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Author Topic: 1cm at 19 weeks and terrified - previous PTL at 23+1  (Read 538 times)

Lana24

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1cm at 19 weeks and terrified - previous PTL at 23+1
« on: June 10, 2018 at 12:51 AM »
Hi Ladies,

I’m new to this site and have been finding some of your stories very helpful and I’m trying to remain positive but it’s becoming increasingly difficult.

This past December I went into preterm labour at 23+1 with our beautiful baby girl. All of my scans and appointments were going well and no cervical shortening was identified. The day I went into labour I was having some mild back pain, not at all what I envisioned contractions to feel like. I happened to be at a routine OB appointment that day and she felt it was necessary to check me. By that point I was already 3cm dilated and in active labour. I was rushed to a larger Center with the hopes they could slow things down, but unfortunately I delivered only 6 hours later. We were absolutely devastated by our loss and miss our little one every day. We were given no explanation for what happened as the docs didn’t think it was due to IC and all of the tests came back negative.

We were incredibly fortunate to conceive again almost 3 months later, followed by an MFM specialist with frequent monitoring. My CL at 16 weeks measured 4cm and to our surprise dropped to a mere 1cm with funneling this past Thursday at 19 weeks. We spoke at length about a cerclage but ultimately decided it may be unsafe at this point as it can rupture the membranes, introduce infection, and cause permanent cervical damage if I go into full labour again. I have been started on progesterone suppositories and strict bedrest at home. We are absolutely terrified as the OB did not seem optimistic about us making it past (or even up to) 24 weeks given my history. We go back for an ultrasound this coming Thursday and hoping that things improve or at least stabilize. I’m really starting to question whether our first loss was due to IC as well. Looking for any encouraging stories you ladies are willing to share.

Lauren

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #1 on: June 10, 2018 at 12:42 PM »
Welcome to the group!
We had a loss at 24+3 in September, and like you, were totally blindsided by it. We had no evidence of cervical shortening at our anatomy scan, and when I went to the hospital for unusual discharge, I had no measurable cervix and was 2cm dilated with bulging membranes. Before we could undergo a cerclage, they found trace evidence of amniotic fluid. It was absolutely devastating and we miss our little guy so so so much.

We got pregnant easily right after our first cycle post partum. Although we had the blessing to do so from our OB, I can’t help but wonder if all of the complications of this pregnancy are related to being pregnant again before my body was really ready (quickly shortening cervix to 1cm post preventative cerclage and funneling to the stitch at 18 weeks, intra amniotic sludge, and irritable uterus).

After my cervix shortened to 1cm, I insisted on another intervention. After much deliberation, my OBs agreed to insert a pessary ring. Basically, this is a doughnut shaped rubber ring that they insert vaginally. It helps to disperse the weight of your uterus on your cervix. It is safe to insert at any time during pregnancy as long as you don’t have exposed/bulging membranes. It takes less than a minute to insert with minimal pain. It has similar rates of effectiveness as a cerclage without the risk of infection (very unlikely) or of rupturing the membranes.

For whatever reason, many doctors in North America have an aversion to pessaries, although they are commonly used in the EU. This really upsets me because it’s such a low-grade and easy intervention, and one that both my OBs and I agree is likely the only reason I’m still pregnant today at 29+3.

Check out this info to learn more.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282542/

If you think this might be for you, push, push, push for it! Many hospitals have a pelvic floor/pessary clinic and you should be able to get one with the support of your OB.

Best of luck with your pregnancy, keep us posted on your progress!

Also, if you’re on bedrest, like me, there is a chat on Tuesdays at 2pm EST. Would love to see you and swap stories there!

Lana24

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #2 on: June 10, 2018 at 09:46 PM »
Hi Lauren!

Thank you so much for sharing your story with me. I’m sorry to hear about the loss of your little boy, I’m sure he was perfect. Congratulations on getting to the 29 week mark and for advocating so strongly for you and your babe. I’m so happy things have been stable for you this far!!

