Incompetent Cervix - stitch/cerclage - threatened labour

[sham1]

Hi Angelmummy, I lost my son last year at 20 weeks due to a placental abruption so I know about second trimester loss and I just wanted to reach out to you. I have cervical issues in this pregnancy so had a stitch at 22 weeks and just turning 25 weeks. I would tell you that the stitch is a wonderful medical intervention and don't be worried about it at all. I realise that this pregnancy will be full of worries for you (we can't help that after a loss) but know that the stitch is very secure and has helped me to get the furthest I've ever been in pregnancy. I wish all the best and this forum is great for support from ladies going through similar issues.

Hey Lizzie, I hope you're well and getting lots of support from fam and friends and you know we are all here if ever you need to talk. xx

 

[KrystalDawn]

Hi Everyone, Just wanted some advice - my midwife just called me and said my swab showed anaerobes - thats the 4 time ive had them in this pregnancy! and the 5th time ill be on anti-biotics! Has anyone experienced this or have any words of wisdom? Im not sure what to do - i follow a strict dont list but i just dont stop getting this infection and im petrified it will interfere with the stitch and get into the womb like it did in my twins pregnancy. I lost my twins last year and on my daughters placenta it showed signs of anaerobes xxxx

 

[Jule71]

Hello!

Mine name is Julia and I was wondering if I could join your discussion? I am 21w with a shirodkar cerclage placed at 14w5d. We aren't sure if I am dealing with true IC or PTL. I had a LEEP years ago so my cervix is shorter and a little distorted. I also had a few DnC's from miscarriages so have had some manipulation with my cervix.
My last pregnancy I had a lot of uterine irritability and was having many many BH starting around 22w and a tightenings. My cervix measured normal at my anatomy scan at 19+weeks and then again at 23w (although they were abdominal scans so not sure how accurate they were). My cervix also felt very soft at 23w and by 26w had a closed but short cervix of 1.5cm so was put on strict bed rest. I had no cerclage and no progesterone. I did have steroid shots at 27w and fFN tests which were always negative. I continued to contract constantly but managed to make it to 38w3d when I was induced. By that point I was fully effaced and 2cm dilated, but think that is probably normal at that point.

Now I am at 21w with a cerclage and last ultrasound (2w ago) showed my CL at 3.19 and closed. I am on bed rest since my cerclage placement and also am on prometrium. I am noticing the last few days my BH and irritability increasing so am very nervous and just praying to make it to 24w.
I am very worried about infections and am not sure how to tell what my discharge is supposed to be like, but mine seems watery most times or mucous (like when you blow your nose) sorry TMI. I also seem to have white milky watery kind as well. I do feel a little irritated down there like I could have a yeast infection (had one after my cerclage due to antibiotics).
I did have a swab done about a month ago and it came back negative for BV.

I am SOO nervous and can't seem to stop worrying all the time. I hope to get to know you ladies and have some support. I have been reading and lurking and everyone sounds so helpful and supportive. I hope to get to know you all better.

J.

 

[lizziedripping]

HI Krystal. It must be so worrying to keep getting positive swabs hun, particularly since they were found inutero after the loss of your twinnies. However, I am almost certain that the problem last time was a premature opening of your cervix which allowed the movement of bacteria up into the uterus. This time the stitch is keeping your cervix nicely closed, and the infection cannot track upwards easily - certainly there is no greater risk to you than there si to any other pregnant lady with a closed cervix.

If all pregnant women were screened as closely as us IC ladies, there would be a high percentage with the same infections/bacteria present. They aren't and in the majority of cases, they are none the wiser and go on to deliver full-term healthy babies. Once the cervix is open, there is a direct threat from the external environment that you cannot really do anything about - it is irrelevant if you test pos for anaerobes or not. This is why a closed cervix is so important to a pregnancy, and this is why you have a stitch hun.

It is impossible to relax in pregnancy after the loss of a baby sweet, unfortunately you probably won't until you hold that little cherub in your arms. However, as regards the infection, try to relax KD - as long as your cervix is closed, then the risk from an external infection is low xxx

Hi Jule and welcome It sounds very much like you had an incompetent cervix in your last pregnancy, and you did brilliantly to get to term despite it. The irritable uterus you describe often goes along with the cervical shortening you had, and it is difficult to tell where one ends and the other begins.

