Incompetent Cervix - stitch/cerclage - threatened labour

[MikaylasMummy]

and helen wow i didnt realise u were so close!!!how exciting i cannot wait to see pics and hear how u went!!

 

[Chase]

Can I join you ladies please? I had a stitch put in at 14 weeks and am now 18+5.
I haven't had chance to read all of this thread, but wanted to speak to people that understand my anxieties and to get advice on how to keep this baby in place!!!! xxx

 

[ejsmom]

hi chase,

Welcome to the board... the ladies from what I have are on different parts of our pregnancies. I myself, haven't got my stitch yet..but will in about a month. I had it done with my last pregnancies. I was diagnosed with IC after the loss of my triplets at 23.5 weeks.

My best suggestion to you.. is to listen to your docs..stay off your feet..drink a lot of water which helps keep your uterus calm.

Good Luck.. BTW.. Both stitches resulted in two healthy boys..they are almost 4 and 18 months.

 

[lizziedripping]

Hi Susanah, Glad to hear all is going so well. It's strange how you can be feeling so much fear, convinced that you'll never make 28wks let alone full term, then suddenly there you are discussing delivery options! I knew you'd make it, but that's easy to know when you're not the one lying there contracting like crazy

As for section - I'd say go with your instincts and opt for it if that's what you had planned. I think that being so aware of the potential risks due to your job puts you at an advantage. I know the risks are minimal, but still...........after all you have been thru, I can understand you wishing to reduce any "room for error" as it were. DOn't be pressurised into going for a vaginal delivery hun.

As you know, there are no guarantees in child birth, but I am a firm believer that women should go with the option they feel most comfortable with. You have had enough anxiety to last you a life time, why have any more. If a section would put your mind at rest, then that's got to be the way to go.

Hope I'm not speaking out of turn, and of course this has to be your decision, but I am concerned that you may be feeling pressure to avoid a section when you've earned the right to have one xxx

 

[Sherri81]

Welcome Chase and any other newbies!!

Vasu, I really do think you will be fine with a heartrate of 170. If you are stressed, it will make the baby's heartrate go up more. If its being active, had caffeine through you, lots of sugar etc... then it will have a higher heartrate. I think if it was 190-210, then you should be worried. When my SIL had my nephew, things were going good, then all of a sudden, while she was in laour, the baby's heartrate was going from 200-210 consistently. They determined he was distressed and did an immediate c-section. He was born fine. But she was in labour, and he was spiking. So I think yours is just fine, because that is a difference of 40 beats per minute before they determined a distressed baby.

Ok, as for me, yes, I am on Promterium suppositories, which is progesterone, and have been since 3+1 (I found out super early with this one). I will not be getting the P17 injections. They are available as a study right now in BC, but I could get a placebo instead of the actual P17, so I would much rather stick with my suppositories, knowing they are the real thing and that I have been getting them consistently. I do them rectally to avoid possible vaginal infections. I wouldn't be worried if they caused excess hair since I would much rather have a healthy baby, and that is what laser removal, bleach, and wax is for, right??

As for the nifedipene... Well, Dr. Johnson has agreed to do it... BUT only if I agree to be on monitored hospital bedrest for the entire time I am on it. Now... this won't really work. So I am going to work on her, and see if she will admit me from 21-25 weeks on it, and then... if I am doing good on it, I will see if she will release me on home bedrest, and I will continue to use the nifedipene, but I will go into my hospital and get monitored 2-3 times a day, if that is what she wants. And I will do the non stress tests as many times as she wants me to. I just don't see the need to be on hospital bedrest for 10 weeks, because they are 4 person rooms, and I won't be in a maternity room... I will be in general population. Which, I know from my cerclage, isn't going to work. I was in a room with geriatrics who were coughing all night, they dumped their porta potty's on the floor, I didn't sleep, the washroom didn't have a sink and the only sink available was in one of the old women's bed curtain area... So what good would this do me for 10 weeks?? I would be more exposed to infections, I would get little rest, and I would be highly stressed. So I don't see how that would help me. The thing she is concerned about is the blood pressure lowering effects it can have, and if it will lower the amount of blood crossing the placenta.

