Incompetent Cervix

[Bec L]

Thank you. Will ask again at the 20 week scan, and am also seeing the midwife next week. They were so adamant that 2.6 was fine though, so I don't really understand it.

 

[JadeyB]

Hi girls,

Bec L - don't quote me on this, but I think you can have a relatively short cervix and it can still be strong and hold or you can have a long cervix and it just gives way at a certain point in the pregnancy.

I'm not sure what a normal cervix should measure. It was never something that I had given much thought too until TTC and by this point I had most of my cervix removed. I now have a pre-pregnancy length of between 1 and 1.5 cm. At my last scan it was measuring 2cm with my stitch.

The doctors thought that I would be fine with 1.5cm (but admittedly with 2 weekly scans). In my first pregnancy, I had a vaginal stitch put in at 19 weeks but unfortunately this didn't hold and I gave birth to my little girl at 24 weeks - sadly stillborn. I don't want to scare you by that, as you have quite a bit more cervix than I did.

Also in my research since I lost my little girl, I read somewhere that if you have had extensive surgery (I had a lletz, cone biopsy and partial trachelectomy) on your cervix then the vaginal stitch has a lower success rate. I think it has very good success rates otherwise.

Is your cervix naturally short or shortened through surgery?

I think rensben is right, I don't think regular scans are too much to ask.

Rensben - I am really pleased that you are doing well. I was thinking of you. I can imagine how hard the bedrest is for you. I'm resting while not at work (i.e. spend the entire evening laying down and all weekend too) just as a precaution. I am bored stiff, so can imagine you are going crazy. Just think it will all be worth it in a few short months - the bedrest is clearly doing its job - best of luck. Keep us up to date with how you are getting on.

xxx

 

[Bec L]

Thank you JadeyB, that's really helpful. I had a cone biopsy a few years ago so I guess it is a 'shortened by surgery' cervix. One of the SHOs I spoke to did say 'We'd normally expect 3cm but seeing as you'd had the cone biopsy, 2.6 is what we would expect.' So I am hoping that is is short but that it is not because of any activity that is actually shortening it, if that makes sense!! They said there was no evidence of funnelling or opening and the plug was all in place etc. I will definitely ask for another internal though, can but try!

 

[lizziedripping]

HI
Just updated one of my other posts, but had my cervical 16 week scan today and was measuring 2.6cm. The sonographer seemed happy with this and said everything was looking good and as it should be. However having just read up a few more posts on here that seems as if it is short so should I be concerned??

They aren't planning to measure the cervix again, unless I get any tightenings? I am not even sure what that means??! Have my 20 week scan soon, do you think I should demand more cervical scans as my pregnancy progresses?

Hi Bec. Just read your post in another thread, and thought I'd comment on you cervix length here. A "normal" cervix length is between 2.5 and 5. There is a huge natural variation in normal women.

Though your cervix is the lower end of normal at 16wks, it is still ok. That said, it will naturally shorten as the pregnancy progresses due to the increasing weight of your uterus - it can also lengthen too with bed rest.

It does need keeping an eye on because you are still only 16wks, and there is a long way to go, but it is unlikely they'll look again until 20wks. The NHS is different to the states, where women can pretty much get checked as and when they feel the need. I was a bit sneaky tho, and if I was worried, I'd go into L&D and ask for an internal between my scheduled visits. This was never a problem considering my history.

Just to let you know, my cervix was at 4.3 at 18wks, and stayed that way til 25wks when it shortened to 2. I do have a stitch in tho, so that probably helped to strengthen it thru the danger zone. I have had tightenings and the most intense Braxton Hicks for weeks now, none of which has ever had any effect on my cervix.

IC is such an unknown. Ladies can have short cervixes, funneling and sometimes dilation, yet still make it term. Others, like me can dilate, have an emergency stitch which doesn't stop preterm birth. If at 20wks your cervix has shortened further, then is the time to push for a stitch, ideally before dilation has begun. As you can see from previous posts the stitch can still work, even if membranes have bulged.

