Incompetent Cervix and desperately awaiting my cerclage

[Eleanor Rigby]

Hello,
Firstly I want to say how happy I am to have found this forum and all the information here. This is by far the best and most comprehensive information source I have found yet and there are so many of you who have gone through or are currently going through the same thing as I am that I don't feel so alone anymore.

This is my third pregnancy and I am 17+3 today, my first two pregnancies ended in 1st trimester miscarriages and we had been TTC for almost exactly 2 years before I became pregnant again this time. My first trimester was fairly uneventful other than the constant worry that someone who has had mulitple miscarriages has. At exactly 12 weeks I had my nuchal fold scan which came back clear for all physical abnormalitles but my blood showed increased risk for trisomy 13/18. We chose not to do any invasive testing and have since had another anomaly scan and everything looks good. As those disorders do tend to show physical markers by this point we have decided not to follow up further and believe our Baby boy will be just fine.

Unfortunately at 15 weeks I started getting stabbing pains in my cervix and dr. diagnosed me with incompetent cervix at 2.5cm and put me on mbr. A week later I went into hospital for another check and cervix had shortened to 2.3cm and was slightly open. I was tested for infection and told I would get a cerclage if all was clear. FFWD to this week (17 weeks) and I'm told that my condition is not severe enough to warrant placing a cerclage and they would just monitor my progress regularly. At my anomaly scan another dr. measures my cervix and I'm now told I'm at 1.6cm which is definitely, from everything I have ever read, not ok, especially as I seem to be losing about 0.5cm cervix every week. I push for the cerclage and dr. agrees and I am booked in next Tuesday for another checkup and (fingers crossed) the cerclage.

I've never been in hospital before and the 2 times I have been under general anaeshtetic (laparoscopy to remove dermoid cyst and D&C after miscarriage) I didn't react so well to the GA but I know how necessary this operation is and I don't see any other way that I won't lose my baby without it. I guess I'm just here for a bit of mutual reassurance and support.

I do have a quick question right off the bat, may go ask in another section as well but, this stabbing pain that I had, it occured every few minutes and was at first localized to the cervix. The first night I had it all through the night and seemed to get worse when I was stressed. I took it easy and it lessened to a couple times a day until it came back but this time on my far right around where my ovary should be. The pain is short, intense, like someone is pinching or stabbing you with a tiny needle and is gone within seconds. The dr. said it sounded like contractions but from what I read, they don't really sound like it to me. To any of you who have had contractions this early in the pregnancy, can you tell me what they felt like? I have not had any cramping or pushing sensation.

Thank you for your help and support.

[crashta]

I don't want to scare you but your stabbing pain does sound like contractions to me.  They don't have to be long in duration and certainly feel like stabbing pain in the beginning before any pulling/cramping/tightening occurs as the labour progresses.  That being said, if your membranes are intact, there are number of drug options for stopping contractions.

Questions I have are:

- have you been seeing a obgyn specialist?  In my opinion, most GP doctors do not have experience in high risk pregnancies and should be referring you asap.

- if you have seen an obgyn have they consulted with a perinatal specialist?

- have you had any endo/trans vaginal (inserted probe) ultrasounds to measure your cervix?  They are more accurate than a physical exam and measurements are taken over a few minutes.  It might shed light on a dynamic vs. incompetent cervix.

- has your doctor gone over the risks and benefits of cerclage?  I had one at 13 weeks with my last pregnancy due to a suspected IC, which I don't have, and it likely contributed to the PPROM as cerclage can hold bacteria which for me is a disaster as I have weak membranes as well.

- are you on vaginal progesterone or P17 shots?  Ask about them.  I wasn't offered this in my last pregnancy but this time around it was the first thing I was put on even before my dynamic cervix was revealed at a 16w ultrasound.

There are so many medical journal articles that I have read over the last month and I find reading them has helped me understand why the specialist are making the decisions they have been for my pregnancy.  Namely, not treating the GBS that is colonized in my body and shows up every time we swab for bacterial vaginitis (which is more of a threat to my pregnancy that my cervix at this point).

