Warning Signs for Incompetent Cervix and Pre Term Labor - Page 13

mommy4god · 04-24-2007, 01:08 PM

So what can be done on the next pregnancy? i assume a cerclage would do no good since the cervix isn't the problem. Would bedrest do any good? How would watching for it help? Wouldn't they just say "oh look, it happened again"?

i'm so confused. But at least i know i'm not the only one out there that went through this. i just had drs. that didn't care enough to find the real cause.

christine

VivC · 04-24-2007, 05:19 PM

Patty, I got antibiotics postcerclage, too. I'm GBS+, so it was better safe than sorry. They prevented problems for me! Also ask if the OB thinks that having some indocin on hand might be a good idea - it helps prevent contractions (just can't take it more than 72 hours).

Mommy, I'd definitely treat for IC with a preventative cerclage in your next pregnancy. You may or may not have IC, but it's better to be safe than sorry (my phrase for the day). It is very easy for docs to MISS IC after water has broken. Look at it this way - that bag of water keeps pressure on your cervix, and that pressure may cause your cervix to open or funnel at the top. Once the water's gone (after PROM), the pressure's gone, which means that your cervix may close back up. You could definitely have IC!

It's hard to tell which came first - your cervix dilating, or your water breaking. If your water just broke without IC, that's PROM (premature rupture of membranes), possibly PTL (preterm labor). PTL can be treated with injections of 17P during future pregnancies. It would just take one shot per week.

A PREVENTATIVE cerclage has few risks. The risks you hear about are very uncommon except in rescue cerclages.

I'd get a cerclage and insist on 17P injections and regular contraction monitoring (it might catch smaller contractions you can't feel).

Day-n-Night · 04-24-2007, 05:23 PM

Hi Ladies, I wanted to update about my appointment today. I went in and she did the doppler the pap and the bv screen. BV was negative
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yay! Anyway, so she did the manual cervix check and scared the heck out of me. She sent me for an immediate cervical scan because she explained that my cervix can be felt protruding through the vaginal canal. She said there was still a chance I could be at least 2.5. So I had the scan and oh man what a relief... my cervix (the cervix inside me) is measuring a 4.2! But for whatever reason I was apparently born with an extra long cervix and part of it sticks out which is abnormal but apparently not an issue since the interior cervix is 4.2. I was shaking like a leaf during the scan so much so that the technician went ahead and left me have a long look at the baby who was fussing up a storm and then she printed me out two pics. Apparently here anyway when sent for just a cervical scan you do not get a scan of the babycakes. So... next week I get another scan then the surgery. I will talk with the anesthesiologist tomorrow. You all can see the most recent baby pics in my siggy. Such a long day... UGH

Day-n-Night · 04-24-2007, 05:29 PM

Viv we must have posted about the same time... So I will indeed ask her about indocin to have on hand, I do know I will be given that post op while in the hospital but she had not mentioned any for at home other than antibiotics. What dose were you given (of indocin I mean). Did you ever have to take it? If yes at what point did you know to go ahead and take, were you feeling contractions? Or pressure or....

Oh Ps she may only be able to do a single stitch on me, she said she will do the double if at all possible but with my protrusion she isn't sure it will be possible but she felt very confidant in the single working as well but also respects my desire for double so we will see...

fairy27 · 04-24-2007, 07:34 PM

Thanks for listening to my post-pain rambling, ladies. I got a cervical u/s done and I'm measuring at 54. mm I'm presuming. The tech said it looks really thick and good so far. I didn't get to talk to my OB so I still don't know what caused my pain. Everyone I was telling about it told me that it was just "growing pains" I'm not convinced that was what it was but I don't really have any other explination so who knows?
Thanks Again Ladies and God Bless!

sweetums · 04-25-2007, 02:49 AM

Hi Girls....

I'm wondering if someone can give me some advice here.