My advice would be to rest as much as you can. No shopping trips, or heavy lifting. This alone can lengthen your cervix. I have a weak but not entirely incompetent cervix (I have carried a baby to term). I think in my second pregnancy had I known my cervix was weakened by my sons difficult birth, I would have made it thru with some bed rest. Instead I was racing around, lifting suitcases and moving furniture - oblivious to what was happening "down below". My cervix didn't begin to change until 22wks in that pregnancy, with some extra care i probably could have salvaged things.

You too managed to carry a baby to 34wks (strictly not IC), so there is every chance you can do the same again with some TLC to your cervix

Don't let things lie tho - if you're concerned demand action! I'm here if you've got any concerns love x

 

[lizziedripping]

Hi ladies,

Just thought I'd post an update on my situation. I had an emergency cerclage put in at 21 weeks because my cervix was 1 cm dilated and 75% effaced (13mm) with bulging membranes. I have been on bed rest at home ever since and my cervix is now closed and at 23mm. The bed rest is tough but i'm hanging in there. I only get up to go to the bathroom!

I'm happy to hear eveyone is doing well. Good luck to us all!!

Hi there. I have been following your journey hun, and thought I'd comment on your scary situation

Firstly, I think you're doing brilliantly. The fact that you have gained cervical length is a really positive sign. I went into hospital with my second at 23wks, and my membranes were bulging and I was dilated to 2cms. An emergency stitch didn't help me unfortunately, and I went into active labour a few days after it was placed

All the signs for you are good - obviously it was caught in the nick of time. Keep resting. I'm on modified bed rest with twins and a stitch placed at 12 wks and it is sooo tedious, but really worth it.

Interestingly you had BH with your IC - this is unusual, since the deadly thing about IC is it usually completely symptomless. I have had horrendous BH with this pregnancy, none of which have had an effect on my cervix. Apparently it is common with twins - very scary tho. Ironically it was amidst a few weeks of no BH that my cervix shortened at 25wks

I am thinking of you all the time hun, and if you need any advice at all please ask. I did the whole IC thing, and here I am again - must be mad. We will get thru this

 

[Bec L]

Thanks Lizziedripping you are SO much more helpful than any of the medical professionals I have spoken to!!

I emailed my consultant today (I didn't see him personally yesterday) and asked for his advice. I suggested they measure my cervix again at the 20 week scan to check for any shortening and I will see what his response is.

It's so difficult with the lifting thing because I still carry Poppy a lot - putting her in her high chair, the car, crossing roads if we're walking somewhere etc. I know I have to try to cut down on it as much as possible but it's very difficult and it does worry me that I could be causing damage.

I'm just so confused as to why the various people I spoke to yesterday said 2.6 was totally fine and nothing to worry about when I don't think that is correct. FX my consultant is more helpful.

 

[lizziedripping]

Hi Bec. Fret not. The reason the clinicians were ok with your cervix is because it is within normal limits. Especially considering you have had previous surgery on your cervix, your starting length is bound to be shorter than the average woman.

The reason this might, and I say might cause a problem is because there is less starting length, so when it naturally shortens as the pregnancy progresses, there is less room for manoeuvre. That said, what matters more is that it stays closed. It can stay closed at 2cms quite happily for the duration.

If every pregnant woman was to have a TVU, some of them would have short cervixes, some might even have funneling - and otherwise would carry on oblivious. In a twin pregnancy for example, funneling and shortening is common quite early on due purely to the extra weight of a twin pregnancy. It would be unusual not to see this happening in a twin pregnancy.

The important thing for you now is that you are aware, and screened. Which is why they have asked to scan you at 20wks. You may find that your cervix has shortened again, or has lengthened. Docs don't rreally worry in the UK until you drop down to the 1.5 mark - even then there is still plenty of time to get in a stitch. I suspect that because your previous pregnancy went to 34wks, there is no clear reason at the moment to put in a preventative stitch - which carries its own risks.

As for lifting Poppy, try as much as possible to sit as you lift. As long as you restrict your activity to just seeing to her, and no other heavy housework, you should be ok. There is a real question mark as to whether bed rest actually helps a weak cervix, but it can't hurt to take things easy.