ABdominal scans are worthless in terms of measuring the cervix, the only way to look properly is with an internal scan - so it is likely that your cervix had begun to shorten around 20wks or so. BH contractions can be normal after a stitch, and I had them badly withthe twins (two babies probably making them much worse). They are unlikely to have any effect on your cervix unless they are happening more regularly than every 15-20mins and/or become painful. You had them last pregnancy, but they had no significant effect.

The stitch is obviously doing a great job if your cervix is around 3, and there is no reason why you shouldn't go a long way in this pregnancy. You made it last time without a stitch or any real intervention, which is a very good sign hun and testament to the fact that your cervix can hold under pressure

As for infection, are you being screened? The mucous you describe is normal in pregnancy hun, so try not to stress. You will have lots of discharge as the pregnancy progresses (I always have), so be prepared for that, it is essentially harmless. The main thing is keeping your cervix closed, then infection is less relevant anyway - a closed cervix is unlikely to let infection in. Take care xxx

 

[Mommy's Angel]

Hi ladies. Krystal, I pretty much lost Jackson the a similar way in 09'. I had IC which wasn't even considered an issue back then with me. My cervix moved, I lost my mucus plug had REALLY BAD BV which the nurse ignored and it led to the amniotic sac buldging and what was found was inflammation due to an infection that got up there after the cervix was compromised.

This pregnancy I have finally gotten past the 22wk milestone where I lost Jackson and am now at 25wks 1day today. NOT without infection though. I had BV the first month, a month or so later C-diff, last week I was found to have BV so I'm taking flagyl and thursday or friday they called to tell me I had another odd bacteria in my urine which I am taking macrobid for in conjunction to the flagyl. Getting these is important as my cervix had been closed, but if for some reason she goes to the stitch and it opens just a bit, they did not want to take a chance because I've been so stern with them. So It's a matter of what's more important right now. At this point I'm confident all is well with amelia but wanted to take that extra step to be sure there's no bacterial issue. I can feel it ALL clearing up which for me is sanity!


Lizzie, I have a question for you... It's been almost 5 wks since my last sono. That was an internal scan which we know the cervix was closed and I had a good centimeter on both sides of the stitch. The nurse practitioner said from there on out they don't do cervical scans. Only the topical is done now.

Since this practice was part of the reason Jackson was lost with their negligence (though the main nurse practitioner that ignored me is gone) and after what happened last week where I kept telling them I lost a white stitch and they kept telling me what I saw was mucus...I'm NOT feeling very confident with these idiots! For the most part, now that the stitch is in, I think what I'm starting to feel is that the Dr. doesn't think I'm as important a risk because the stitch is in and thus, unless I want to sit there for 4 hours, I don't get to see her. So it's these idiots that I have to depend on to monitor me. Again, after last weeks incident with the stitch and telling ME I was in fact seeing mucus and then saying "oh yeah, that's what it is"! after the speculum exam...I'm wondering if I should call tomorrow when the Dr. is in and ask that she call me (she's given me permission to do this) and tell her that next Fridays scan I want an internal done just to see where Amelia is in conjunction with the stitch and check the amniotic fluid just as a precaution with the leaking I've had.

They DID test last week with a ph strip and said it wasn't amniotic fluid. Honestly the smell has started to go away and I'm not leaking as much (which I'm thinking has to do with the latest un-named bacteria they gave me macrobid for). But for sanity sake I'm wondering if I need to be sure since I'm not having too much faith or trust in the idiots there.

Should I PUSH for an internal this time since it's been 5 wks since my last one? Or do you think I'm being too skeptical? I guess I'm just wondering a couple things.

1.st, I was told that I'd be getting the shots to mature her lungs. When? If they're not doing internals to check where she is in conjunction to the stitch how do they know how early she'll be arriving?? Can they see this from the top of the belly where she is in conjunction to the stitch and know that way? Can they actually see the amniotic fluid on top when they scan instead of internal scans?

