Incompetent Cervix - stitch/cerclage - threatened labour

[KrystalDawn]

Thank you both for replyin! Means alot that i have this support at such an anxious time. Lizzie do you know if B.V can cause a problem with infecting the stitch and what i should look out for? - im petrified that my B.V infects the stitch. I know with my twins i never had the security of a stitch so thats why after pprom B.V would have got into my womb. Im seeing my consultant tomorrow to discuss whats happening and she may take a look at the stitch herself - hopefully ill get some answers and reassurance! Thanks again xxxx

 

[Mommy's Angel]

Krystal hun - I had BV diagnosed at 23wks with the twins, and no one from the hospital had contacted me to let me know, so antibiotics were delayed for 3wks!!! I was gutted, and terrified. However, my consultant (brilliant lady) explained that BV is very much a chicken and egg infection - no one is sure if it actually triggers preterm labour, OR if it tracks upwards only after the cervix has opened usually because it is incompetent.

The current thinking is that BV is common, many, many pregnant ladies have it, don't know it and it ONLY becimes a problem if and when an incompetent cervix opens. You have a mucous plug, a brilliant barrier to infection, and a stitch. There is no easy way for any infection to track into your uterus at the moment. If you think about it, many people continue to have sex during pregnancy, in which a million different bugs are introduced directly onto the cervix. Becuase it is closed and sealed, the bugs are harmless to the baby or pregnancy. Your BV should be treated, because why not cover every potential issue, but it is very, very unlikely to cause preterm labour or problems for you r pregnancy if your cervix is closed and doing so well. Hope that helps xxx

Now why didn't I think of this. This MUST have been the scenario I had with Jackson. I had BAD BV in the beginning and they kept giving me cream that never worked. Week 16 I lost my mucus plug. Must be I started having cervical length issues before they figured it out (though they'll deny it at the office...the last length they had a couple days before I gave birth to Jackson was 4cm's but they never did an INTERNAL so I'm thinking it was inaccurate).

By week 22 the cervix must have opened and the BV took action wreaking havoc.

THIS time around, since I found this thread, I was able to FIGHT for a cerclage...though they refused to put one in at 14wks I was still keeping them accountable and we found the length dwindling early enough to hopefully work while also having the 17P. My cervix is CLOSED and she saw the mucus plug which is fully in tact up there.

I just keep learning more and more from you Lizzie. I can't thank you enough. I think this has helped me a great deal advocate for myself and my baby this time around.

 

[Mommy's Angel]

Thank you both for replyin! Means alot that i have this support at such an anxious time. Lizzie do you know if B.V can cause a problem with infecting the stitch and what i should look out for? - im petrified that my B.V infects the stitch. I know with my twins i never had the security of a stitch so thats why after pprom B.V would have got into my womb. Im seeing my consultant tomorrow to discuss whats happening and she may take a look at the stitch herself - hopefully ill get some answers and reassurance! Thanks again xxxx

Hm, Im guessing that even IF the BV affects the stitch that any antibiotic would be strong enough to get rid of it. If there was an infection to the stitch I'm wondering if it would be from the stitch alone...but Lizzie would be more knowledgeable with that information.

My thought though is that if you get enough antibiotic (the right one) that it will kill ALL bacteria no matter where it is located. Unsure if you had an infection in the stitch if you'd need something else totally that's Lizzie's expertise.

Please let us know how your appointment goes tomorrow.

 

[lizziedripping]

Hi there - it is unlikely that BV would infect the stitch as such. BV exists quite commonly in the vaginas of pregnant and non-pregnant women. Your cervix is closed below the stitch, and therefore it is doubtful it could track to it. Think of your cervix as closed - even if it is the stitch which is keeping it that way. Stitch or no stitch, a closed cervix is unlikely to allow BV inside, and/or anywhere near the stitch and beyond. This infection can only cause problems if it gets into the uterus (atleast that is the current thinking), and as it currently stands, there is a darn good barrier preventing it Try to relax darlin' x And MA - thanks for your kind words, always happy to help if I can xxx

 

[KrystalDawn]

Oh i didnt realise that my cervix is closed before the stitch i thought it was the stitch that was holding the entrance shut so that if it became infected it can easily spread. Im still so confused with everything as you can tell! lol

Ok so i saw my consultant this morning - who wasnt that helpful. She just said that im just one of those women that are prone to B.V and theres nothing i can do to prevent it. She went on to say that the swabbing was an expense so she may just put me on anti biotics every 3 weeks and not swab me anymore (not sure im happy about that) For now im on clindimycin so hopefully that will clear the B.V until it comes back! ahhhh.

