Incompetent Cervix Questions

[murrt]

Hi everyone, (X-post with PAIF)

I'm a regular on PAIF, Pregnant over 35, and the Dec. BCB, but thought you might have some stories/answers for me here.

Just wondering for anyone that had an "Incompetent Cervix" (which BTW I love that name almost as much as "Advanced Maternal Age"...who comes up with these names?!), when were you diagnosed and how did it change your pregnancy?

I had two colposcopy's followed by two LEEPs about ten years ago and there is some scarring on my cervix. After I had my second LEEP, the doctor told me I would be at increased risk for miscarriage and unfortunately, they can't really know if there's a problem with the cervix until you experience a miscarriage or two. Which now, sounds completely assanine to me, but at the time scared the shit out of me and put up shop in my brain. That said, I'm petrified of getting through first tri then experiencing a miscarriage due to a cervical issue.

I brought it up to the nurse midwife at my 9-week appointment yesterday, (she said they'll keep an eye on it and do more appointments because of it) and will bring it up to the OB at my 11-week appointment, but I'd really like to understand from some women that have been through it, when was it found? Did you have to keep on your OB to check for it or did they just know to look? Were you on bed-rest earlier in pregnancy?


Thanks all!

[flutterfly88]

***loss mentioned***

Sadly mine was not discovered until it was too late to intervene. I started leaking fluid and when I got checked at the hospital already had bulging membranes. I was about 21w +2 days when I first noticed fluid (but didn't know that was what it was at that point), and was admitted at 21+4. I delivered my son at 23 weeks. I had had no procedures done that would've weakened my cervix. Just in that "lucky" small percent with cervical issues.

In your case, since you know it could be a problem and your OB won't intervene unless a problem arises, I would push hard for extra monitor of your cervix. In my case things happened so fast. At my a/s at 19w + 3d, my cervix looked fine, no issues or shortening. So the problems can come on fast.

[murrt]

I'm so sorry for your loss flutterfly88 . Thank you for sharing your story. I will definitely push my OB for extra monitoring

[lucylulu]

I had an emergent cerclage placed in my first pregnancy at 20 weeks. My IC was discovered at my anatomy scan. My cervix was 1.7 with some funneling. It held strong through ptl at 24 weeks and stayed in until they took it out at 37 weeks. I was placed on modified bed rest, especially after the ptl at 24 weeks! I had more monitoring but really once they had a good cerclage in place it was mostly considered good to go.

Now in my second pregnancy, I had a prophylactic cerclage placed on Wednesday at 14 weeks. My OB measured early on and agreed that I had a short cervix to start with (lucky me!). I had a consult at around 13 weeks with MFM and we agreed that I would place another one preventatively. My goal is to not be on bedrest since I have a busy little boy to chase after!

As you'll see in my other post, I"m having some issues but frankly they are super duper rare so I wouldn't let that sway you. Most docs wont even measure until later in pregnancy, and they wont place a cerclage until after you've hit the second tri. Did you say you are AMA? If so they will want to know if you did a Mat21 test or other chromosomal test and what the results are.

Hope that helps!

[murrt]

Thanks lucylulu, I am AMA at 37 y/o. I have my Panorama test at 10w6d and they said it would take about two weeks or sometimes longer for results. Good to know I'll have to wait for the results before they'd do anything. That would put me at around 13 weeks.

[flutterfly88]

My OB won't do a cerclage before 14 weeks, because of the higher chance of miscarriage. And said he normally does them between 14 & 16 weeks. It's usually only later on, as the weight of the baby gets heavier that problems arise, so you should have lots of time to talk to your OB and decide on a course of action. FX that all goes well for you, and you have a healthy baby come December.

[Nittany]

My IC was found incidentally at my 20 week anatomy scan. My first pregnancy was normal and I have no other risk factors, so it never even crossed my mind that we'd have a problem. I had an emergency cerclage placed, which I've been told has lower rates of success than the preventive ones they can do around 14-16 weeks. My cervical length was about 1.5 CM when they discovered the problem and by the time they did the procedure 1.5 days later it was completely gone.

I've been on some form of bed rest for the last 12 weeks, and was hospitalized once around 25 weeks for 9 days because of more shortening and slight bulging membranes. I've also had weekly 17P injections, a few rounds of indocin, and now Procardia around the clock. Definitely many more appointments with both MFM and my OB.

I feel incredibly thankful to be here at almost 32 weeks. I hope things go smoothly for you!!