I guess I'm wondering if I should depend on the idiots who've proven they haven't a clue most of the time to know this while the Dr. is barely seeing me at the appointments now or whether I should continue to be my own advocate and push to see my cervical length, where Amelia is in conjunction to the stitch and actually SEE the amniotic fluid is alright in there vs. listening to their guesses because they only know what they see and are not really looking at the pictures of the area.

Would you leave it because it looks like things are okay or would you want to monitor for yourself?

I'm not sure what to do here. I WANT to trust these medical staff here, but they've proven to be dummies! I mean the women in this thread new a heck of a lot more then they did but the scary aspect of that is these idiots are supposed to be the ones taking care of Amelia and I.

What would you do?!

 

[inperfected]

It's been really interesting reading this thread... I'm not sure I"ve got IC, but close enough at this stage... I went into labour last Tues (1 week today) and they managed to get me steroids and labour stopping drugs (was in too much pain to listen to what they were) and antibiotics and stop him coming. By the time they'd checked me, i was 3-4 cm dilated, and waters were bulging. Later on that night, they were pretty certain I was fully dilated, but seem to have come down at least now. Now I'm on bed rest in hospital until he's born.

 

[lizziedripping]

Hi Inperfected and welcome hun

From what you describe, it is unlikely you have an incompetent cervix. You went into PTL at 27/28wks, and had contractions which dilated your cervix fully. IC presents itself much earlier than this - usually between 16 and 24wks, and is when the cervix dilates to around 3cms without contractions. By 26wks IC is not usually a threat to a pregnancy because a weak cervix opens under the weight of the growing baby, but does not open past 3/4cms - it needs strong regular contractions to do so. Once a baby is past 26wks it is too small to simply fall through such a small opening.

You seem to have been through so much in this pregnancy hun, and have done so well to reach this point. Given you have probably experienced PTL, and the medication seems to have brought it under control, then fingers crossed you hold your little boy in for a while longer. Take care, and let us know how you get on xxx

 

[lizziedripping]

Hi MA

Oh hun, you are understandably going crazy with worry, and who can blame you? I've been there, and it's a nightmare!!

Firstly, just to reassure you, an abdominal scan can check for fluid levels, but can't really see your cervix clearly. It will show Amelia's position in the womb, and would easily pick up if she had passed down into your cervix, she would be very low down in your pelvis and it would be obvious. It will be impossible to tell without a TVU the length of your cervix, or if you have dilated to the stitch, tho it is possible they could see if your membranes had bulged into your cervix.

However, if your worst fears had been realised, and the membranes had bulged, and you were leaking amniotic fluid, I am certain you would be having symptoms to alert you to the fact hun. THere would be lots of pressure, and the fluid would run, like a trickling tap (sorry, fawcet). It is possible for you to have funneled to the stitch by now (as I did with the twins), BUT that is ok, the stitch will not allow it to open further. If it did (and that happens only in rare cases), you would feel tearing, and there would be bleeding.

I have had a failed stitch, and hun there was no mistaking it You have had a nicely closed length of cervix, it is unlikely that there have been significant changes in the past 5wks. However, I'm with you that you should have had more checks, even if only for your peace of mind. I would be reluctant to have too many internal exams via speculum, BUT can you ask for another TVU? It is always worth checking an IC up to atleast 25wks, beyond which point it is no longer a direct threat.

I do know that routinely many doctors stop scanning a stitched cervix after 20wks because they have "done all that can be done" - supposedly. I don't agree with this rationale, and feel it is important to check the status of a weak cervix stitch or not. My gut feeling is that your cervix is doing fine hun (for what it's worth), BUT I can see no harm in pushing for them to check it again.

I don't think you have a leaking amnion, nor do I think your cervix has changed in recent weeks, but I totally understand your need for reassurance. I hope that's answered your question MA? Get back to me if not x

 

[Mommy's Angel]

Hi MA

Oh hun, you are understandably going crazy with worry, and who can blame you? I've been there, and it's a nightmare!!