 Are you receiving care in Canada or the US? I will definitely bring up the pessary at our next appointment. I know about the use of pessaries for uterine or bladder prolapse and keep hearing about women having them inserted for IC from the forums but it was never brought up as an option. Likely because, as the article states, there have been no randomized head to head trials comparing their use to cerclage or progesterone even though there may be a place for them in practice! You’re a great example of that. It seems like the risks are relatively low so I will definitely inquire. I want to do everything I can at this point.

Are you also on progesterone suppositories? It’s interesting you brought up the sludge because that was identified on my ultrasound as well which my OB said was a sign of possible PTL. That’s another reason she was a little more hesitant to place a stitch. It makes me hopeful that you have made it so far despite those changes!

I will definitely try to make the chat on Tuesday. Sending you lots of positive thoughts.

Lauren

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #3 on: June 10, 2018 at 10:19 PM »
A fellow sludge pal! We are few and far between! Not that it’s a club that either of us want to belong to. They discovered my sludge just over 2 weeks after the placement of my preventative cerclage.

I have been on progesterone suppositories since 6 weeks of pregnancy, with a brief break of about 3 weeks in and around the time of the placement of my cerclage. I’m not sure if they have had any impact, other than creating more discharge and putting flakes in my urine. That being said, my OB has ensured me that they help with contractions and strengthening the cervix, so I’m not willing to stop!

I’m in Calgary, Canada. Where are you located?

Lana24

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #4 on: June 10, 2018 at 10:48 PM »
Haha definitely a small club I’m learning but there’s comfort in knowing I’m not the only member!

I feel you on the flakes and increased discharge, but I think they have made a difference in the tightening and “contractions” (not sure if I can even define them as that) I was feeling before. I guess the real test will be our scan this week.

We are in Ontario, Canada so we likely have similar guidelines! It’s nice to have some leaverage with a fellow Canadian story :)

Lauren

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #5 on: June 10, 2018 at 11:21 PM »
Wahoo! Fellow Canadian!

If you’re on Facebook, you should also check out the incompetent cervix group. Along with this forum, it’s been a great source of support and information.

Lana24

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #6 on: June 18, 2018 at 12:59 AM »
Quick update, holding on at 20+4!
At our weekly scan last week we had some interesting developments. My OB has diagnosed me with a dynamic/incompetent cervix - she said she’s never seen one so dynamic in her career. The technician actually took a video of our ultrasound which showed my CL at 3.1cm which, in a matter of seconds, funnelled down to <1cm (almost to the base of the cervix) and then a few seconds later it closed right up, back to 2.9cm. It was pretty remarkable to watch. While this was happening I was experiencing some tightening in my abdomen. My OB was happy that we did not place a cerclage because the rapid movement and funnelling would have continually pulled at the stitch.
Unfortunately this means there aren’t any (additional) interventions we can try at this point but my OB was happy with the progress we’ve made so far. Looks like bed rest and progesterone are gonna be my BFFs for a while (fingers crossed). The pessary idea didn’t fly due to the limited evidence available and the OB did not want to increase risk of infection when the CL gets as low as it does.
Some days are good, on others I feel like the tightening increases, particularly at night. For those that have contractions or tightening, do you feel like the progesterone starts to wear off as you approach your next dose? Just hope we are able to keep cooking for many weeks to come. The uncertainty of it all is overwhelming sometimes.

Hope all of you mamas are doing well!

Lauren

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Re: 1cm at 19 weeks and terrified - previous PTL at 23+1
« Reply #7 on: June 18, 2018 at 03:15 AM »
Wow, I’ve never heard of such a dynamic cervix!

Glad you were able to run through all of your options with your doctor. Hopefully the progesterone and bed rest helps alleviate some of the contractions.

I’ve also been experiencing contractions/tightenings throughout this pregnancy. To our knowledge, they are only Braxton Hicks, although they started so early, who knows what influence they’ve had on my cervix.

Anyways, glad to hear you’ve reached the 20 week mark! Keep us posted on your progress!