Please bear in mind that when you come onto forums like this you are dealing with women who have unfortunately suffered the extremes of IC, and so we will always urge caution at the slightest hint of a problem. Our cases are extremely rare - but nonetheless it is better to be safe than sorry, and the ladies here are trying to stop you going thru the same.

I have every confidence that your cervix will be ok - if it has changed in a few weeks, then you are being monitored, and doing absolutely the right thing to stop things in their tracks. You have carried a baby to 34wks, and like me probably have a weaker, but not entirely incompetent cervix, so try to have confidence that it can take you thru the pregnancy, even if it needs help.

Good luck hun, and write any time x

 

[Bec L]

Thanks again hun, all really helpful. The thing is though, they are not scanning me again at 20 weeks (other than the usual baby growth scan by ultrasound). They have pretty much said I won't get another cervical scan at any stage. I feel as if another cervical scan at 20 weeks would be beneficial, so just need to get my consultant to agree with me!!

I'll be keeping you posted!! xx

 

[lizziedripping]

Oh. You should defo get another scan at 20wks or thereabouts, but I know how hard it is to demand anything on the NHS!

Why not do what I do and go into L&D in 2/4 wks and tell them you're really worried and you are convinced your cervix might be changing? That is of course if you can't persuade your consultant to do one. I don't know if you'd have success, but I have discovered that actually they don't refuse, but rely on the fact that most patients don't think they are entitled to ask.

It is usually because I have complained of braxton hicks, my history of suspected IC, and the fact I'm carrying twins. It's worth trying tho hun. That aside, if you do feel any twinges, aches or pains definitely go in and ask for TVU. If they know you're anxious they may do it just to put your mind at rest.

Keep me posted with how you're feeling - even if it's on a daily basis, and I'll try to help x

 

[JadeyB]

Bec L - I'm sorry that you are experiencing frustrations in getting appointments. Fingers crossed hon that you get to see them when you want to. Try not to worry too much, a friend of mine that I met through a cc support forum had a similar cervical length and she got to 35 weeks with her little girl (with no stitch) - and she is perfectly healthy. She did have fortnightly scans, but never showed any signs of funnelling.

I noticed that you gave birth to poppy at 34 weeks. Was this after your surgery? Did they just not measure your cervical length in that pregnancy or was it measuring longer then. Big hon.

Lizzie-dripping - All of your advice is really intersting and you hit the nail on the head when you said

"Please bear in mind that when you come onto forums like this you are dealing with women who have unfortunately suffered the extremes of IC, and so we will always urge caution at the slightest hint of a problem. Our cases are extremely rare - but nonetheless it is better to be safe than sorry, and the ladies here are trying to stop you going thru the same."

I always worry that I will scare people, but want to share my experience as I would hate for someone to go through losing a baby, if some advice I could have given would have helped. I know what happened to me is extremely rare. The population of the island that I live on is approx 64,000 and i know that not one person has experienced exactly what I have.

Do you mind if I ask you a question? I've managed to persuade my consultant to see me once a week for the next couple of weeks although he made me feel like I was wasting his time - aaarrrggghhh!! Now I'm worried about having too many transvaginal u/s. Have you had much experience with them in the past?

I noticed that you gave birth to your little girl at 24 weeks - that must have been really scary, but I'm really pleased that she is now 5. I hope that she is doing well. It really is lovely to hear stories of little ones surviving at that gestation. We searched for so many stories when my waters broke with Amelia.

xxx

 

[Bec L]

Thanks JadeyB. It's good to hear stories of people who have made it close to term even with a shortened cervix.

My surgery was in 2003 but no one ever mentioned anything about it affecting my chances of carrying a baby to term (and I asked the question at the time). A friend who I have met since having Poppy had the same surgery of me, was told she'd struggle to conceive (as we did) and would never carry a baby to term. (She got pregnant first time and went overdue, so you never can tell!!)

So I had no additional scans or checks when pregnant with Poppy at all, and no one has ever investigated the possible reasons for it happening

 

[lizziedripping]

Bec L - I'm sorry that you are experiencing frustrations in getting appointments. Fingers crossed hon that you get to see them when you want to. Try not to worry too much, a friend of mine that I met through a cc support forum had a similar cervical length and she got to 35 weeks with her little girl (with no stitch) - and she is perfectly healthy. She did have fortnightly scans, but never showed any signs of funnelling.