[angelsnight]

Mine was only discovered when I went into pre-term labor and my daughter was stillborn at 22 weeks. So we were proactive the next time around. For whatever reason, cervical measurements are not routinely taken if you have no reason to think you could have IC. Which I think is dumb because maybe mine could have been caught in time.

Anyway, I started getting transvaginal ultrasounds around 12 weeks to measure my cervix and I had a cerclage placed around 14 weeks (basically it ties your cervix shut to strengthen it). I hadn't had any shortening but due to my previous loss, they weren't taking any chances.

So I had to have cervical measurements done every other week (because the cerclage isn't always 100%, you can still have shortening and funneling and some women still end up going into pre-term labor). I never had any shortening and the cerclage held until they took it out around 37-38 weeks. I saw an MFM but I was already seeing her due to my loss history and having GD.

I was on pelvic rest (no sex, no orgasms) for the duration of the pregnancy once the cerclage was placed, and I couldn't do any strenuous exercise so I mostly just walked. I never ended up needing best rest.

The requirement to go through X number of miscarriages before they will do something is BS and as my OB put it, inhumane. Like I said, for the standard pregnancy they do not do cervical measurements, but seeing as how you have had procedures that could possibly up the chances of having IC, I think you definitely should have them starting around 12-14 weeks.

If your doctor won't do this, or gives you a hard time about it, find an OB who will or an MFM. Sadly there are many doctors who think one loss or the possibility of a loss isn't enough to take certain action, but there are plenty out there who see you as a human being and care about you and your baby. Good luck!

[flutterfly88]

murrt how are things going?

[murrt]

I had my MFM appointment yesterday (I'm 15 weeks today) and cervix was measuring 3.8. The doctor said she wants to see me every four weeks - my next appointment is at 18 weeks.

She said there are three things to do if we need to address it, in the following order:
1) Progesterone
2) Cercilage
3) Ummm...I forget this one but it's basically a diapharm-like thing that helps your cervix.

She said MOST women who've had LEEPs don't have this issue. But then again, I tend to defy the odds as I'm the type of woman who had two inconclusive NIPT tests. So, I like that we're checking me every so often. She said if there seems to be an issue at 18 weeks, they'll likely want to see me more often.

[flutterfly88]

Jun 9, 2015 12:22:45 GMT -5 murrt said:

I had my MFM appointment yesterday (I'm 15 weeks today) and cervix was measuring 3.8. The doctor said she wants to see me every four weeks - my next appointment is at 18 weeks.

She said there are three things to do if we need to address it, in the following order:
1) Progesterone
2) Cercilage
3) Ummm...I forget this one but it's basically a diapharm-like thing that helps your cervix.

She said MOST women who've had LEEPs don't have this issue. But then again, I tend to defy the odds as I'm the type of woman who had two inconclusive NIPT tests. So, I like that we're checking me every so often. She said if there seems to be an issue at 18 weeks, they'll likely want to see me more often.

Glad to hear the appointment seemed to go well, and that you're concerns are being taken seriously.

Was #3 a pessary?

[murrt]

Jun 9, 2015 12:42:44 GMT -5 flutterfly88 said:

Jun 9, 2015 12:22:45 GMT -5 murrt said:

I had my MFM appointment yesterday (I'm 15 weeks today) and cervix was measuring 3.8. The doctor said she wants to see me every four weeks - my next appointment is at 18 weeks.

She said there are three things to do if we need to address it, in the following order:
1) Progesterone
2) Cercilage
3) Ummm...I forget this one but it's basically a diapharm-like thing that helps your cervix.

She said MOST women who've had LEEPs don't have this issue. But then again, I tend to defy the odds as I'm the type of woman who had two inconclusive NIPT tests. So, I like that we're checking me every so often. She said if there seems to be an issue at 18 weeks, they'll likely want to see me more often.

Glad to hear the appointment seemed to go well, and that you're concerns are being taken seriously.

Was #3 a pessary?

Could have been. I know I have it written down

[mrswheelo]

I'm glad you have an MFM! I am having extra monitoring and measuring during this pregnancy, but my MFM wants to hold off on the cerclage. He says that there is a risk for inflammation and prefers to start with progesterone injections and place a cerclage only if I have shortening or funneling before 24 weeks.

This plan is probably unique for my situation as my loss was with 21 week twins. And twin pregnancies are always treated differently. Unfortunately. My cervix was checked digitally and I had an abdominal ultrasound the day I went into PTL. My cervix looked great at noon. By 6 pm, I was in the ER with bleeding and contractions. I was completely effaced with bulging membranes, so there was nothing that could be done. It was my first pregnancy.