I do hope that I am not adding to your stress with my questions but I know what it is like to walk around feeling like a ticking time bomb that is about to go off.  I wish you all the best and look forward to seeing updates on the forum as you keep your little one cooking!

[Eleanor Rigby]

Thanks for your response, you are definitely not adding to the stress, it's good to have information and first hand accounts. I guess it does sound like the stabbing I had was contractions and that is worrying but it's good to know. As of yet I haven't been prescribed anything for them except magnesium but they seem to have gone for the most part.

That's interesting about a dynamic cervix vs. an incompetent cervix, my measurements do change each time they are taken but they seem to worsen each time. At one point my cervix was a little bit open last week but this week it closed up again which is promising, I guess.

To answer your questions, I am seeing an obgyn although he's not a perinatal specialist, the cerclage will be done in the hospital and I'm not sure what kind of doctor will be doing it but I assume it will be someone specialised in the procedure, at least I hope so. I haven't been given much information from the doctors so it's pretty much been up to me to read up on everything. From every thing I've read, I do believe the cerclage is the only way forward. I did have a test done last week to confirm I didn't have any infections that could be locked in by the cerclage and that has come back clear. All of my ultrasounds have been vaginal and they have checked how my cervix reacts when I bear down with my muscles etc. I've had low progesterone levels since the beginning so have been taking the suppositories since week 5. I actually went off them at week 14 and 2 days later the pains started so they could well be related, I'm back on them this week. Maybe I'll ask my gyno for the shots if things keep worsening.

I very much hope that the cerclage is the answer, it seems to be in most cases although it sounds like it didn't help with you, I'm very sorry to hear that.    I read on another thread that you and are 17+3 today as well, I hope everything works out for you this time and that we can both deliver our full term babies. 

[crashta]

The perinatologist that is overseeing my pregnancy reviewed the ultrasound images himself today and does not agree with the radiologist's report of me having a dynamic cervix.  Frustrating as I hoped it would explain the different lengths in the reports that are a week apart.

He also said that it is perfectly normal for the Cx length do decrease 2-5mm each week.  So your shortening does fall into the normal range.  Also, not every woman will start with a Cx length of 4-5cm, some are naturally shorter but did say that if mine shortens to 1.4cm, I would most likely receive a rescue cerclage. 

To hopefully prevent the cerclage being necessary, my vaginal progesterone has been doubled to 200mg.  Hopefully going back on progesterone will have positive effects for you as well.  This is really good article about progesterone in high risk pregnancies: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218546/

[Eleanor Rigby]

That article has great information, thank you.

[Eleanor Rigby]

Unfortunately things have escalated for me. I went in on Tuesday and my cervix measured only 4mm so was given an operation for a TCO (total cervical occlusion) which is similar to a cerclage but rather than sewing a ring around the cervix they sew the tip completely shut. They wanted to do a cerclage as well but there wasn't enough cervix left for that. The advantage of the TCO is that it completely shuts the cervix so no bacteria from the vagina can enter. The doctor has said the procedure should buy us 10 weeks which would put me at 28 weeks and hopefully I can go a bit longer. I'm still in the hospital but should be allowed home tomorrow. It seems everything went well and I'm just trying to take it day by day.

[crashta]

Thanks for the update, glad to hear they had other options when you cervix had shortened so much.  I hadn't heard of a TCO before.

[Eleanor Rigby]

It has been just over 3 weeks since the operation and I 21+2 today. I'm at home on modified bed rest so can get up to shower and eat and go to appointments but should spend most of my time laying down. So far I have had no complications, I had a 24 hour period of shooting pains on my left side which were triggering and increase of braxton hicks contractions but once I applied a heating pad to the area for 15 minutes they completely disappeared. I'm aware that heating pads on bumps are not good so will only use it as an option when absolutely necessary but very happy it works. I had gone to the doctor and he could see nothing wrong so was very worried but I'm leaning toward it being ligament or muscle pain, why else would it be so easily relieved by adding heat?

