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Author Topic: Short cervix success story: + fFN @ 24 wks, 4 mm cervix, healthy 36 week baby  (Read 1973 times)

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.

kelsknob

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Thank you so much for sharing! I am in a very similar situation but do have a cerclage, not a pessary, and am on vaginal progesterone with hospital modified bed rest. I am 27 weeks and really hoping to make it to 36 weeks when they plan to remove my cerclage. The last cervical check was 8mm, they are checking again next week. I appreciate your success story so very much. I hope to be back sharing the same hope with others in a few months! Thanks again for sharing!!

Kelsey

reasontohope

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Good luck, Kelsey! You're almost at 28 weeks. That is such a turning point. I remember feeling so scared that week, but while I cried in his office, my doctor told me, "Congratulations. You just made it through the most important month of your life. Now you just have to get through the second most important. And there's a good chance you can do it." I was at 6 mm that week! How have your fFNs been? Sending you all my best wishes. By the way, are you having a baby shower? I was so miserable I didn't want one, but luckily my friends intervened and threw me one at 31 weeks. It was very moving and really the highlight of my pregnancy. Maybe some close friends or family can throw you one in the hospital? In hindsight, I think I would have so regretted not doing it, though at the time I felt in no mood to celebrate (and also felt superstitious). Good luck!!!

reasontohope

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I also read this woman's account of her bed rest pregnancy recently and it was really cathartic: https://www.theguardian.com/lifeandstyle/2017/oct/24/88-days-trapped-in-bed-to-save-a-pregnancy-bed-rest

kelsknob

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Thanks for sharing! What a great read and killed some time for me! Thanks for the positivity. Yes, we are very excited to be almost 28 weeks! I’m not sure what my cervix is measuring right now, will find out next Tuesday when they do an exam. They are trying to check as little as possible, they don’t want to keep stirring things up. I have talked to my doctors about the ffns but we decided together it wasn’t appropriate for me to have done because it would not change my plan of care and it would mess with my head because they’re not always accurate. I have moved my shower to right around my due date when I know we will be home. But my family just set up a “gift card sprinkle” for us. So we have been receiving gift cards to where were registered and buying stuff online off of our registry. It’s great because we will have the main stuff we need when we bring her home and it’s giving me something to do while I have all this down time ????

Twins2018

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I'm in a similar position but with twins. I am currently having the disability talk with doctors and they want to give me steroid shots at 24/25 weeks. I have read that these shots can cause issues with babies longer term - but I haven't spoken to doctor yet. Could you please tell me your experience with these steroid shots and how you balanced the decision to have it? I also read they are only effective between 2-7 days after receiving to benefit the baby.

reasontohope

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Hi Twins2018! I'm really sorry you're going through this. It's immensely hard on a physical and emotional level. I imagine with twins it is even more harrowing. Please don't worry about the steroid shots. I did too, and read dozens of studies and did as much research as I could from my bed, as well as grilled my doctors, and ultimately concluded the shots aren't harmful. They're the opposite—immensely helpful in preventing severe lung problems (which can be lifelong) or death in preemies. There was 1 study which I think showed that multiple courses (beyond the currently standard two) had a correlation with ADD/behavioral issues, but as my doctor put it, choosing between mild ADD and chronic lung disease? There's no contest there, go for the (slim) chance of behavioral problems.

I also thought they were only effective for that short period. For that reason, I resisted getting a second course at 28 weeks when it was on the table depending on my fFN result, because I wanted to "save" my second course for the possibility of real preterm labor vs. a false positive fFN (by then I was convinced the steroids were vital and lifesaving and was worried about wasting them). My doctor explained they were even more important earlier in the pregnancy in preventing crisis-level issues, so better to "waste" them at 24 or 28 weeks and then not use them during actual labor at 32, etc. Does this make sense? Also, another doctor in the practice (this is a big research practice affiliated with a university, they are amazing doctors) said it was misconstrued to say they wore off or were only effective for that week after getting them...basically they bump the baby/babies lung development ahead slightly, but then the bump in maturity wears off as time passes and the baby grows more, if that makes sense. But the improvement in lung function doesn't go away.

Anyway, I got 1 course at 24 weeks and my daughter was born at 36 weeks, screaming, with absolutely no lung issues at birth. She's now almost 4 months and seems prone to colds but has no breathing problems. She's also meeting milestones based on her actual age (so she's ahead for her gestational age) which is hugely reassuring.

I hope you make it 28, 32, 34, and beyond. Sending you all my best.

reasontohope

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Also, Kelsey, how are you doing? Thinking of you and hoping you are still cooking!

kelsknob

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Thanks for checking in! We are doing good still! I am 31 weeks and 2 days 😊

My last check which was 2 weeks ago, my cervical length was still stable at about 1cm and no dilation. We have another check up next Thursday. The plan right now is to remove cerclage and stop progesterone at 36 weeks.

reasontohope

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Woohoo, congrats, Kelsey!! You are so close! <3 I hope you're having a great holiday and starting to feel some of the worst anxiety lift. I went into labor pretty much right away after getting the pessary out & stopping progesterone, and with all the fear and distraction I wasn't really prepared, so I hope you have all the stuff you need for when the baby is here :) You're having a girl right? Sending you all the best!

kelsknob

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Thank you! We are still cooking here almost at 34 weeks. Yes, we’re having a girl! I’m counting down the days until I get my cerclage removed. My husband and both of our families have been amazing with helping us get things ready for her. I was able to get what I will need to bring her home because of gift card sprinkle my family did for us and we’re planning to have an actual baby shower after she arrives! We are so thankful!!! Hope you had a great holiday!