Thanks so much for all your help! xx

 

[Mommy's Angel]

Oh i didnt realise that my cervix is closed before the stitch i thought it was the stitch that was holding the entrance shut so that if it became infected it can easily spread. Im still so confused with everything as you can tell! lol

Ok so i saw my consultant this morning - who wasnt that helpful. She just said that im just one of those women that are prone to B.V and theres nothing i can do to prevent it. She went on to say that the swabbing was an expense so she may just put me on anti biotics every 3 weeks and not swab me anymore (not sure im happy about that) For now im on clindimycin so hopefully that will clear the B.V until it comes back! ahhhh.

Thanks so much for all your help! xx

Your siggie doesn't say but how far along are you?? I'm just wondering why they have you on that drug. It's usually given in the first trimester for safety reasons but it sounds like your BV is like mine. You should be prescribed Flagyl as long as your in the second trimester. It's potent and I know some Dr.'s are hesitant with the side effects, but it's stronger and works better. There are women who've been on it and they're babies are fine. The drug your on takes longer to work. It's also making you susceptible to C-diff for taking it too much/too long.

 

[rensben]

Oh i didnt realise that my cervix is closed before the stitch i thought it was the stitch that was holding the entrance shut so that if it became infected it can easily spread. Im still so confused with everything as you can tell! lol

Ok so i saw my consultant this morning - who wasnt that helpful. She just said that im just one of those women that are prone to B.V and theres nothing i can do to prevent it. She went on to say that the swabbing was an expense so she may just put me on anti biotics every 3 weeks and not swab me anymore (not sure im happy about that) For now im on clindimycin so hopefully that will clear the B.V until it comes back! ahhhh.

Thanks so much for all your help! xx

Just a thought..I'm not sure what kind of stitch you have. A Mcdonald stitch keeps the entrance of the cervix closed and a shirodkar is placed higher up so that the cervix remains closed below. Am I right? My doctor is always talking about a risk of infection because I have a modified shirodkar which means that the cerclage in sewn into my cervix higher up put the strings or whatever they use still hang loose and can be felt on examinations. He said the strings could pick up any infection and track it upwards. Does this sound right to you all?

 

[KrystalDawn]

Im 27 weeks today. I was put on flagyl (metronizadole) by the gp 2 weeks ago, but on the strong course when you take 4 tablets at once (My consultant said she wouldnt have put me on metronizadole as its such a strong dose all at once but i took it without realising!) . However when i was reswabbed a week later anaerobes still showed. I was then put on clindimycin again (i have had b.v 3 times in this pregnancy now) I suffer from thrush as well but ive been told B.V is a different problem to thrush and requires different prevention methods? I take pro-biotic tables every day and do not swim or have baths etc

I have the mcdonald stitch but my cons said it was placed quite high up - not sure what that means for this stitch. Im not sure what is more prone to infection but i heard the Mcdonald is?

Thanks everyone for your help! xxx

 

[Mommy's Angel]

Im 27 weeks today. I was put on flagyl (metronizadole) by the gp 2 weeks ago, but on the strong course when you take 4 tablets at once (My consultant said she wouldnt have put me on metronizadole as its such a strong dose all at once but i took it without realising!) . However when i was reswabbed a week later anaerobes still showed. I was then put on clindimycin again (i have had b.v 3 times in this pregnancy now) I suffer from thrush as well but ive been told B.V is a different problem to thrush and requires different prevention methods? I take pro-biotic tables every day and do not swim or have baths etc

I have the mcdonald stitch but my cons said it was placed quite high up - not sure what that means for this stitch. Im not sure what is more prone to infection but i heard the Mcdonald is?