Firstly, just to reassure you, an abdominal scan can check for fluid levels, but can't really see your cervix clearly. It will show Amelia's position in the womb, and would easily pick up if she had passed down into your cervix, she would be very low down in your pelvis and it would be obvious. It will be impossible to tell without a TVU the length of your cervix, or if you have dilated to the stitch, tho it is possible they could see if your membranes had bulged into your cervix.

However, if your worst fears had been realised, and the membranes had bulged, and you were leaking amniotic fluid, I am certain you would be having symptoms to alert you to the fact hun. THere would be lots of pressure, and the fluid would run, like a trickling tap (sorry, fawcet). It is possible for you to have funneled to the stitch by now (as I did with the twins), BUT that is ok, the stitch will not allow it to open further. If it did (and that happens only in rare cases), you would feel tearing, and there would be bleeding.

I have had a failed stitch, and hun there was no mistaking it You have had a nicely closed length of cervix, it is unlikely that there have been significant changes in the past 5wks. However, I'm with you that you should have had more checks, even if only for your peace of mind. I would be reluctant to have too many internal exams via speculum, BUT can you ask for another TVU? It is always worth checking an IC up to atleast 25wks, beyond which point it is no longer a direct threat.

I do know that routinely many doctors stop scanning a stitched cervix after 20wks because they have "done all that can be done" - supposedly. I don't agree with this rationale, and feel it is important to check the status of a weak cervix stitch or not. My gut feeling is that your cervix is doing fine hun (for what it's worth), BUT I can see no harm in pushing for them to check it again.

I don't think you have a leaking amnion, nor do I think your cervix has changed in recent weeks, but I totally understand your need for reassurance. I hope that's answered your question MA? Get back to me if not x

Yes, you've answered my question thank you! I'm actually 25wks 2 days and the sonogram is scheduled for next Friday. Since I'm almost over this 25wks, it seems as though the direct threat is as you said almost over. So it looks like there's no point. I won't be having anymore speculum exams as they've done enough unless there is a direct reason (emergency even) to do so. If we could basically figure things out from the regular tummy sono, then I think we'll just go with what we have since I'm almost at 26wks. I see no point then in adding anything extra through the vaginal area if everything looks fine.

It seems fine to me, I just wasn't sure about the fluid issue and sounds like I'd KNOW it because I'd have a lot more fluid than what is coming out.

So we shall see what happens at the regular sono next friday. I feel Amelia kicking more and more. While I feel her kicking or punching still in the lower area, I'm starting to feel more right below the belly button so they ARE getting higher.

I still can't believe I'm almost at 26wks and am dancing around that we have a few short weeks to 28.

Thanks for the information Lizzie! It's hard to know how much lead to give the medical staff when they've proven they're ignorant to many things they should be aware of. Thought I'd get a different perspective and it seems to me that everything is a-okay with just the topical sono.

 

[Jule71]

Lizzy-thank you for all your insight. You sure seem to know a lot about IC. I appreciate your help! Looks like you have beautiful children and I'm happy you beat IC.

I just wanted to answer you about if I'm getting screened. I have had 2 swabs done in the last 2 months and will have another one next appt (next week) I feel irritated down there and still have the watery discharge so want to check it to makes sure it's not BV. It's just so hard to tell the difference btw BV and YI.

I am noticing much more uterine irritability this week and hope it's not changing my cervix! It just seems so early to be getting BH's and all the IU. I thought that only started in the 3rd trimester? My uterus is very cranky and feels tight when I walk and makes it painful. I am trying to stay on my side and drink a lot of water to keep things quiet. i am on progesterone (prometrium) but it's not helping like I thought it would.

Mommy's Angel- Sounds like you are having rough time with the infections but at least you are at viability. May I ask, can you describe the leaking you are experiencing? Is it urine or discharge? Maybe from the BV? I'm paranoid I have an infection since I have watery discharge, but have had it since my cerclage placement 6.5w ago and tested neg for BV a month ago.

 

[Mommy's Angel]

Lizzy-thank you for all your insight. You sure seem to know a lot about IC. I appreciate your help! Looks like you have beautiful children and I'm happy you beat IC.

I just wanted to answer you about if I'm getting screened. I have had 2 swabs done in the last 2 months and will have another one next appt (next week) I feel irritated down there and still have the watery discharge so want to check it to makes sure it's not BV. It's just so hard to tell the difference btw BV and YI.

