Incompetent Cervix - stitch/cerclage - threatened labour

[Sherri81]

See, I have had a million and one internal scans without problems before. But they were all done by a registered technician. This one was done by my OB, and there was a big difference in how she did it. She shoved it right up to my cervix, and she pulled and twisted and pushed and angled it all over. I felt like I was ripping apart. She had a good 4 inches of the probe in there. So now I just have a fear of them, and I don't think I could ever do one again during a pregnancy. And I figure, if they're going to see any changes in the cervix, they will see them externally as well as internally.

So... you want to ask your Dr to prescribe them for me?? Lol. I know, it sucks how different countries are from each other. There are like 8 different meds they can give you in the States to stop preterm labour, but Canada just refuses. They say they tested them like 20 years ago and found they didn't do much, so they just won't use them. But that was 20 years ago! And those people may have had other complications... It is just really frusterating. Sometimes I feel like if I lived in some other country, like the US, then I would be able to have my baby no problem. Well, not 'no' problem, but I think I would get farther than I do in Canada. Well, BC, specifically.

 

[dippy]

i have a question about really bad thrush and a stitch. somebody has said that they wont place the stitch in if u have thrush but i get it bad. iv treated 4 times and still have it nothing works and im only 14 weeks. they even gave mo miconazole. is that true? thrush= no stitch!!!!!!!!!!!! scared .

 

[lizziedripping]

Hi dippy - good question, but really not sure about this. I imagine they'll try to treat the infection first, but as many women probably have thrush but aren't aware of it, they can never be completely sure beforehand anyway.

I certianly wasn't screened for thrush before my op, but did have swabs to check for MRSA. Thrush can track to the uterus if your cervix is already dilated, but if a stitch is being placed electively then the cervix should be long and closed at that point. I wasn't even given antibiotics for infection before, during or after my stitch went in, and bacterial infections are an equal risk.

I really don't know the answer for certain, but will defo be finding out now you've raised it hun. There is a lovely lady called Susanah on here who has had experience of thrush and cervical incompetence, may be she will know more xxx

 

[Susanah]

Hello Dippy
Posted on your other thread but really would advise taking something orally at this stage. There is evidence stating that uterine foreign body + candida is seriously bad news. Some people get thrush a lot more than others and lack the immunological capability to deal with it. I am one of those people and have had thrush on and off since being a child. As I mentioned before, I had a course of antibiotics at week 18, the candida present overgrew and colonised the stitch. I developed candida sepsis and chorioamnionitis and lost the babe at 22 weeks, but his autopsy showed that he stopped growing at about 18 weeks. This overgrowth can also happen at the time of stitch as any disruption of the flora can cause the fungus to accelerate its growth.

If your symptoms are really bad and fails to respond to oral fluconazole, then there is an option of having IV Amphoteracin B but that really is reserved for systemic fungal sepsis and you might have a hard time trying to persuade a doc to prescribe it.
For now, put in canestan every day until you are clear and consider taking an oral medication - fluconazole is prob the best. Discuss it with your obstetrician first. Have swabs done before the stitch to ENSURE no thrush present. Delay stitch until clear. Then you could do what i am doing, and place a canestan pessary twice a week vaginally. I have also had courses of antibiotics during this pregnancy (as am GBS positive also) and have taken oral fluconazole every time. There is evidence that long term use at a higher dose (400mg instead of the 150mg usually prescribed) can cause problems. No evidence that short term/one-off lower dose use causes problems.

As for the yoghurt question, I wouldnt be putting it anywhere to be honest, except my mouth. It really is pretty useless compared to medicines and really messy. Also masks symptoms.

Every women should be swabbed for infection before having a stitch placed. If they dont offer it to you, ask... demand!! A very cheap, simple test that could prevent a lot of problems.

Hope this helps.
Susanah

 

[jessabella]

I had thrush when they placed my stitch but they didn't test me and I didn't really know to tell them as everything was happening so fast!
I know that doesn't answer your question but just wanted to say! I agree with sue and have someone look at it and get treated as I gave heard bad things about what it can do if left untreated!

