Incompetent Cervix

[kimbotrav]

Hi Kim - spotting and pressure at 12wks can be perfectly normal, but it can never hurt to mention it to your midwife and/or get checked at labour and delivery. I had a full term first child, and then delivered early in my second pregnancy, so it can happen but is less likely if you have a "proven track record". Every pregnancy is unique tho, and complications can arise. At the moment I don't think you have any particular reason to worry hun x

Ashley - welcome hun. I have seen you over at twins section, and didn't realise you had a stitch placed in your twin pregnancy. I did too and delivered two healthy boys at 38wks weighing 9 and 7Ibs! If you need me, please feel free to get in touch x

thnak you so much for ure reply another reason i forgot to mention i worry is because i had an abnormality a vaginal and uterine septum a big bit if tissue which seperated them both in half and it says that ic can run along side them but with my son i didnt know i had this...i have had an op to remove them and everything is fine so far so hopefully it will carry on ill mention it to my specialist nxt tuesday as i am under one for my pregnancy because of my history...i was also wondering do they check ure cervix length on ure 12 week and 20 week scans???? thanks xxxxxxxx

 

[lizziedripping]

They don't check the cervix routinely Kim, but if you ask they might x

 

[kimbotrav]

They don't check the cervix routinely Kim, but if you ask they might x

brill thank you for replying i think ill wait and mention it to my specialist im sure if she thinks i need to be checked she should arrange it for me xxxx

 

[lsh2010]

Hi,

I had my cervix length measured last week, I was 12w 6d, and it was 22mm is that normal? there was no funnelling. It was done because I have had several treatments for pre-cancerous cells of the cervix.

 

[lizziedripping]

Hi Ish. 22mm at 12wks is short, but after surgery on the cervix is to be expected. A short cervix in itself is not necessarily incompetent or weak, and may well stay firmly closed for the duration of your pregnancy.

However, during pregnancy, as the baby grows and the weight on the cervix increases, it naturally shortens in all women. It usually stays above 2.8 until the last few weeks when it shortens and opens in preperation for delivery. Because most women start out with a cervix of between 3.6 and 5 before pregnancy, there is plenty of "length" to allow for this natural shortening. If however the cervix is short to begin with (as in women who have had previous surgery), then there is less room for manoeuvre if that makes sense? An already short cervix has nowhere to go when it feels the pressure of a growing uterus.

I have come across women like you who have managed well in pregnancy with a short but firm cervix, whilst others have needed a stitch to help keep it closed if it does get down to the last mm. Personally, I would be asking for an elective stitch now just to be on the safe side, tho your clinicians may typically advise you to "wait and see", putting in a stitch if it shortens too much over the next few weeks.

Hope that helps, and let me know if need to know anything else chick x

 

[lsh2010]

Hi,

Thanks for your advice and info I have an appointment on the 28th April to see a consultant to get a plan of action for the pregnancy, do you think that's too long to wait? I will be 14w 5d when I see him. My placenta is also covering my cervix at the moment, but they told me that was fine at this early stage!

 

[lizziedripping]

Hi - it can be normal for the placenta to cover the cervix this early on, and as it and the baby grow it should move up and away from that position.

As for waiting, an elective stitch works best when placed between 12 and 14wks. It sounds to me like the doc intends to scan fortnightly to check how your cervix is doing - a typical course of action in these circumstances. Knowing what I know now, I personally would be asking to see someone asap with the option of discussing elective stitch placement. That said, being monitored can work well, especially if they intend to stitch as soon as the cervix looks like it might be shortening further.

For some reason consultants generally take a conservative approach to managing short/weak cervixes. Having had an IC and a prem baby as a result, I refuse now tot take any chances hun - fortunately I have an obstetrician who shares that view. Why not try calling the consultant's secretary, explaining how anxious you are and asking if he/she might see you sooner? If they won't then make sure you gently but firmly push to have a stitch - explain that the anxiety you'll feel if you don't will only put you under too much stress, which isn't good for you or the baby xxx

 

[lsh2010]

Hi,

I spoke to my midwife and she said as long they didn't find any funnelling to just wait and see the consultant next week, so I'm doing the waiting game now!! When I had my dating scan they put me ahead by a week so when I see him I won't be quite 14 weeks going by my LMP, I also know when I ovulated as I was using the tests, which is a good thing