I am noticing much more uterine irritability this week and hope it's not changing my cervix! It just seems so early to be getting BH's and all the IU. I thought that only started in the 3rd trimester? My uterus is very cranky and feels tight when I walk and makes it painful. I am trying to stay on my side and drink a lot of water to keep things quiet. i am on progesterone (prometrium) but it's not helping like I thought it would.

Mommy's Angel- Sounds like you are having rough time with the infections but at least you are at viability. May I ask, can you describe the leaking you are experiencing? Is it urine or discharge? Maybe from the BV? I'm paranoid I have an infection since I have watery discharge, but have had it since my cerclage placement 6.5w ago and tested neg for BV a month ago.

Thank you, yes. I made it to viability this time. Last time I gave birth at 22wks and my little guy passed away shortly after. That was because of IC though and in conjunction with a series of other thing. It feels really good to get here. I couldn't go through another loss again like that. Jackson was my first and the experience was quite traumatic.

As for the leaking. It was watery and I noticed an INTENSE acidic smell.

I DO have BV however, the acidic smell and intense having to urinate but only a little bit I believe was the infection they just caught in my urine. They said it was a very unknown bacteria but gave me Macrobid for it. Just noticed today that the smell of my urine isn't at all acidic and to be honest I think I finally have a normal urine again. So my belief is I had some kind of odd bacteria in my urinary tract. Have you been tested for the UTI? I would ask them each time for them to send the urine for analysis as one day it'd come up normal, the next it didn't and then finally it did again. So having taken this drug I'm starting to feel good. I had no idea how bad I felt until all this is starting to actually clear.

The inflammation sounds like an infection of some sort. Keep pressuring them to test. Check for UTI bacteria, and the other two in which you have been ......you don't feel like that for no reason.

Good luck hun. I pray you get past viability too and WAY BEYOND!

 

[Jule71]

Thanks MA- I really appreciate your advice. I am so very sorry to hear about your loss of your sweet baby, Jackson. You definitely have an angel in Heaven. I am so happy for you that you made it this far. That must be a relief and I think you can make it much further. My Peri says that once you past 26w the weight of the baby moves off the cervix and more into the abdomen so IC is less threatening. He is sure if I make it to 26w, I will make it all the way.

I did have a UTI after my cerclage (i think due to the catheter) and was also on Macrobid for 10 days, which gave me a YI. I have been getting urine cultures sent every 2 weeks and they come back neg for infection. I go in next Mon for a swab and urine culture so will find out what is going on. I sort of feel like I did with the YI but the discharge is clear, not 'cottage cheesy' like it's described. I used Monistat last time and not sure if it cleared it up. I have been looking into this product called Rephresh Pro B it's sold in drugstores and is suppose to help with ph in the vaginal. I will ask my Peri about this as well.

Funny you had the acid smell, was that from your urine or your discharge. I thought BV had a fishy smell. I have no smell to my discharge (that I can tell) but hard to say. I am just so paranoid of infection.

Thanks again, hope you feel better now that you are getting treated.

 

[Mommy's Angel]

Thanks MA- I really appreciate your advice. I am so very sorry to hear about your loss of your sweet baby, Jackson. You definitely have an angel in Heaven. I am so happy for you that you made it this far. That must be a relief and I think you can make it much further. My Peri says that once you past 26w the weight of the baby moves off the cervix and more into the abdomen so IC is less threatening. He is sure if I make it to 26w, I will make it all the way.

I did have a UTI after my cerclage (i think due to the catheter) and was also on Macrobid for 10 days, which gave me a YI. I have been getting urine cultures sent every 2 weeks and they come back neg for infection. I go in next Mon for a swab and urine culture so will find out what is going on. I sort of feel like I did with the YI but the discharge is clear, not 'cottage cheesy' like it's described. I used Monistat last time and not sure if it cleared it up. I have been looking into this product called Rephresh Pro B it's sold in drugstores and is suppose to help with ph in the vaginal. I will ask my Peri about this as well.