Over the weekend I started having some sharp stabbing pains and the only way I could describe where they were, was that it felt like they were in my cervix. I don't know if that's actually where they were, that's just what it felt like. Anyway, after talking to a nurse yesterday I went to L&D and got monitored for contractions, checked urine and blood for infections, visual speculum exam of the cervix which showed it firm and closed and there were no contractions. My OB was there delivering babies yesterday and so he came and checked me out and then told me that if I was still having the pains today, that I should call and then come in and he would do a cervical ultrasound to make sure everything was looking good. Well, that's just what ended up happening. So we went in today and he did the cervical ultrasound with a portable machine in the office and he said "Oh, well it looks fine! It's measuring 3.2cm which is just fine. Nothing to be concerned about." Then he did an abdominal ultrasound and checked the babies quick, they are both doing fine. He said everything looks good and he told me to stay off my feet as much as possible if that helps the pain. The pains just come and go at random. I hadn't had them for a long time and then they started happening again over the weekend.

Ok, now here's my thing. I had to fight tooth and nail to get this 1 cervical ultrasound, when he told me that he'd do them any time at my request (I've been requesting them at every visit but he tells me that he's sure it's fine) and then he tells me that 3.2 is fine for where I am in my pg, but is it really? Isn't it on the very low end of fine? And is staying off my feet going to help enough to keep it from shortening more? My OB doesn't think it's shortening, he said it's fine and nothing to be worried about, but honestly I am worried. I have another appt on May 11 when we'll be having the anatomy scans of the babies done, but will they check my cervical length then? He told me in the beginning that he'd see us every 2 weeks, but now he's scheduling us for only every 4 weeks. When I asked about it he said "There's nothing to be worried about and the pregnancy is going fine, so we only see you as often as you need to be seen." I'm very, very frustrated.
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I really like this guy, he's very personable and such, but I feel like I'm fighting tooth and nail to get checked out when I have a fear about something. What do I do? How do I find a specialist? Do I need to? Is my 3.2cm ok? Am I freaking out for nothing? My husband just thinks I'm crazy because he says I'm worrying for nothing. I can't help it. I know too much, I've read too many stories. I'm scared beyond words that something's going to happen to my babies because no one will listen to me or take me seriously.

Manders

VivC · 04-25-2007, 01:42 PM

Patty, I don't remember the dose I was given, but I took it as often as allowed the first day - I was just ultra paranoid (no sign of problems, just being extra careful)! Then I took it twice the second day and none after that.

My peri was originally going to do one stitch. After he placed it, though, he though he could get another one higher, so he pulled the first stitch down so he could reach above it. So I ended up with two. Then my cervix was softer than he'd like, so he did a small stitch at the opening to prevent any yucky germs from getting in.

Lyndy, that's a great cervical measurement!

Manders, 3.2 is at the low end of a good measurement. My concern is more that your doc is dismissing your worry, though. Regular U/S should be a given with a twin pregnancy! I'd insist on U/S at least every other week and think about switching docs if necessary.

You could look for a maternal-fetal medicine doc or a perinatologist. Either would have experience with multiples.

Full bedrest (not up except for potty and a shower) has kept cervixes from shortening, but it's often not enough. And I'm a big believer in Mommy intuition - if it's telling you to find another doc, then please find another doc!

angels091506 · 04-25-2007, 04:34 PM

Hi girls...I keep an eye out on all the bulletins because I am ttc #2 after losing my son to PTL and IC and also a placental infection. I just wanted to tell everyone that when you feel something is wrong insist it be checked. I kept telling myself it was nothing, just part of pregnancy and I was to late. I should have listened to my body when I started feeling different and maybe things would have been different. Also girls at first my thinning cervix was almost missed during the abdominal u/s the tech said everything is perfect my cervix was 52 I believe she said....well she was unable to get a good measurement of Jaidyns head and asked me to empty my bladder so we could do an internal for better measurements and low and behold during that check she said "you are gonna hate me....you are thinning out" for some reason with my bladder full my cervix was comp. closed with an empty bladder it was open.....so my advice is when you feel something is wrong insist that you be checked until absolutely sure. Its a scary feeling knowing that I could have come home and delivered my baby anywhere if I hadnt insisted...sorry to keep going on