So I am going to work on her. And then I figure I will stop the nifedipene no matter what at 30 weeks and take whatever happens. More than likely it would take a week to fully get out of my system, and if I delivered at 31 weeks, I would be happy.

As for delivery of this baby, if it gets down to it, I would like them to remove my cerclage at 35 weeks (if I make it), and since I will be under general already, I would see if they would just do a c-section on me then. It would eliminate the chances of having to re-anesthetize me again a week or so later. They have already said they won't let me go past 36 weeks, and quite honestly, 36 weeks scares me. I feel like if I've made it to a good gestation, why push my luck with a full term birth. Why not just pull it out while it is healthy and won't need much medical support.

Okay, and now I am a tad bit worried right now. I went pee and wiped, and there was a teensy streak of blood on the t.p. And since my pikachu is a no fly zone, I can't just stick some t.p up there and see what's happening. So I just kind of wiped again, and it would appear that I just have regular CM from my pikachu, but there is still a teensy streak on the outside edge of the t.p. So I don't know whether I should be worried, or maybe do I just have a teensy cut or something on the outside of my pikachu? But if that's the case, where on earth did I get a cut from? I tried looking, but well, that didn't work out so well...

What do you ladies think? It isn't smearing all over the tp. It is like a little streak, like if you had a pimple that was bleeding and you pulled some tp across it.

 

[Sherri81]

Okay, found it!! The reason for the bleeding that is. This is so gross... but like you ladies wouldn't investigate either... So I took a good look around, which involved hiking my leg up quite high considering I have a bit of a bump already (hope I didn't squish the bean). Anyways, there is like a little pimple right on the inside part of my pikachu, NOT a herpes, because it sounds like that is where I am heading!! Anyways, I think it might be like an ingrown hair because I shave down there. Anyways, it is irritated and bleeding. So the bleeding is NOT coming from anything internal, but rather some ingrown hair thingy...

 

[MikaylasMummy]

im not at all worried about his cute hair =) i know it will lesson as he gets a little older and he's a boy anyway..doesnt really matter!besides my family is quite hairy anyway so i know what its like to wax lips ect..i was just wondering if the progesterone had anything to do with it..
Sherri why is ur doctor so insistant u be in hospital while on nefidipine??my ob was never worried never questioned it and the only checks i got was the routine blood pressure at each visit..sometimes i got a bit dizzy in the shower or getting up too fast and i had a fair few episodes of gold stars in my eyes but apparently low blood pressure is only dangerous cos it can make u pass out and fall..had to be careful driving though.

 

[Chase]

Thanks for the welcome ladies!

Ejsmom- I am so sorry to hear about the loss of your triplets. Losing children is the most painful thing in the world. I am happy that you have had two successful stitches so far and good luck with this next one.

Sherri- sorry to hear about the loss of Devon and your other angels. I am glad that the bleeding turned out to be nothing untoward! Can I ask you what is nifedepine, and should I be asking for it???

So far my care is: progesterone pessaries, shirodkar suture and I have taken to having bedrest at home for the next few weeks. My consultant is also scanning and seeing me fortnightly and I can ask for swabs whenever I want.

What care is everyone else having/ had? Are any of you on bedrest?

I am also unsure about whether to request a c section or vaginal birth as I am scared of scarring on my womb (this is something I had investigations for after losing my girls as my periods became vvvv light and as I had to have surgery to remove my placentas). I am also scared of having a vaginal birth as my cervix tore after my emergency stitch (which they shouldn't have put in as I was too far gone) and now I have a permanant tear at the bottom, which I am scared will rip further with vaginal birth.

Anyone any thoughts?