Anyway sorry I've been away, I'm feeling a little selfish these days in that I'm really wanting my princess now! I highly doubt thst labour will dtart anytime soon but for some reason i really want it to! Im admitted for 24 hous on thursday to have cerclage removed and im so excited but still upset as i know the odds to going straight into labour ae unlikely if you are not already showing signs such as contractions! I am however happy that on thueday doctor declares me full term and since my baby is GIGANTIC he might induce... It's all so unknow! Will keep you all posted! I can't believe I did it!! We made it! Hang in there girls

 

[Susanah]

JB - so happy for you! Congratulations. Inspiring to us all.
Keep us posted. Excited

 

[jessabella]

oh my gosh remind me not to type on my phone again..appears that I never finished school with that spelling!! hahaha
I will keep you posted susanah..definantly..thanks everyone who has helped us get to this point!!

 

[Vaudha]

JB congrats. It must feel so good, safe and relieved to reach that stage. I am very happy for you. let us know your experience after stitch removal. all the best hun.

 

[x-amy-x]

im feeling really let down by the people who are looking after me. I had my scan nearly 3 weeks ago now which showed i had a 2.3cm cervix. i've been bleeding pretty much every day since and with two previous 2nd tri births (both ended in a loss ... one neonatal) im so disappointed i have to wait til monday for some advice. I'm scared all the bleeding is my cervix shortening and by the time they think about the stitch it'll be too late

my heads all over

 

[mich1365]

Amy..I really dont think you should wait until Monday with bleeding. I dont know how the UK works, but can you go to an ER? I had to do that here in the US once when it was a holiday and I had bleeding...mine turned out to be a polyp, though at the time that thought (guessed really) subchorionic hematoma. Ive had to advocate for myself all along...none of the docs or clinics care about your baby like you do, sadly. I am so angry at mine for the way they have treated me...like Im going to lose my baby anyday, yet like every other patient with no special treatment in terms of getting appts, remembering my case details, etc. The hospital perinatologists a different story, in a good way.

JB...So excited for "our" next baby after Nikita. Good luck on Thurs. Its been too long, as we all need to hear these happy endings. And Helen shortly behind you!

 

[x-amy-x]

I cant go in all the time though, i understand that. i've not really stopped bleeding and it was the same with my last two losses. but this is the first time we've found something abnormal and im still waiting for my consultation

 

[Susanah]

Amy - True - you cant go in all the time - but you havnt been given an answer or explantation for whats going on. Demand some answers. Its awful being sat at home without any idea whats happening. Id be in a real state.
Hope you can get someone to give you some advise/help.

 

[JulieWoolie]

Amy I think you need to kick up a fuss. I was told my cervix was 2.1 on Monday 6th December. Since then my midwife organised a consultant meeting on the Thursday 3 days later and I met her again yesterday (in a bit of a state) and she's managed to wangle me a 'reassurance scan' on Tuesday. I've had no bleeding or cramps, or previous losses but have just cried a lot to the relevant people! Kick up a stint hon and make them listen!

Good luck, this is just the worst I know x x x

 

[JulieWoolie]

stink! Not stint, dur.

 

[Sherri81]

No real update on my cerclage situation. I have an ultrasound and appointment with my OB on thursday to check viability again. It will be my 4th scan, and I am hoping everything is alright.

I did get a phone call from a surgeon in Toronto yesterday morning. They want to set up a tele health conference with me for hopefully Dec 22. It is with a Dr Lisa Allen. So obviously I goolged her and it turns out she is the head of Obstetrics and Gyn at Mt Sinai in Toronto, and she actually runs the team with the other Drs I had talked to, Wendy Whittle and Jaquie Thomas. She is also head of Pediatric Gyn at Sick Kids in Toronto. So hopefully she is the person who can help me out. I asked her receptionist which cerclage specifically we would be discussing, and she said she couldn't say, so I am in the dark as to which ones she does.

On google, she has done a study with the Cervico-Isthmic cerclage, but they did it laparoscopically, which I thought was a no no during pregnancy because of the CO2 in the abdominal cavity. So now I am worried. 2 of their 68 patients had losses directly related to the operation. I believe another 4 or 5 had losses a few weeks after surgery and they believe it was due to blood vessel constriction. And there were about 5 more who also delivered very prematurely at about 24 weeks, resulting in 2 neo natal deaths I think.

So now I am really nervous about talking to her about this one. She also does the TAC, but I think we've decided that isn't an option for me.