I noticed that you gave birth to poppy at 34 weeks. Was this after your surgery? Did they just not measure your cervical length in that pregnancy or was it measuring longer then. Big hon.

Lizzie-dripping - All of your advice is really intersting and you hit the nail on the head when you said

"Please bear in mind that when you come onto forums like this you are dealing with women who have unfortunately suffered the extremes of IC, and so we will always urge caution at the slightest hint of a problem. Our cases are extremely rare - but nonetheless it is better to be safe than sorry, and the ladies here are trying to stop you going thru the same."

I always worry that I will scare people, but want to share my experience as I would hate for someone to go through losing a baby, if some advice I could have given would have helped. I know what happened to me is extremely rare. The population of the island that I live on is approx 64,000 and i know that not one person has experienced exactly what I have.

Do you mind if I ask you a question? I've managed to persuade my consultant to see me once a week for the next couple of weeks although he made me feel like I was wasting his time - aaarrrggghhh!! Now I'm worried about having too many transvaginal u/s. Have you had much experience with them in the past?

I noticed that you gave birth to your little girl at 24 weeks - that must have been really scary, but I'm really pleased that she is now 5. I hope that she is doing well. It really is lovely to hear stories of little ones surviving at that gestation. We searched for so many stories when my waters broke with Amelia.

xxx

Hi there. I never mind you, or anyone else asking me a question. I am glad to be able to help

I am sorry to see you lost your little girl hun, it must be something which stays with you forever. Hopefully, 16wks from now you will finally hold your healthy baby in your arms and you can begin to heal darlin'.

Don't worry about having TVUs. There is always a slight chance of infection being introduced when anything is placed inside your "bits and pieces", but I feel that the benefits far outweigh the risks.

When you think that most women continue to have regualr sex throughout their pregnancies, and the chance of infection is much higher with sexual activity than having a sterile probe inserted. Given your history I would feel very reassured by scans - it is the ONLY way of checking cervical length accurately.

Do you have a stitch in place btw? What is your current CL? And please don't worry about the Doctor's attitude - this is your pregnancy, your baby and you should do everything in your power to get you thru.

I learnt a long time ago to disregard the "rolling eyes" and "sighs" from clinicians who thought we were too pushy when my daughter was born. If we hadn't been, she would have been born at 23wks because Docs said there was nothing they could do to stop it happening - yeh right - that's what they thought

Don't accept anything they advise unless you are entirely happy. They don't know everything.

Good luck love x

 

[JadeyB]

Thanks hon - thats a good point about others having sex. We have to abstain, last thing I feel like at the minute anyway. I've only booked in for the next 2 weeks on the trot and then I'll ask to be seen 2 weeks after that. Then I will reach 25 weeks and hopefully feel confident not to be seen for 3 or 4 weeks.

I currently have an abdominal stitch, I had that placed pre pregnancy. I had an occlusion stitch put in when I was 18 weeks, this is thought to close up the tip of cervix and give extra protection against infection. I think it is designed to act like a mucus plug in someone who has very little cervix. From the research that I have done, this is not commonly practiced.

The stats of an abdominal stitch are very good - thought to be about 95% effective.

At my scan on Thurs my CL is measuring at 4.2cm (wow!) - pre pregnancy and pre-stitch it measured at 1.5 cm. I'm not sure where the extra length comes from?!

Thanks for all your advice honey - its very valuable. When I come out the other side (praying that I do) I hope to be able to offer advice to others.

xxx

 

[Bec L]

That's great news JadeyB, so pleased for you xx

 

[lizziedripping]

Hi Jadey, that's a brilliant CL! Stitches serve to reinforce the cervix and sometimes create an overall tension which was absent before. It is common for a stitch to lengthen the cervix. From what I understand, the trans ab stitch is a brilliant solution for women with little or no cervix to begin with. I think you have a great chance of making it to term.

It's great that you have so many TVUs planned, even if they just serve to reassure you, that has got to be a good thing. Btw, once you reach 27/28wks the threat of IC lessens, mainly because baby moves away from the cervix and onto the pelvis. My consultant was thrilled that my cervix length hadn't lessened until 25wks, so if yours is looking good then, chances are it will remain that way.