Xxx

 

[Chase]

I also forgot to ask, do any of you have a disolvable stitch? That is what mine is and that worries me too! X

 

[Susanah]

Lizzie - I think you are right and I am feeling pressured to have a normal delivery when its not really what I want. I have been thinking about it pretty much all night - and didnt sleep well at all . For now Im sticking to the section plan - if only for my mental wellbeing!
The last time I had normal delivery was with Thomas, who had died, and all I can think of is the memory of delivering a dead baby. Its too close to that time to be able to see NVD as a "safe" alternative.

Chase - Welcome. Dissolvable stitch sounds somewhat unlikely given that they are about as thick as a bootlace. Are you sure? I had a Macdonald stitch (twice). Where are you?
Nifedipine is a calcium channel blocker commonly used for angina and hypertension but also used for decreasing the tone of smooth muscles - uterus.
Is only used in a few cases for this action.
Best way to find out what care people have had is to read the posts (all 75 pages ) as the care varies so much depending on so many things.
Often people find someone with a story similar to theirs.... and Lizzie knows more about stitches than any obstetrician Ive ever met

 

[Chase]

Thanks for the advice susanah, I will read through the thread now.
Sorry to hear about your loss too.

No I am sure about the material being disolvable, she said it would start to disintegrate after about 32 weeks! It is used by the consultants at my hospital (Burnley) instead of mercelon tape, which is what I had before. Has noone else heard of this?? Xxx

 

[lizziedripping]

Hi Chase, and all the other new ladies here -sorry, every time I come here (daily) there are about a hundred new posts, and so many to keep up with

I'm sorry for your loss of the twinnies love, that's tough THe good news is that with a shirodkar stitch, there is a brilliant chance that this pregnancy will go to term. I had a shirodkar with the twins, and very floppy cervix at 12wks. I made it to 38plus wks with very big twins and no problems at all as far as my cervix was concerned. It did funnel to the stitch, but the shirodkar is so damn secure, it didn't let my cervix change beyond it despite the huge weight it was holding.

Susanah is right when she says it is normally mercilene tape they use for cervical stitching, it's a bit like typewriter tape. I am certain tho that any dissolvable option is likely to be foolproof in the same way hun - I'll see if I can find anything out.

I strongly recommend rest, and plenty of water - I didn't take any chances in this last pregnancy hun. If you need any help/advice whatsoever then you know where we are. xxx

 

[Chase]

Hi Lizzie, thanks for your advice and congrats on your twins! It is reassuring to see that a stitch can even work well when there is more than one.
I had a bit of a panic earlier after reading that everyone else was having merceline tape as my consultant had debated with using it and decided on the disolvable one, so ended up contacting her and she has reassured me that if anything she finds it doesn't dissolve and then she worries about removal. It's called pds I think and she said it is like a rope type substance which is also used in hysterectomy.

Xxxx

 

[Sherri81]

The reason she wants me hospitalized during the course of the Nifedipene, is because it is not used in Canada to stop labour contractions, and she has never given it to any of her patients before. So she is very nervous, and it was only because I was pressing her, that she started looking into it.

I don't know if you'll remember, but I saw MFMs in Vancouver back in September, and I asked them about all the different toxolytics, and I was refused every single one of them, because 'in their experience, they had never been shown to help prevent labour, and they caused more problems then they resolved.'

This line of reasoning on their part really pissed me off. Especially since if I could just hop across the border into the States, I would be able to get Nifedipene, Terbutaline.... whatever! And here in Canada, they will only give you Indomethacin, IF you are past 24 weeks, and ONLY for 4 days.

So I was really pushing my OB for the Nifedipene, and she kept refusing me because it is not available for this usage in Canada. However, it is available for its on label use. And I just kept saying 'well, your a Dr, you can still prescribe it. They don't need to know what it's for.'