Funny you had the acid smell, was that from your urine or your discharge. I thought BV had a fishy smell. I have no smell to my discharge (that I can tell) but hard to say. I am just so paranoid of infection.

Thanks again, hope you feel better now that you are getting treated.

The acid smell was DEF. from the urine. It's gone now so the macrobid worked.

As for the fishy smell. The only thing i get from BV is REALLY ITCHING and I get the cottage cheese too. I thought it was YI but turns out it was BV. So odd.

 

[KrystalDawn]

Thank you Lizzie and MA for your reassuring replies! Big phew! Well im back on clindimycin for the next 7 days - hopefully that will clear up the B.V. I never seem to have the usual `smelly` symptoms and i always have excess discharge so i can never tell, i just find out from the fortnightly swabbin! I have 3 more appointments where ill be swabbed and then hes out! I have a c-section scheduled for the 23rd of Aug so thats less that 8 weeks - scary!!! THANK YOU BOTH FOR HELPING ME KEEP SANE! XXX

 

[Susanah]

Hi Woody
I just wanted to write to you and tell you how very sad and sorry I was to read your post. Your words were ones that could have been written by me, 16 months ago, and I wanted to offer you support and belief at such an awful time for you. I lost my boy at 22 weeks in february last year. I had cervical incompetence and I was absolutely devastated. I truly also had a broken heart and it was the most difficult and painful experience of my life. I was angry with myself and it took me quite a long time to stop beating myself up. I felt like I was the only person in the world who had ever experienced such a tragedy, but people slowly came out of the woodwork saying that they had lost babies, children - people I had worked with for years, but never knew - for it is such a painful subject.
I want to reassure you that the infection will NOT prevent you from further pregnancies and you will get much better hospital care (hopefully) as a result of what you have been through.
I got pregnant after 6 months and we had our little girl in March of this year. I found the pregnancy very stressful, but now life is so very wonderful.
The sadness never goes, but it gets easier to manage with time and the soul of your little one will remain in you always.
I wish you all the best at this sad time and the best for the future. Your happiness will come.
susanah

 

[Susanah]

Hello everyone
Apologies for my absence... my little one is keeping me very busy!
So pleased to see that MA and Rensben are doing well, and others! Well done girlies
Lizzie - my heart and thoughts are with you. Im so sorry you are going through this. It is so difficult and I hope you are coping ok. Sending you big hugs. I echo something I read above... "Lizzie We LOVE you!"

We are doing great. Just loving my time off work with my little girl and she is now 15 weeks. We just got back from a holiday to barcelona and life is good

Good luck to everyone xx

 

[nkbapbt]

I only have like two mins between breast feeds...so sorry for this slightly one sided post (I haven't caught up on every one just yet, but will be back!).

Marlow came home from the NICU on Monday!!! She's doing just amazing!! She is fully breast feeding, sleeping well...and just such an easy happy girl. Her big brother is great with her and we are all pretty pleased she's home!!

Here she is at home:

https://a7.sphotos.ak.fbcdn.net/hphotos-ak-snc6/267976_10150218481406638_523391637_7607543_4095299_n.jpg

https://a1.sphotos.ak.fbcdn.net/hphotos-ak-snc6/267843_10150218477506638_523391637_7607500_4621926_n.jpg

If you missed my posts before...Marlow was born at 34.4 weeks due to PPROM, PTL and IC. I had a stitch placed at 20 weeks due to IC and my cervix shortening quickly between 13 and 20 weeks, down by nearly 2 cm in that time. In the end IC wasn't my only issue, my water broke on the day of our baby shower. The stitch was removed that night and I was induced the next day to avoid infection.

I also had our son at 23.3 weeks due to the same.

I hope everyone is doing well and all the bumps are cooking well and to full term!!! Lots of love.

 

[lynz85]

congratulations on getting her home she is beautiful.

 

[nkbapbt]

Lizzie

 

[lizziedripping]

NK - what an absolute cutie!!! I am so pleased to hear all is well and you have your second "little miracle" home with you. Another success story - love it!!! xxx

PS - Please give me a nudge ladies if I've missed any questions lately - I haven't been here as often and it's amazing how fast this thread moves on in such a short time! x