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Topics - reasontohope

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Hi all,

I’m here with a short cervix success story. It is possible to have a positive fFN at 24 weeks, a cervical measurement as low as 4 mm (.4 cm) at 29 weeks, and still take home a healthy baby with no NICU time. It happened to me! I know that isn’t the case for everyone, and my heart goes out to everyone with a more difficult or tragic story than mine. But I want to share my story in the hopes it can give some strength and optimism to everyone who is here right now and in the future, very scared and uncertain. I was that person for most of this past spring and summer—I lurked hard on this board, too upset to ever post anything, but looking for any and all information I could find. I promised myself I'd come back to post my story. (I'm just sorry it took me almost 3 months to write this up.)

Quick version of what happened with me:
-2.1 cm cervix discovered at 21 week anatomy screening
-started progesterone (vaginal) that week
-started what seemed would be temporary activity restriction that week—spent most of it in bed.
-dropped to 1.2 cm in week 23
-got a pessary in week 23 (I am convinced this saved my daughter’s life—please, anyone reading this with a short cervix, push for a pessary!)
-went on real “activity restriction” (worked from home, no stairs, no walks longer than 5 minutes)
-cervix dropped to .9 cm (9 mm) at 24 weeks
-positive fFN at 24 weeks **this was definitely a low point psychologically**
-course of rescue steroids at 24 weeks
-many BH contractions starting around week 22, but no labor
-cervix dropped as low as 4 mm (yes, 4) in week 28 **second major low point**
-last fFN (negative) and last cervical check (low measurement of 7 mm) in week 30
-start of random more intense “false labor” in week 35, but not enough to go to hospital
-stopped progesterone and got pessary out at exactly 36 weeks
-was dilated to 3 cm and 90% effaced at 36 weeks, doctor guessed I had about a week at most before labor
-went off “activity restriction” at 36 weeks (I had been easing up since 33 weeks and made a few short trips, like to my baby shower at 34 weeks, which I had been so doubtful I would get to have)
-around 34 hours after pessary removal and last progesterone dose I went into labor

 :) healthy baby girl born screaming at 36 weeks 3 days  :) 6 lb 3 oz, 9/9 Apgar score, no NICU time, came home with us 2 days later
-slight worries while she was in the hospital about glucose levels (we supplemented with formula and they went back up) and jaundice (again, formula supplementation and some time in a sunny window resolved this without need for the lights)

I lurked this forum and read many, many older posts all through this spring and summer, the most difficult period of my life. At the time, I was too mute with fear and sadness to participate in the conversation, but I promised myself I would come back to post my story in the hopes of helping others in the future. As it turns out, my story is a very hopeful one.

Here’s a longer version of the above digest. My husband and I became pregnant very soon after beginning to try last December, with a due date of September 14. We were elated! Things progressed well, except for a sudden bout of bleeding in February. At the time, I thought nothing could be scarier, though my doctors (already a high risk practice as I had a DVT on birth control pills more than a decade ago) did not seem particularly alarmed, which I found a bit irritating; they diagnosed a subchorionic hematoma that was shrinking, not growing. I had spotting for about a month, which gradually cleared. Little did we know something much more dire (and unrelated) was on its way, and we would soon find out how different the doctors were when they felt they were dealing with something truly dangerous.

This came at my 21 week anatomy scan. Baby was perfect—and definitely a girl! We were over the moon, chatting happily, as the tech began to do the cervical length exam by vaginal ultrasound. I wasn’t really paying attention until she grew quiet, finished up, and said, “Your cervix is a little short. One of the doctors is going to come talk to you.” She was a tech who wore her emotions on her sleeve (we would come to know her and deeply appreciate her empathy), and I could immediately tell something was really wrong. While we waited for the doctor, I began to google, and I think even landed on this site. By the time the MFM arrived, I was really panicking.

My cervix, it turned out, was 2.1 cm—pretty bad, enough to make me begin to cry and my husband feel sick with worry, but considering how low it was to go later, a number that in hindsight sounds fantastic. The MFM immediately prescribed progesterone and weekly cervical checks, as well as a mild version of “activity restriction” which they would lift if the cervical lengthened turned out to be stable. Because of my blood clotting issues (I was on Lovenox) they were wary of bed rest.

The next week (week 22), miraculously, my cervix had gone back up to 2.4. We thought just maybe we were in the clear.

But the week after that, at 23 weeks, we got a shock. It had dropped to 1.2.

I had the good fortune of being seen by one of the most experienced MFMs in the practice that week. We think of him now as our guardian angel. Cracking sensitive jokes all the while, he checked me for dilation, which he’d use to determine whether or not to do a cerclage in the hospital that night. No dilation. This practice currently  avoids late/rescue cerclages in the absence of dilation, as they have found them to have a high rate of failure and complications. Instead he put in a pessary. Which we are 95% sure saved my pregnancy.

The pessary. Please, please, women with short cervixes and no cerclage reading this now: GET A PESSARY. Find a doctor who uses them and will insert it, as soon as you can. If you are not a good candidate for a cerclage (first time mom, or no issues in previous pregnancy), and your doctor is reluctant to use the pessary, or is pushing a cerclage when it you are past 22 weeks and not dilated, get thee to another doctor, pronto. In the high patient volume, academic/research MFM practice I went to, they’ve found that the pessary appears to work as well as the cerclage in first pregnancies with short cervixes (undilated) and is virtually completely free of serious complications. Unlike the cerclage, it can’t hurt.

The pessary was very uncomfortable (I was back in the office two days later to check its placement, which was fine—it was just not pleasant to have it in) but completely worth it. With it in, my cervix began to stabilize, at least by the doctors’ cautious assurances. Every week, though, the low measurement (which is the one the practice used each week) reduced by another few millimeters, which was psychological torture.

Roughly (typing this from traumatized/seared memory):
21 weeks— 2.1 cm
22 weeks— 2.4 cm
23 weeks— 1.2 cm
24 weeks— .9 cm
*at 24 weeks I got a positive fFN and steroid shots. All of my other fFNs were negative*
25 weeks— 1 cm
26 weeks— 8 or 9 mm
27 weeks— 8 or 9 mm
28 weeks— 6 mm
29 weeks— 4 mm **was feeling very bleak at this point
30 weeks— 7 mm and the high measurement was 9! That felt like a good omen.

At 30 weeks, they stopped checking my cervical length and doing fFNs, which was a huge relief and we went to visiting every two weeks instead.

I was still terrified through week 34, but around 35 weeks started to feel like I could see light at the end of the tunnel. At my 36 week growth scan and BPP, they could see her practice breathing and estimated she weighed 6 lb. (This was very accurate, as she was born 3 days later (at 36 weeks 3 days) weighing 6 lb 3 oz!)

At exactly 36 weeks, I stopped the progesterone and they pulled the pessary. I went into labor 36 hours later.

There was a NICU team in the room because she was born before 37 weeks, but they left within 15 minutes because of her high Apgar score.

I could write a lot more about the psychological aspects of what I went through—it was hell. I really feel like my otherwise amazing MFM practice had one blindspot, which was mental health. I made it through OK thanks to my above-average support structure (husband who works at home and retiree mom who took care of me), but I really teetered on the edge of postpartum depression and anxiety after the birth.

I'm not sure how to wrap this up, there is so much more I could say. My heart is with all of you. Please stay strong and know that with even the most dire possibilities in sight, things can work out ok too. In my case, more than ok.

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