So she must have finally looked it up, and one day she said she would agree to do this, but that she was uncomfortable, as she had never used it, and no Dr that she could find in Canada, would use it. But she will give it to me, and she is worried about the blood pressure lowering effects it can have, and the effects on the baby. So she wants me hospitalized so she can monitor me.

This just all comes from her discomfort with the off label usage of this medication. So I am going to work on her, and see about coming home after a few weeks, as long as I agree to get monitored twice daily.

I am hoping she will go for this. It would seem to be the best option as after 25 weeks, I will be viable anywhere, and keeping me in hospital for 10 weeks will be a massive drain to their resources since they are such a small hospital. And I don't see how they can possibly put me in a general population room, as I will be too susceptible to infections, and I will need specialized maternity care, which is not available in general population.

As for my cerclage... if I EVER get contacted about it. It is supposed to be a Sharodkur, and they are supposed to be using my thigh tissue, so it is more organic and less inflammatory to my body.

So I guess I will be on the phone in the next 10 minutes here to see if I can find out about my damn surgery... They are really cutting it close here, since I have an 8 hour trip ahead of me just to get to the hospital.

 

[HelenGee]

Nooooo, I've just done a massive post and lost it all!

Ok, short version- welcome to all the new ladies, I'm continually amazed and shocked by the number of ladies affected by this awful condition and I'm so very sorry to hear about the losses suffered.

Susannah- I think you're doing the right thing by opting for the section if that's what you want. Being induced isn't always pleasant, it landed me in the situation you want to avoid, an emergency, out of hours section, waiting for the surgeon to be available. It must be such a burden for you to know so much about how hospitals operate in these situations as it makes it more difficult to make the right choice. Sometimes ignorance is bliss. Go with your gut instinct to give you some reassurance and comfort. A section will also make delivery a lot quicker for you, and hopefully less traumatic.


Jb and nikita- it sounds like you're all doing great. I'll keep you posted, I'm getting nervous that I won't hang on til 39w1 and I'll end up with an emergency section. The baby is getting bigger, she's now measuring near the 80 th centile, she started off on the 50th! I'm still a bit worried about the hair thing too, I guess time will tell....

Susannah - I wanted to ask you about group b strep as it was discovered after the birth of my first. He wasn't affected, but I was given antibiotics during labour as a precaution as my waters broke before labour started. Should I ask for them during my section this time? My swabs have all been negative so far, but I have an appointment on wed and I was going to ask for a swab then. I know that group b strep can just appear from one day to the next. Can it disappear of it's own accord too?

Sherri - I think you're right about avoiding the hospital bed rest, I've been there on the geriatric assessment ward when I was still on self-imposed bed rest at home and it was torture. Ladies shouting out all night, I was upset as I wasn't expecting to be admitted to hospital, and certainly not prepared to be in a non-maternity ward. The toilets were a disgrace as the old dears kept missing the toilet, and I was literally cleaning the toilet before I could use it. I spent more time on my feet, my hands were red raw from scrubbing them clean and the nurse didn't have a second for me as the other ladies were so demanding. She actually apologised as I close to starving in the middle of the night, but they had no food. She bought me a cup of tea with 4 sugars in it and a stack of biscuits. Never again if I can help it.

I'm glad the blood was nothing untoward. Phew!

 

[Susanah]

Helen - Yes you should ask for swabs and for prophylatic antibiotics. The guidelines from the RCOG (last time I checked which was about 2 months ago) stated that any prev GBS, even if not present in this pregnancy - is an indication for prophylaxis this time also.

GBS comes and goes however it pleases and nobody really knows why. The vital thing is to get the antibiotics into you 4 - 6 hours prior to delivery, be it by a section or NVD.
x

 

[Sherri81]

It turns out that somewhere between my OB's office fax, and the Vancouver office fax... all of my paper work has been lost. And this would be why, when I finally reached a person today at the Women's hospital, they had no idea who I was.