I will try and push for a stitch, having one this early does it still have a risk of miscarriage? Should they scan me weekly or fortnightly to check the length?

x

 

[lizziedripping]

A very minimal risk of miscarriage hun - less than 1%. I have never come across a woman yet who has miscarried after elective stitch placement. Fortnightly scannign would be ideal, but in the UK it's usually every 3wks - was for me x

 

[tashina]

Hello everyone,

this is my first time pregnant and we've been so lucky because we got pregnant straight away. So far everything has been ok, until today (Easter Saturday) I recieved a call from the midwife asking me if I had my second scan yet.
I was totally confused as I am 14 weeks pregnant tomorrow and had my first scan at 12 weeks, which showed that all is ok - or so I thought. Turns out that my cervix is short and I need to have another scan asap. WELL THANKS A LOT! They had 2 weeks to alarm me and they choose Easter Saturday to tell me this and now I cant do anything till at least Wednesday.
So after a lot of crying and fearing for my precious baby, I started googling, and felt better now that I know I am not alone and not the only one with this problem.
I have noticed though that most women find out about this half way through pregnancy, at 20 weeks or so. So now I dont know if its a really good thing they found this early (at 12 weeks), or a really bad thing that its short this early?
I really dont know what to do with my self, I am sooooo worried and I cant stop crying>
I havent had any bleeding or cramping, but do have a lot of pains of the right side of tummy, which everyone says is normal.
I would appreciate any reply please..

 

[lizziedripping]

Hi Tash. Sorry you've had this worrying news hun. We've all been there, and it is scary when you find out your pregnancy might have complications

Firstly Tash, don't panic. Did the midwife say how short is short? A "normal" cervix is usually between 3 and 5cms long at 12wks. Have you had previous surgery on your cervix for any reason? Or does your Mum have a history of incompetent cervix at all? The reasons for a short cervix sometimes determine how well it will hold up under the growing weight of a baby, and will help me to advise on a possible course of action - if indeed you need to act.

A short cervix at this early stage is not usual, BUT neither does is automatically indicate disaster. It is good that they have picked up on it, because most of the ladies here knew nothing of their cervical issues until it was too late to effectively do anything about it.

Until you know how short it is with an internal ultrasound, then it's difficult to say how best to deal with it. Docs take one f two approaches - they either recommend monitoring fortnightly with scans, and if the cervix significantly shortens/opens, then an emergent stitch is placed. Or they place a stitch now before any futher shortening. I personally always recommend a stitch immediately because it is the most effective, and usually does the job, but it is n't always possible to persuade clinicians to agree.

It could also be that by short, your cervix is around the 2/2.5 mark, and was this length before you got pregnant. This may be normal for you, and it might stay closed despite the lack of length. the problem is with a short cervix to start with, is that as the baby grows, and the cervix naturally shortens, as it does in ALL women there is less "room to play with" in a shorter cervix - if that makes sense? There is no real way of predicting this hun, BUT as it stands at the moment, you have options, and something can be done to help. I am still not convinced you have an issue until you have the TVU - it was very bad of the midfwife to scare you like this when you can't do anything for several days.

Over the next few days, try to relax, rest and know that nothing is going to significantly change "cervix-wise" over the next week anyway. A shorter cervix really does not become a problem (if at all) until 16/18 plus weeks. The pains you describe are nothing to do with the cervix hun - it is normal to have these pains, and they can be quite bad as your ligamnets stretch to accomodate the baby. A stressed cervix causes bulging pressure down below, something which wouldn't show itself for several more weeks yet anyway.

