General Category => Pregnancy Complications => Topic started by: Lauren on March 12, 2018 at 01:17 PM

Title: Sludge/Contraction/Short Cervix/Preventative Cerclage - 16 weeks
Post by: Lauren on March 12, 2018 at 01:17 PM
Here's a doozy:

We recently lost our first child due to IC at 24 weeks and became pregnant again after our first cycle.

This has been an incredibly anxious pregnancy as a result.  I had a preventative cerclage at 13+5 and take daily progesterone suppositories (200mg).

I just came back from an elective ultrasound at 16 weeks. During this ultrasound, they found that my cervix had shortened to 2.4cm. I had a cerclage placed at 14 weeks, and it is sitting at 2cm on the cervix - it looks like a strong stitch with good placement.

They discovered during the vaginal ultrasound that I was having a contraction, and this may have influenced the cervix measurement (I'm hoping that because the contraction was low, it was the cause of a shortened cervix, but I have no medical info to back that up).  The tech told me that painless contractions are usual for many women during pregnancy and not to worry.  She was hoping that the contraction would resolve before the end of the exam, but it didn't. 

In addition to this, the US tech thought she saw funnelling through the contraction, leaving only .4cm between the stitch and the end of my cervix. The doctor said she didn't see any funnelling. Again, not sure what to think. How can two experienced professionals see two completely different things?

All of this has left me me anxiously wondering why I would have such a long contraction and whether or not it was in fact impacting my cervical length and whether I am funnelling and if I should take additional precautions.

Finally, and scariest of all, is that they found "sludge" in the intrauterine sac. This puts me at a higher risk of infection. Infection in the intrauterine sac means immediate delivery. They tried to reassure me that "sludge" is common with women with IC, and that it doesn't guarantee infection, it just increases the risk.

My mad Google online research has resulted in 2 findings:

1.  Women with short cervix and presence of sludge have a 50% chance of delivery prior to 24 weeks (2007 study).

2.  Age of gestation for women with cerclage is not impacted by the presence of sludge  (2010 study).

Has anybody else had a preventative cerclage and found out later that there is sludge in the amniotic fluid?  What were your outcomes?
Title: Re: Sludge/Contraction/Short Cervix/Preventative Cerclage
Post by: EnglishRose23 on March 12, 2018 at 07:53 PM
Hi Lauren,

I can't be much help to since my complications are quite different, but my heart goes out to you, that is so soon after a devastating loss to be dealing with a high-risk pregnancy. Given your ultrasound results I would try and seen by your dr for another ultrasound again as soon as possible, they will probably be able to get a much clearer idea of what's going on with your cervix if they do a scan when you aren't having contractions (I'm guessing braxton-hicks since you weren't feeling them?). The sludge does sound terrifying, are you already seeing a high-risk ob (mfm)? On bedrest? So many doctors don't prescribe bedrest anymore, but don't be afraid to make that decision for yourself if it will give you any peace of mind.
Title: Re: Sludge/Contraction/Short Cervix/Preventative Cerclage - 16 weeks
Post by: Lauren on March 14, 2018 at 12:45 PM
Ended up in ER last night after a gush of clear fluid after inserting progesterone suppositories.
Was concerned that it was amniotic fluid, as this was something the doctor told me to look for.
Luckily, everything came back negative, and baby is still doing just fine.

Will be following up with an MFM ultrasound this afternoon. Fingers crossed for good news - stable cervix and no funnelling would be awesome!
Title: Re: Sludge/Contraction/Short Cervix/Preventative Cerclage - 16 weeks
Post by: OBmom on March 14, 2018 at 04:35 PM
Hey Lauren,

How are you feeling today?
In general, any fluid that drips to the floor if you are standing and have no underwear on is a good reason to go to the ER. That being said, good news that everything checked out. I'd say your discharge can be just a reaction the progesterone. Keep it up anyway, there's a recent and major article saying it reduces preterm birth.

Regarding your scan, funneling is a dynamic event and can be an on-and-off phenomenon depending on whether your uterus is contracting. So no wonder the doc and tech may have seen different things. What I don't agree with is the "normal" contractions part. There are no "normal" contractions this early in second trimester, painful or no.
And don't give up hope just yet, sludge is kind of tricky to diagnose and doesn't always mean infection. Especially if there is no PPROM. It's a sign of a fragile cervix, but you knew that already so..

Please let us know about your ultrasoud today. Hope everything goes well.
Title: Re: Sludge/Contraction/Short Cervix/Preventative Cerclage - 16 weeks
Post by: Lauren on March 14, 2018 at 06:42 PM
Back from the ultrasound.

Baby looks good.

Amniotic levels are perfect, so they really don't think that the membranes ruptured last night.

Cervix has shortened again. I think she said 1.7 or 1.9, but I can't remember.  It was definitely lower than 2cm.  I'm feeling disheartened by the change in length.  However, the doctor said that she's not worried about the length at all because that's not the best predictor of a loss, especially with the cerclage. What is a good predictor is whether or not it's closed. Currently the cervix is closed. So that's good.

The sludge is still there. It still puts me at higher risk. There's still nothing they can do about it.

There was another "contraction" today in the exact same place as it was on Thursday.  Again, there was no concern.  It seems to me when looking at the ultrasound that the contraction is "pinching" off the part of the cervix that has the sludge.  Hopefully it doesn't pinch too hard and rupture the membranes!

US doctor thinks that it's a good idea that I still continue to take it easy and not to return to work at this point.  I have a follow up with my OB tomorrow and another ultrasound booked for Monday.

@OBmom - thank you for your words of wisdom and support.  I really appreciate it, especially regarding the sludge.  Worried about your take on the contractions and will be asking my OB tomorrow if there is anything that we can do to relax the muscles.
Title: Re: Sludge/Contraction/Short Cervix/Preventative Cerclage - 16 weeks
Post by: Lauren on March 15, 2018 at 07:34 PM
OB follow up:

The doctor said that he is not concerned about the cervix length - it is open to the stitch, but the cerclage is doing its job and he cervix is closed. There was no funneling seen, which would have been more concerning.
2 doctors and 1 tech have now said no funnelling, so that's good.

He also said further ultrasounds are not needed until the one on the 29th because our course of action will not change.

He said that sludge is rare and there isn't a lot of research. He thinks that it could potentially be from bleeding at 8 weeks when I spotted for a couple of days. So, he hasn't ruled out infection, but just said that the spotting earlier on could be the cause of the sludge - apparently it takes a long time for the blood to dissolve if it's being carried in the sac.

That being said, my OB gave me a RX for antibiotics to help with the sludge, just in case (although there doesn't seem to be that much research out there to support the benefits of antibiotics, I'm glad that we're doing what we can).

He is not worried about the contraction at all and says that it's absolutely normal and expected.  He did not want to prescribe any sort of medication to help restrict contractions because they are not related to labour and do not pose a risk to this pregnancy. He is the 4th doctor/tech to say that, so I'm going to try to drop that from my worries.

Finally, I asked him if we need to prepare for another loss. He said at this time, no. He reiterated that it's a possibility, but he thinks we are more likely to be successful than not, but as I knew before I got pregnant after our first loss, pregnancy doesn't guarantee a baby, and I am at high risk.  So... yeah.

He hesitantly admitted that if we lose this child/decide to try again, that he would do the transabdominal cerclage, which is highly frustrating because that's what I wanted with this one. I was told that they don't perform TAC in Canada until you have experience a loss with a TVC.  It breaks my heart to think that if we lose another healthy child, it's because we didn't have that surgery.

Anyways, I'm off work until the end of pregnancy.  Only 23 weeks left to go...