General Category => Preterm Labor: Anything and Everything => Topic started by: littlemissamanda on April 10, 2018 at 08:41 PM

Title: Ultrasounds after week 24?
Post by: littlemissamanda on April 10, 2018 at 08:41 PM
Hi all,

I was hoping I could get some advice or at least, some other perspectives on this.

Story so far: threatened miscarriage at week 13, went to ER with bleeding, diagnosed with IC and funneling. Emergency cerclage and modified bed rest ever since. Bi-weekly ultrasounds have shown varied cervical lengths, but all above 3cm.

We had our Level II ultrasound two weeks ago and everything was great. The specialist there was concerned that my regular OBGYN has not been doing ultrasounds vaginally since stomach ones are less reliable. But I also know my regular OBGYN has been trying to limit anything "down there". They did a transvaginal U/S and cervical length was between 3.5cm and 3.8cm. All great.

I went back to our regular OBGYN office this week (we rotate through docs) and saw someone new. The doctor who did my cerclage has always insisted on the modified bedrest, but this other doc said she would like me to get up and move around more. Drive short distances, do simple chores, go for short walks, rest sporadically etc. I am a little nervous about this, since I think my good cervical lengths have been down to me resting for most of the day. Thankfully, my husband agreed that I should probably not take this advice too literally; I will move enough to avoid blood clots but still rest as much as I can.

My greatest concern is that after my next appointment in two weeks (week 23), this doctor said I will not be getting any more cervical checks/no more ultrasounds. She said that after 24 weeks, the cervical length checks are not as useful. I asked about other measures - progesterone, FFN checks etc and she said because my length has been good and because I have had no preterm labor symptoms, those things are not needed.

I know I SHOULD feel like this is good news - that I am maybe getting the chance to have a somewhat "normal" pregnancy, but I cannot help feel that all of my safety nets are suddenly being taken away. I know I still have the cerclage, but I still feel so far from any real milestone for a healthy baby. Should I be THAT woman and be more pushy when I go back to the doctor's in two weeks? (I'll be seeing someone new again) I am terrified that the moment the doctors stop checking, my cervix is going to fail again.

Thanks in advance.
Title: Re: Ultrasounds after week 24?
Post by: OBmom on April 11, 2018 at 04:48 AM
Hi Amanda.

First of all, great news the fact that you've been stable for these past weeks. That alone is reason enough to celebrate.
I'm all in favor of moving more, but moving with caution. All the studies available at this point say strict bedrest is harmful for the moms with no benefit for the baby. They also say when you're in preterm labor, staying still is not going to help. But of course, as most moms here can tell you, we tend to feel better and have less contractions when we rest.
All in all, I would say IF you feel well, start moving around the house - preparing breakfast (NOT a meal for 10 members of the family), 5 minute showers (NOT scrubbing the toilets), short walks (this one is personal but I don't think you should be driving - if you have a painful contraction you can step on the brakes or swerve, and someone else can end up in danger).

As for cervical checks, here's the deal: yes, transvaginal ultrasound is more reliable than abdominal measurements. BUT, when you have great lengths such as yourself (anything over 25mm really), it doesn't really matter how you measure it. (As opposed to really short cervix like 8-10 mm, in those cases you can't see that well with abdominal, and should ask for vaginal probe). I agree with your OBGYN in "not poking around in there", as a matter of fact, that's what I chose for my own evaluations. As a general approach, we do bi-weekly checks until 34 weeks or 6 weeks stable. I can understand them wanting t stop the checks (even tough it gives you some reassurance, fact is you've been stable and each check means getting out of the house, driving, waiting rooms, etc..)

I would ask if they're planning on a growth scan around 28 weeks - that would be a great time to take another look at cervical length.

If things change for any reason or you have ANY symptoms of preterm labor, make sure you head to L&D - no living soul will refuse to do a cervical length check if you're feeling pressure or contractions.

There! Sorry for the long post! :)
Title: Re: Ultrasounds after week 24?
Post by: EnglishRose23 on April 11, 2018 at 10:27 AM
Hi Amanda,

Just wanted to let you know that this is standard practice where I am too. With this pregnancy and my previous one my different MFM groups (Vermont with my son, NY with this pregnancy) have both said they don't do any routine cervical length checks after 24 weeks because it lacks predictive value after that point. My checks have all been vaginal, but they usually do a quick belly measurement too and I haven't noticed a big difference between the measurements.

Like OBmom said they will still check you if you go in with ANY symptoms at all. As you reach viability it is very important to go in at the first warning sign so that the steroids have enough time to help baby's lungs.

Congrats on the great cervical lengths and staying stable!
Title: Re: Ultrasounds after week 24?
Post by: littlemissamanda on April 13, 2018 at 09:48 PM
Thank you both! It is reassuring to know that this is standard practice; the specialist doctor who was critical of the abdominal U/S being used made me doubt my OBGYN which is unfair, because she has been awesome! I probably would have lost this little stinker in the ER if it hadn't been for her quick action.

I think my concern is that being a first-timer, I'm not always sure if something is a preterm labor symptom or a regular ache/pain. For example, I have had some back pain today. I don't want to run to L&D because of it, but I also don't want to dismiss it as normal just in case. It's so hard to decide what is best. I have become incredibly anxious again.

OBmom - it is so reassuring to have a professional on here! I read on your post that things are going well for you and you're getting closer and closer to the big day! That's so exciting! But please don't leave us just yet! ;)

EnglishRose23 - I think of you often, since there is only a day or two between us. Can you believe we are almost at week 22 already?! It seemed so far away when this all began.

Thanks again, ladies. Have a great weekend!
Title: Re: Ultrasounds after week 24?
Post by: jmomma on April 16, 2018 at 04:40 PM
I've been anxious about this exact thing littlemissamanda! I'm also 22 weeks, and have my last cervical length check on Friday (when I'm 23 weeks). I've been wondering and worrying what to do after, although I believe after that mark, until you actually experience symptoms, the best thing that has been shown to prevent PTL is progesterone. At least in my case, where I've already had one PTL. I'm not exactly sure what the research says about first time moms, although I think you've got the odds in your favor with a cerclage and the great measurements you've been having.

My cervical lengths have not warranted any sort of restrictions at this point, even when they were around 26mm. At my last appointment I was measuring 31mm (so I seem to be lengthening!), and have really not been taking it very easy at all, other than avoiding major heavy lifting and any kind of exercise or prolonged walking. So at least in my case, at this point, my CL doesn't seem to be affected by more activity. I truly believe it's the progesterone that's helping the most, as the research shows!

So all this to say, unless I hear differently, I'm not sure the research shows anything beyond 24 weeks as necessarily beneficial (other than continuing progesterone). You've been doing all that needs to be done (cerclage, bi-weekly scans) and since those have come up good, I think you already fall into the percentage that has a good chance of not going into PTL. I will still be asking my doctor Friday though, because I agree, it seems like all the safety nets are just gone.