So this time, I get measurements every 2 weeks to check for shortening and funneling. And I get weekly P17 injections to help strengthen my lady parts. All studies show great success with progesterone use. I've got my fingers crossed that it is all it takes to keep Baby Boy in there!

Will you be starting the P17 injections?

ETA: To add that I have a long, firm cervix and no history or surgery or abnormal shape.

[anonymouseliza]

May 1, 2015 16:51:01 GMT -5 flutterfly88 said:

My OB won't do a cerclage before 14 weeks, because of the higher chance of miscarriage. And said he normally does them between 14 & 16 weeks. It's usually only later on, as the weight of the baby gets heavier that problems arise, so you should have lots of time to talk to your OB and decide on a course of action. FX that all goes well for you, and you have a healthy baby come December.

Interesting - my MFM prefers that prophylactic cerclages be placed between 12 and 14 weeks.  I was worried about placing the cerclage before I got my NIPT results back, but he talked me into it at 13w, because he didn't want to go much longer.  As it happened, I got the results the night before the placement, so it was fine.  Interesting how different doctors think differently on this issue.

[flutterfly88]

Jun 16, 2015 20:13:31 GMT -5 anonymouseliza said:

May 1, 2015 16:51:01 GMT -5 flutterfly88 said:

My OB won't do a cerclage before 14 weeks, because of the higher chance of miscarriage. And said he normally does them between 14 & 16 weeks. It's usually only later on, as the weight of the baby gets heavier that problems arise, so you should have lots of time to talk to your OB and decide on a course of action. FX that all goes well for you, and you have a healthy baby come December.

Interesting - my MFM prefers that prophylactic cerclages be placed between 12 and 14 weeks.  I was worried about placing the cerclage before I got my NIPT results back, but he talked me into it at 13w, because he didn't want to go much longer.  As it happened, I got the results the night before the placement, so it was fine.  Interesting how different doctors think differently on this issue.

I also find it interesting the differences with bed rest vs no bed rest. Some say it's beneficial and some are almost completely against it.

[anonymouseliza]

Jun 16, 2015 20:36:45 GMT -5 flutterfly88 said:

Jun 16, 2015 20:13:31 GMT -5 anonymouseliza said:

Interesting - my MFM prefers that prophylactic cerclages be placed between 12 and 14 weeks.  I was worried about placing the cerclage before I got my NIPT results back, but he talked me into it at 13w, because he didn't want to go much longer.  As it happened, I got the results the night before the placement, so it was fine.  Interesting how different doctors think differently on this issue.

I also find it interesting the differences with bed rest vs no bed rest. Some say it's beneficial and some are almost completely against it.

I know, right?  I was told to bedrest for 48 hours and then onto normal restrictions, but from what I've seen, my restrictions are stronger than others.  I'm not sure if they are typical for my MFM or if it's specific to my medical history (non-traditional IC).  And at the same time, someone on my BMB is essentially on bedrest for the duration (again, not clear if that is medical history or  specific to her medical situation).

[pinkcamino]

I'm a bed rest momma. I had my stitch placed at 14w3d after dealing with some complications with my blood work. My MFM is super conservative and puts all her ladies with histories of IC/PTL/PPROM on bed rest. It's a non negotiable with her. So, I'm on strict bed rest with bathroom privileges. I'm not allowed to cook, clean or sit up. According to my doctor sitting up puts your body at a 90 degree angle which puts an enormous amount of pressure on the cervix. Now, I'm well aware that there are conflicting opinions about the necessity of bed rest. The resident at the hospital even mentioned that when it comes to restrictions it usually is doctor preference so although my situation is somewhat extreme it's likely not the norm for most ladies with a preventative stitch.

[debatethis]

Jun 18, 2015 20:09:59 GMT -5 pinkcamino said:

I'm a bed rest momma. I had my stitch placed at 14w3d after dealing with some complications with my blood work. My MFM is super conservative and puts all her ladies with histories of IC/PTL/PPROM on bed rest. It's a non negotiable with her. So, I'm on strict bed rest with bathroom privileges. I'm not allowed to cook, clean or sit up. According to my doctor sitting up puts your body at a 90 degree angle which puts an enormous amount of pressure on the cervix. Now, I'm well aware that there are conflicting opinions about the necessity of bed rest. The resident at the hospital even mentioned that when it comes to restrictions it usually is doctor preference so although my situation is somewhat extreme it's likely not the norm for most ladies with a preventative stitch.

::waves at PC::