Get back in touch if you need any more help - I check in here atleast once per day, and I'm happy to help. x

 

[tashina]

Thank you so much for your reply!
I have been crying non stop, this has totally ruined my Easter weekend as not knowing is the worst! I've been hardly moving at all these past few days just in case!
Well, this was a total surprise for me as I've never had anything wrong down below, never had surgeries, and my mom always had normal pragnancies.
The midwife didnt say how short the cervix is, and I didnt know to ask, as at that point I wasnt even sure what a cervix is exactly and what part it plays in a pregnancy. Now I know believe me.
I just cant handle the wait; Im waiting for the place to open so that I can book in the ultrasound. Then I will know what is happening and what the next step is.
The thing that scared me is that when I asked the midwife who told me my cervix is short and thats not normal, I asked her what does that mean, and she said that "basically the cervix shortens as your body is preparing to go into labour, so we need to see exactly what is going on with the second ultrasound". Then she said that I should call them immediately if i have period like pain and/or bleeding. Keeping in mind I knew nothing before this phone call, that to me sounded as if its only a matter of time pretty much. Horrible, and very poorly handled by the midwife.
Now I wait I guess...
Once again thank you, and at least now I know there are options and its not a total disaster like I initally thought...

 

[lsh2010]

Right, I'm off to see the consultant this afternoon, any advice or tips on what I should ask him or how I should persuade him to put a stitch in???

 

[lizziedripping]

Hi Ish - good luck for this afternoon. The only thing you can do is to express how anxious you will be simply watching and waiting for your cervix to change, and that stress alone might put the pregnancy at risk. At 2.2cms there is little room for error, and why wait to potentially lose a baby when somethign can be done to prevent it? (I am not suggesting that is going to happen btw, but you need to emphasise your concerns to get the result you want hun). Let me know how it goes xxx

 

[lizziedripping]

Any news Tash or Ish? x

 

[lsh2010]

They refused to put a stitch in because at my hospital their cut off measurement is 17mm and I'm 22mm!! So she has given me progesterone pessaries to put inside every night for a month and then rescan me at 22 weeks, but I managed to get the internal scan booked to be done at the same time as my 20 week. I felt like she just wasnt bothered and wasn't taking my concerns seriously!!! Im seeing the midwife Friday so going to complain then and see if I can get an earlier scan.

I'm worried now that if it starts to open how will I know? What are the symptoms? It just makes you feel really alone and it's all on you to keep the pregnancy going but I have no control

 

[lizziedripping]

Ish hun, those feelings are so familiar to me, I know exactly what you mean, and you do feel the weight of responsibility when you have a pregnancy with complications. No one else really understands that burden until they too have encountered it.

As for your doc, this is a typical response to women in your position, and it makes me so mad. Whena cervix is being scanned to check for shortening, the cut off for doing an emergency stitch is usually 1.7, BUT this doesn't mean an elective can't be placed before any shortening has occured. You qualify for an elective stitch because there is evidence that your cervix might not cope with the rigours of pregnancy. This "wait and see" approach is common practice, but in my opinion a total mismanagement.

Anyway, on the positive side, the progesterone pessaries have an excellent proven effect on a weak cervix, and I desperately wanted them during the twin pregnancy, but my HA don't routinely prescribe them. THere is evidence to suggest that they prevent PTL and cervical changes in women with very weak cervixes, and have comparable success rates to stitching. Also, you have a short cervix, but this does not mean it is weak, or will dilate in pregnancy hun. You are being closely monitored, and at the moment there is no reason why it should cause you problems.

My cervix was long and closed to start with, and at 12wks still long, but incredibley atonal and floppy (consultants words). The length was irrelevant for me, and it was the case that despite its length, it would have simply "given way' under the weight of the babies. You don't have this problem, and so long as your cervix stays closed, its length does not necessarily mean it will let you down. Keep in touch xxx

 

[lsh2010]

Lizzie,

Thank you for your advice it is much appreciated!! You have made me feel far more calm about this than any of the doctors!!

Laura x

 

[lizziedripping]

Any time hun x

 

[Mommy's Angel]

Thank you for all the information you keep sharing lizzie. I'm on my second 17P injection and I can literally feel the muscles tightening. First injection still has me in pain on my right side as the muscle is swollen. This weeks on the left side is just fine though. Aside from the nausea it's brought back, I can deal with everything else.

My cervix is closed tightly, no funneling or anything but my length keeps going down every two weeks from 39 to 37 and now 35. Hopefully next weeks measurements will show that the Injections are not only keeping the PTL at bay but also stopping the length from dwindling. I know it's still safe where I'm at, but it doesn't make me feel confident seeing it go down every two weeks.