trimester, as the placenta is supposed to be producing adequate amounts of progesterone by weeks 12. So I wouldn't think they would give you any of this now as it probably wouldn't make a difference to the pregnancy. Progesterone support is pretty hotly debated anyways, with some Drs finding no reason to use it as they believe the pregnancy will survive if it should and progesterone may only prolong a 'doomed' pregnancy. I am fortunate that my Dr will use it though, and am currently on the suppositories at the moment.

As for shots to mature the babies, I was under the impression that if there was ANY danger of going pre-term, that they would do it. The fact that your cervix has funneled would seem to put you in that category, so I would definately be asking the Dr for them.

After bleeding at 24 weeks 2 days, with my 3rd pregnancy, I had an u/s which showed that my cervix had thinned/funneled, and I was sent 800kms sounth to a hospital that had a NICU. They said I was in imminent danger of going into labour. I was obviously placed on bedrest, and they did do the steroid shots for me. I did give birth at 25 weeks exactly, and he is now 6 and healthy. They did say that in any subsequent pregnancies (if I ever make it to 20 weeks....) they will start giving me steroid shots to prepare the baby for an early delivery. They said there would be no harm to giving it for 20 weeks (as they don't think I will make it anyways), but that the benefits would be in our favour if the shots were started at 20 weeks, and there was a pre-term delivery.

Was your cervix funnelled and open (dlating) like lizzie's was? You mention you had a bleed so I am assuming your cervix was open.
I haven't had bleed or show and thankfully 15mm (1.5cm) is still closed. I have an appoinment today so I am going to ask about the steriod shot and progesterone support.

thankyou for sharing your experience. It is wonderful to read that both yours and Lizies little ones are now healthy normal children.

 

[Sherri81]

It had been a very complicated pregnancy, following 2 losses within that year already. Dr didn't believe I was pregnant a first because his test came back negative, 2 weeks later it was positive but I started bleeding, bedrest, heartbeat seen on scan at 7 weeks, 8 weeks more bleeding, bedrest, bleeding at 11 weeks and a SCH was diagnosed. More bedrest. Car accident at 13 weeks. Bedrest. And then, at 24 weeks 0 days, I had some light pink spotting. No pain, just spotting. Was having severe diarhea though so I knew to keep an eye on it. The next day, a bit more pink discharge; ER said was a yeast infection and I was sent home. Next day bright red bleeding and some 'tissue?' Went to Dr and he did an internal and more tissue came out. Sent me to hospital for an u/s, and I remember the tech asking what he was supposed to do with the results. Next thing I know, I am being told to wait for my Dr in the ER. So I'm sitting there waiting in the waiting room, and a nurse comes and tells me to get a gown on. Thats when I knew something was up. My Dr saw me and just told me I would be flying out as my cervix was thinned. No one mentioned dilation, no one mentioned amniotic fluid loss. There was a lot of confusion surrounding that when I arrived in Vicotria as they put me right into a delivery room. I held on for 5 days, and in those 5 days, no one ever truly figured out if my water had broke or if there was dilation happening. It wasn't until the night I went into active labour that I remember them saying I was 4cm. Up until them I belive I had been having regular contractions but the nurses had said I wasn't.

Good luck though.

 

[bek74]

I had my appointment and my OB gave me a steroid injection and I go back tomorrow morning for another one. He doesn't feel I need progesterone support so I am not on that. He did an internal scan to check my cervix and it is back to 32mm with slight funnelling of about 2mm. I am still on strict bed rest for the next 5wks and at 30wks if my cervix is still at 32mm then I can go to mod rest, which allows me up and a bit more freedom but still horizontal for 5hrs during the day, which would be fine with me.
He was completely shocked that it was closed past the stitch and at 32mm in just 1wk but he did say it can chage so still strict bed rest.
I am feeling alot better now, you were right Lizzie about the stitch strengthening and making it longer again.
Thankyou so much hun

 

[lizziedripping]

Oh Bek, I'm so pleased for you hun. I thought that if you hadn't already dialted you had a good chance of recovering the situation. Stitches can still get closure on a dilated cervix, but as in my case dialtion means infection can have already worked its way in.

Please, please continue resting - it really makes a difference, especially with twins.

As for progesterone, it is now licensed for use in later pregnancy because it can prevent the uterus from contracting in women whose own levels of the hormone don't remain high enough to sustain the pregnancy. In the states they give progesterone injections, here in the UK some hospitals give the pessaries. However, they will not give it here unless absolutely necessary - I pushed for it as a precaution, but was told that prem labour wasn't my issue - it is a weak cervix, two different things. I still believe it can't hurt to try everything for women like us tho.

You too seem to have a weaker cervix Bek, and as such the stitch has so far solved the problem. Drink plenty of water hun, don't move for the next 10 wks and try to relax. Keep us posted xxx

 

[bek74]

Thanks hun I won't be chancing anything and all today did for me was ease my nerves and show me the rest is the best medicine and I will continue resting.
When are they removing your stitch?? If all goes well with me and the bubba's hold on they will take it out at 37wks and deliver them at 38wks.

 

[lizziedripping]

Hi Bek. Stitch was due out at 34wks, but my last scan showed that the leading twin was breech so I'm scheduled for a section at 38wks. In which case they'll remove the stitch at the same time.

I was reluctant to have the stitch removed at 34wks tbh, because there is a chance it can trigger labour, and I'd rather these bubs stay put til they're ready to come out. Incidentally, midwife just been and thinks the leading twin may now be head down Typical!!!! Had it all planned out..........

x

 

[selina22]

Hi i have just read and wanted to say the advice u have been given is ace just want to share my IC experiance with my daughter after a loss at 23w6d i had internal scans every 2 weeks which showed i started funneling at 18weeks had the stitch placed then and was put on bed rest still had internals every 2 weeks and they gave me steroids at 23w 2 shots in 24 hours i stayed on bedrest and since having the stitch my cervix had not changed i started mod rest at about 32 weeks had the stitch removed at 37 weeks at which stage i was walkig every where went for curries i remeber doing all the christmas shopping walking up and down the hills lol i was so happy to be able to move again lol she arrived 2 weeks later perfectly and is now 2yrs old. Just wanted to share how good the stitch is and with bedrest and regular check ups you will be fine you can find all of us in the thread incompetent cervix we are all there for support and chats lol
speak soon
and lizzie you are doing so well cant wait to see pics of your lil boys xxx