So I'm wondering if she does the Sharodkur as well... And if she does, are the outcomes better? But if she does the Sharodkur, is it worth it to travel across the country for this surgery, or should I just do it in BC?

And one of the things that bothered me is they discussed the two types of CI in their study; mechanical and functional. Mechanical would be from cone biopsies, loop procedures, DES exposure etc... AND over dilation during a prior D&C. And this is where I am worried. They also threw failure of a prior TVC into the mechanical category. Well, I have had like 8 D&Cs, so I would assume I would fall into mechanical for this reason, AND I failed a TVC, so another mechanical failure. BUT, I also fall in the functional failure category, in that my cervix did start to ripen earlier than expected with Devon. At the time my OB told me not to worry as many women can have ripening cervixes for a long time before going into labour. But by 22 weeks, she was saying I was starting to ripen... So I have both functional and mechanical issues with my cervix!

AND, they went on to say that women who presented with acute chorioamniotitis in a prior pregnancy (which I did with Devon), usually don't have good outcomes with cerclages no matter when they are placed or where they are placed, because it usually means there is a constant infection in the uterus, and it is this infection which will cause recurrent problems whether or not there is a cerclage in place.

So now what?? I had acute chorioamniotitis with Devon. So is this automatically going to reoccur. I am on low dose Erythromyacin throughout this pregnancy, but will that be enough to stop the chorioamniotitis from re-occurring...? Bah! Why did I do this again??

 

[mich1365]

Sherri...This is all so overwhelming for you, and for me just reading it. Im so sorry for the losses you have had to endure, and that must live with you. I hope you can find the right answers and make it! You are clearly doing all you can. Best wishes.
Michelle

 

[HelenGee]

Sherrie- we must have posted at exactly the same time! I'm so sorry for your losses and the stressful situation you're in. My ic was found at 20w4 (13mm with funnelling) and I had an emergency shirodkhar placed the next day. I think the funnelling must have gone for the op. I last had my cervix scanned at 29 weeks and it was 33mm. I also had the progesterone pessaries. I am now 34 weeks and having my stitch out on dec 20th. I wasn't given a choice about which cerclage, but I have had no prior issues with ic, so I'm thinking mine is purely mechanical. That said, my cervix was giving out by 8 weeks I think, I felt awful pressure and couldn't walk far without feeling like my insides were falling out. Good luck and I hope you find the right ob for you.

Jb- good luck for tomorrow hun, been thinking about you. Are you nervous? I'm hoping that I hold on til dec 20th for my stitch removal, feeling very uncomfortable right now! Lots of love and well done xx

 

[Sherri81]

So, so far it seems those that have had the Sharodkur have had it work out well?

It makes me feel better to know that they will be 1.5cm away from baby, as my cervix is 3 cm long and it will only be going halfway up.

And as far as I was aware, I was doing okay with the McDonald, and truth be told, it was still there when I delivered. I ripped beside it, but the knot never came loose. But by that time I'd been having contractions for about 4 days.

So maybe the Sharodkur is the way to go. I know I have enough cervix left for that...

 

[jessabella]

Thanks hun! I'm so ready but nervous as birth is unknown! I want her in my arms yet love feeling her protected inside of me!! I tell you what I won't miss, feeling wet down below, has been that way for 2-3 days and I don't know what is going on! It's like I'm producing double discharge and also can't hold wee properly!! Sorry tmi!! But eh... With all we have been through!! Hahah!! I will be online while in hospital so will keep you updated!!! I will go at 8:45am so will post shortly after with how it went! I'm really praying for the removal to not be so painfulas this stupid cervic tumour is right next to the stitch and not to mention he tied it double round whatever that means!!

 

[jessabella]

well its all done and done...went in and it was painful..but it came out after 5 mins of clip and tug...hubby held my hand..and mum turned away and actually feel asleep
anyway...now my cervix has closed back up...was nearly 2cm when they put the stitch in and now im completely closed and only 3/5 engaged . The hospital is completely full so said it would take ages for me to get a bed as they had a few emergency c sections that werent planned and since I looked so well to just go home..as I only live 8 mins away from hospital. They want me to try and go in labour on my own for five days and then see the doctor to discuss induction if I dont!