Thanks everyone for your help! xxx

Wow! You were given 4 pills to take in the same day?? That may be your issue. The idea is to take two pills daily for a week or two not given all in one dose. Sounds like all the eggs were put in one basket. Wowee that's potent stuff to be taking all at once. Maybe you had a different dosing than me though since your in the UK. I'm assuming with the high dose all at once it wouldn't work anyways because you were given too much too soon. These drugs are supposed to work over a period of time though Flagyl is much stronger and kills it quicker than the drug your on at the moment.

I was on that drug first trimester for I think a week or so. It worked over time and did the trick. I was quite surprised but figured my body wasn't used to it since it was new to me so it worked like a charm. I'm praying it takes affect soon. BV stinks to have! Since my lasting STRONG dosing (I was in the hospital on IV due to c-diff) I haven't had it since. I DO have thrush though and have been playing with the thought of taking a diflucan. Diflucan here though is only oral and will cross the placenta. I'm trying to rid the thrush with special medicated wipes and may try putting a pess. up there by finger to work it out. I'd take diflucan as an extreme last resort.


Rensben, I have no idea about the stitch and infection, everything I've learned thus far has been from Lizzie.

 

[lizziedripping]

Hi everyone. A cervix - even an incompetent one is closed and long at the point when an elective stitch is placed. A shirodkar is placed high up at the top of the cervix near the uterus, and as a result the bladder and vaginal walls are dissected away from the cervix so it can be placed that high. If the cervix opens with this stitch in, it usually opens to the stitch, but stays closed below it. Often there is still a good 2cms of closed length left below the stitch. Sometimes the cervix stays closed above, and below the stitch for most of the pregnancy.

The Macdonald is more of a purse string suture, sewn thru the cervical walls, and lower down the cervix. It is an excellent stitch, which works just as well in women with singletons, and when placed electively. You can funnel to it in the same way, and sometimes (in rare cases) the cervix can open right thru it. More often tho, there is funneling to it, but still a good length of closed cervix below.

Stitches of either kind are placed to effectively keep the cervix closed, above and below, tho in women like us there is usually some funneling at the top of the cervix - hence the reason for placing the stitch originally.

Infection can track into the uterus, but usually only if the cervix is open, top to bottom. WIth an intact stitch in place, there is likely always some barrier to this infection. Stitches can become infected, but normally immediately after placement, and as a result of having the surgery.

Rensben, I have never heard of the stitch "strings" hanging down to such an extent that infection can easily track back up them, but theoretically I suppose that is possible. It is still extremely unlikely tho if the cervix is closed below the stitch. If the cervix does open thru the stitch, then preterm labour is often the first problem, quickly followed or tied in with significant infection risk. Certainly an infection which starts with the stitch, tho possible is a very minimal risk. Hope that helps to clarify things. xxx

 

[KrystalDawn]

Yup 4 pills all at once! :-S The anti-biotics that im on is 3 a day for a week and it did the trick and got rid of the B.V the first time i had it! Cant believe it keeps coming back! This may be TMI! lol but i did ask my cons why i am not having the `smelling` symptoms like i do out of pregnancy and she said its probably because we get to the infection early before symptoms start - so i guess thats good!
Ive become quite a thrush expert and ive always been advised to not use any wipes whatsoever. My cons did not recommend taking the pill at all and even went as far as saying she wouldnt take it if she was pregnant. The pessaries i use almost once a week (esp with all the anti biotic taking it increases thrush!) and they seem to work quite well - i alternate with the tablet pessary and the internal cream version. I also use the external cream most nights and i sleep with nothing on my bottom half so its airy! lol

 

[KrystalDawn]

Lizzie = my new stitch guru lol THANKS!

 

[rensben]

hi ladies,

How's everyone doing? I am now at 29+5 and having some bad back pain and pressure down below. I've also got a cold so I'm really not feeling my best. Am a little nervous as you know I went into labour with Gabriel at 30+2. I've got a scan coming up on thursday so we'll see how that goes. Hope to hear how you are all getting on. Take care!