Mine at 28wks is still 2cms, and has barely changed since week 25. I am hopeful that in a few weeks it may have lengthened further as the babies move up and way from that region. If it doesn't, well the stitch should continue doing its job.

Good luck and keep us posted x

 

[Blessed1]

Hey girls...just an update. After being seen every 2 weeks by a perinatal specialist my cervix measured 3.3cm at my 24week check up!! Dr. said it was not an abnormal length and I don't have to go back to see them anymore! Yipee!
Of course my husband and I asked if we still had to abstain from sex/orgasm and he said "No" but recommends we use a condom or the "pull out" method when my hubby ejaculates. Apparently there is something in the sperm that can bring on labor.

thanks for all the advice ladies. I truly knew what questions to ask and what kind of treatment to expect. I am praying I carry full term.

Glad to also hear some updates from you gals...

 

[JadeyB]

Hey girls...just an update. After being seen every 2 weeks by a perinatal specialist my cervix measured 3.3cm at my 24week check up!! Dr. said it was not an abnormal length and I don't have to go back to see them anymore! Yipee!
Of course my husband and I asked if we still had to abstain from sex/orgasm and he said "No" but recommends we use a condom or the "pull out" method when my hubby ejaculates. Apparently there is something in the sperm that can bring on labor.

thanks for all the advice ladies. I truly knew what questions to ask and what kind of treatment to expect. I am praying I carry full term.

Glad to also hear some updates from you gals...

Hey hon,

I'm really pleased that you had positive news at your scan and baby continues baking until your due date.

It is quite common to be asked to wear a condom when you have cervical issues. This is my second pregancy with little cervix. We were told to abstain from sex altogether, but that is only because I have such a little amount of cervix to start with. Although it has been artificially lengthened, I am still considered high risk for infection so not allowed swims or baths either.

I had my little girl in April, and we got pregnant as soon as we were allowed to start trying again, so I feel like we haven't had sex forever!!! Not that I'm complaining - lol! So long as bubba gets here healthy and preferably on my scheduled c-section date!

keep us posted. xxx

 

[JadeyB]

Hi Jadey, that's a brilliant CL! Stitches serve to reinforce the cervix and sometimes create an overall tension which was absent before. It is common for a stitch to lengthen the cervix. From what I understand, the trans ab stitch is a brilliant solution for women with little or no cervix to begin with. I think you have a great chance of making it to term.

It's great that you have so many TVUs planned, even if they just serve to reassure you, that has got to be a good thing. Btw, once you reach 27/28wks the threat of IC lessens, mainly because baby moves away from the cervix and onto the pelvis. My consultant was thrilled that my cervix length hadn't lessened until 25wks, so if yours is looking good then, chances are it will remain that way.

Mine at 28wks is still 2cms, and has barely changed since week 25. I am hopeful that in a few weeks it may have lengthened further as the babies move up and way from that region. If it doesn't, well the stitch should continue doing its job.

Good luck and keep us posted x

Thanks honey - I didn't realised that once you get to 27/28 weeks baby shifts - thats reassuring. If I can make it to then I will hopefully feeling a little less crazy and a little more confident about making it to term.

I am really pleased that you are continuing to have good news with your CL. Especially with 2 little bubbas.

xxx

 

[Bec L]

JadeyB - Interesting you should mention swimming. I asked about whether it was ok when I was at the hospital and they said yes (althouth they also said sex was fine and I'm erring on the side of caution with that one and abstaining!)

It's the only exercise I get (swimming I mean ) other than walking - is it only in 'extreme' cases that they advise against it? xx

 

[JadeyB]

Hey hon,

I'm not completely sure to be honest - the doctors I've seen were against me swimming.

I've spoken to a lady that has had the full version of the operation I had, so has absolutely no cervix whatsoever and just has a stitch in place and her doctors have said that she can swim - as the chances of water getting right up there (for want of a better way of explaining) are extremely slim.

I will ask my friend who had a similar length of cervix to you and went on to have her baby at 35 weeks what she was advised to do if you want me to?

xx