SoI freaked, stressed, got my blood pressure up etc. Tried to call my OB to let her know they had no records of me, and she isn't in the office today. And on Monday she is in the OR, so she won't be able to do anything until Tuesday!! I will be 13+1.

So I went to my GP in town here, and she said that she will help me in whatever way she can. Just then, I got a call on my cell from the Women's hospital. They had been in contact with my OB today, and she was sending in the paperwork all over again. I was actually given a contact and a number this time, and told to call on Monday afternoon as they should have something figured by then.

Since I was there, the Dr listened to the heartbeat, which was about 150, which is good.

But then I got into a terrible fight with my husband tonight. And my blood pressure was so high that I was seeing stars, and my heart was pounding. So I really hope it didn't hurt the baby at all. I tried meditating as soon as I could to bring my heart rate down. And it came down well within 5-10 minutes. So do you ladies think I hurt the baby with this fight. And believe me when I say it was a big one.

 

[lizziedripping]

Oh Sherri, you really are on an emotional rollercoaster hun, and it is hardly surprising I too would get into an awful emotional state and my heart would pound, bp up and then I'd start contracting - very stressful. It never hurt the bubbas tho.

Have you tried talking to someone about just how firghtened you are, and perhaps got help to manage those feelings? I am concerned that in trying to have a baby you have never really dealt with your past losses hun. Trying to deal with that, AND getting this pregnancy to term is an awful lot of pressure for anyone.

Take it easy, please try to relax (even just a little) and give yourself a break. As for the hospital, they really need to get their act together and get you sorted - it really isn't good enough. Take care hun xxx

 

[dippy]

i need advice please. i had a scan at 17+3 and cervix measured 45mm- compared to my last pregnancy when i was 17+2 i measured 34mms with cervical shortening.

now my concerns are :

1. after a loss at 20 weeks and a preterm delivery at 26weeks why wouldnt doc just put a stitch in automatically this time.

2. im being monitored every 2 weeks again and last scan showed 45mm and closed os at 17+3 (which i have to admit is better than last time) !!!
Is two weeks a big gap OR should i go for a private one next week? CAN i shorten and dilate dramatically in 2weeks.?

3. i have a baby to look after who is 7 months was a 26weeker and doing fab) and the strain of that is killing me and the worst thing is with IC there are no symptoms-if its anything like my last then ill have no symptoms which scares me as i don't know what too look for.

4. i think the doc thinks cuz i have a child its not important but surely a prem baby is much more expensive to provide care for than jus putting in a simple stitch?

5. these private scans are killing me they are soo expensive- im tempted to go for a scan tuesday as im getting back ache that wont go away and 2 weeks feels like ages. also if there are changes at my private scan how do i tell my docter to stitch me up-how can i make an earlier appointment.?

6. anyone have any success stories of a cerclage put in after week 19- a rescue one?

7. any helpful tips to keep PTL at bay as i think i have irritable uterus.

lol so many questions yet ud think i was an expert with my history. thankyou for any responses in advance. xxx

 

[Chase]

Sherri- I am really sorry that you are having such a hard time!!! I agree with Lizzie about it not harming the baby and the importance of you getting support during this time. I know I am struggling and I haven't had the issues with paperwork etc that you have.

Dippy- Sorry to hear about your loss. I guess it depends on whether they know why you went into ptl as there are many more reasons than ic. In answer to your question about being able to stitch after 19 weeks they can and it can be effective, but the odds of it working are decreased if your cervix is open or very very short with funnelling so it is best if you are having a stitch for it to be done before that happens. Your cervix length at present seems really long andclosed which is a great sign. Have you asked your doctor for more scans during this time? I would speak to your consultant and ask about why he hasn't recommended a stitch and if you could have a few extra scans to see you through this time. Also I would ask about progesterone pessaries, which I am on as these have some evidence for reducing ptl. If you live in the uk they are doing a trial at the moment to see how effective they are, although I am not on it as I didn't want to risk being in the placebo group. Xxxx