 

[KrystalDawn]

Hi! This is probably a very stupid question BUT is what is the difference between a sho and a mucus plug or are they the same thing? I had a very very light pink discharge when i wiped yesterday and when i called the midwife she was worried it may be my sho. I went in to the assessment unit to be monitored and they checked baby and my cervix - everything seemed fine and my stitch was in place with cervix closed. My fear is if my sho is part of the mucus plug would that have then meant my cervix would have opened slightly? Im so worried about infections getting in as im still taking anti-biotics for anaerobes. Thanks everyone x

Rensben - Ive had alot of back pain and pressure below - i keep getting told its the baby moving and body parts stretching. Good luck with your scan. I have my scan on Tuesday x

 

[Mommy's Angel]

Hi there. Nothing new so far. I have my scan on Friday. I'm a bit nervous with these scans but hoping all is well. Feeling a bit of pain in my lower right abdomen. kinda feels like pulling a rope and I hope it's not the stitch. Nothing too major, just a slight pain. Other than that I'm lying on either side.

Amelia was kicking away over the weekend. Yesterday not so much and today I don't feel her all that much either. I know at 22wks there are times she kicks and i can't actually feel her so I won't freak out.

Speaking of 22wks. It's milestone week for me. Lost Jackson at 22wks so I'm a bit nervous. It seems as though I'll make it through this week but I'm hoping to make it long past that to 37wks at LEAST. Am I fooling myself that it could be possible to make it to term with both a stitch and the 17P injections? It seems possible.

 

[rensben]

Good to hear that there are no new developments MA. I'm sure you will make it way past 22 weeks. good luck with your scan on friday!

KD: can't give you any advice about show/mucus plug. I didn't see either one with Gabriel. It must have just come out at the time of the birth. Good luck with your scan tomorrow.

As for me, my lower back pain has turned into period like pains. I'm not sure what to do...my appt is on Thursday but should I wait that long? I don't even know who to call at the hospital. They will probably just tell me to come in and get checked but I don't want to overeact and go in for nothing. Especially since it means having to call my MIL to come and pick me up and take me over. Any advice ladies?

 

[KrystalDawn]

I think you should go in just to get checked out. Its better to know for sure x

 

[lizziedripping]

Hi ladies

KD - when a "show" comes away, it is like a large blob of mucusy discharge tinged with brown or bright red. I had it during early labour with my first, and there is no mistaking it. Before the whole plug comes away, there can be extra discharge, and bleeding - whihc is probably why the midwife was concerned.

If your cervix was closed on inspection, then it is unlikely your mucous plug which you saw. A hint of pink blood in pregnancy is not unusual, nor is it sinister necessarily hun. Bleeding can happen all the way thru pregnancy for all kinds of reasons - most of them harmless. How many weeks are you now? WHen did the stitch go in? If you see more bleeding before your scan and/or you get any regular pains at all, then it's always worth getting checked, but at the moment, I can't see that you have any immediate cause for concern

Rensben - sorry if this message comes too late, but I would always advise getting checked hun. The pains you describe can be normal for this stage of pregnancy, particularly in someone like yourself who has a sensitive/irritable uterus. COntraction pains are usually regular and gain in strength - period-like back pains are similar to labour, but true labour is unmistakable, and will not subside. I do hope you're ok hun - let me know how you're getting on if you can xxx

MA - You are at a very stressful point in your pregnancy hun, when you are convinced you'll never make it, but pray hourly that you will I have been there, and there are no words to describe the torment. I spent wks 20-30 in a state of perpetual fear, and cried daily - I was utterly convinced that I would never make 28wks, let alone full term. I could never have imagined in my wildest dreams that I would have made 38wks with such large babies - but I did, and so can you chick. Hang in there, dreams do come true xxx

 

[lizziedripping]

Rensben hun, you ok? I do hope you're managing to hang on chick. Thoughts are with you xxx

 

[Mommy's Angel]

Rensben hun, you ok? I do hope you're managing to hang on chick. Thoughts are with you xxx

Yes! Hang in there...