The doctor also checked the progress on my cervix and the good news is it hasn't got any worse since the operation. When the operation (total cervical occlusion - a procedure that seems to only be performed in Germany, sometimes in conjunction with but also, as in my case, without a cervical cerclage) was done I was around 1cm dilated so they basically just sew the very tip of the cervix shut. They stitch it in a way that scar tissue forms on the cervix making a tight seal where no bacteria from the vagina can get through. They also like to do a cerclage further up on the cervix but this wasn't an option for me. The status now is that the stitch is holding but I am funneled down to it and because the stitch is at the tip of my cervix there is nothing left below it either. I'm guessing as long as the stitch holds, I'll be in good shape but if it were to fail, I'll be out of luck as I have no cervix left to hold the baby in. The dr. did say that my cervix felt good and firm from the outside though. I have been given a heavy duty pregnancy band to put under my belly and take the pressure off my cervix and continuing to take 200mg progesterone and 450-600mg magnesium to help with the contractions.

So, right now, desperately counting down to 24 weeks.

[crashta]

Best wishes for you and baby in these coming weeks!

[Emily_Aldargator]

Wow. Sending lots of love to you and baby. Fingers crossed that the surgery buys you ten weeks or even more. You are in my prayers tonight.

[BrittGeorge1]

It has been just over 3 weeks since the operation and I 21+2 today. I'm at home on modified bed rest so can get up to shower and eat and go to appointments but should spend most of my time laying down. So far I have had no complications, I had a 24 hour period of shooting pains on my left side which were triggering and increase of braxton hicks contractions but once I applied a heating pad to the area for 15 minutes they completely disappeared. I'm aware that heating pads on bumps are not good so will only use it as an option when absolutely necessary but very happy it works. I had gone to the doctor and he could see nothing wrong so was very worried but I'm leaning toward it being ligament or muscle pain, why else would it be so easily relieved by adding heat?

The doctor also checked the progress on my cervix and the good news is it hasn't got any worse since the operation. When the operation (total cervical occlusion - a procedure that seems to only be performed in Germany, sometimes in conjunction with but also, as in my case, without a cervical cerclage) was done I was around 1cm dilated so they basically just sew the very tip of the cervix shut. They stitch it in a way that scar tissue forms on the cervix making a tight seal where no bacteria from the vagina can get through. They also like to do a cerclage further up on the cervix but this wasn't an option for me. The status now is that the stitch is holding but I am funneled down to it and because the stitch is at the tip of my cervix there is nothing left below it either. I'm guessing as long as the stitch holds, I'll be in good shape but if it were to fail, I'll be out of luck as I have no cervix left to hold the baby in. The dr. did say that my cervix felt good and firm from the outside though. I have been given a heavy duty pregnancy band to put under my belly and take the pressure off my cervix and continuing to take 200mg progesterone and 450-600mg magnesium to help with the contractions.

So, right now, desperately counting down to 24 weeks.

That's awesome! Praying for you and your little one!

[Sky]

Sending you lots of love in your wait to 24.
In regards to the heating pad, you might try a rice sock instead and see if that helps.
Wishing you the best!

[Eleanor Rigby]

I lost my mucus plug yesterday and am now on hospital bed rest for the duration of my pregnancy. The found that my stitch had failed and the amniotic sack was bulging into the vagina. They are checking for infection and if all clear and they are still able to, they will give me another stitch. I know that it is very risky at this stage but I don't think I'll be able to hold on without it so really, really hoping I last until next week. I'm 23+1 today.

[Emc]

I'm at the exact same stage as you (23+1) with no stitch, and as of last week no cervix, dilated 3cm and bulging membranes.  All I can say is stay positive and I'll send you lots of good vibes.  We can count down the days to 24 weeks together!

[crashta]

Eleanor and EMC, stay strong mommas, you are in my thoughts!