sweetums · 04-25-2007, 05:43 PM

Viv, so do you think bedrest is necessary at this point for me, or is it ok that I'm still in the normal range, even though it's the low end of normal? At what point or measurement would they do something, like a cerclage? At what measurement do they become concerned? And to find those types of specialists you mentioned, would I need a referral? Would my insurance still pay for it if I'm requesting these things be done? (not that it matters, just curious). I wish I knew if this was Mommy's intuition or if I'm just super paranoid because I have heard so many heartbreaking stories and it has me scared. Either way I am definately keeping an eye on all this, I just don't know how far to take all this, you know? Thanks for answering my questions....I just need someone to talk to who understands.

Manders

klg221 · 04-26-2007, 01:42 AM

Hi Manders,
I just wanted to tell you that my cervix always measured between 3 & 3.5 and my peri was always very happy with that. Until I was 28 weeks and it shortened to 1.5. That lead to hospital bed rest for 3 weeks followed by home bed rest until I delivered at 36 weeks. The cervix was never open though.
I was seen every three weeks (up til 28 weeks) and got an ultrasound every time. i do think you should express your concerns to your dr. this is too important to mess with.

See you 'round

Metalmama · 04-26-2007, 10:19 AM

Manders,

I went through the same thing with my doctor and I wanted to let you know what I ended up doing. I have a risk factor for IC and after reading this thread I became terrified of it and decided I wanted regular cervical ultrasounds - absolutely not was my doctor's response. They did a manual check, said I was perfect - long, thick and closed and that I had nothing to worry about. I was not satisfied but also did not want to go through the hassle of changing docs.

I was worrying myself sick over it and finally I just told the doctor that I didn't want to have to find another doctor but I would not be able to relax the rest of the pregnancy unless I could have a cervical ultrasound every two weeks. I asked the doctor if excess stress and worry could affect the pregnancy negatively - and she said yes. Then I told her that I would probably worry myself into the trauma ward unless I could get these checks and be reassured everything was ok. She finally relented and said that while she still thought it was unnecessary and a waste of time she'd do it just to keep me calm (I was also told to stop reading and going on the internet).

Every check I was told I was perfect until week 22 when I was suddenly very short and sent to a high risk peri. There I was told that it was too late for a cerclage - prescribed 17p shots and put on complete bedrest.

Since then I have been on bedrest, spent three weeks in the hospital with virtually no cervix left and am currently back home and 35 weeks today. I consider myself VERY lucky.

Everyone is right about mother's intuition, you can't deny it even if it turns out to be false - you have to do everything you can to help your little ones, regardless of what passive doctors feel.

I just wanted to tell you my story because your doctor may change his mind if he understands just how much this is worrying you - even he doesn't, find one who will.

Lots of luck!

VivC · 04-26-2007, 11:21 AM

Manders, I don't want to freak you out! You ARE in the normal range. I'm just worried that as your babes grow, they may put more stress on your cervix. Bedrest never hurts, KWIM? Maybe you could do partial bedrest - sitting up for meals, etc...then it wouldn't seem too much like prison.

A rescue cerclage is called for anytime your cervix gets under 2.0 cm. 2.5 should be CLOSELY monitored, and should probably have a cerclage put in.

Your insurance will cover anything your doc tells them is medically necessary. Depending on your insurance, you probably need a referral to a specialist. You'd get that referral from your primary care doc, who might be more willing to help you out.

Angels, a full bladder puts pressure on the cervix, which makes it look closed. I wish I'd known that before losing Rivi - his foot was IN my cervix during my big U/S, and the idiot woman just said it was "cute." Then he pulled it out, and my cervix looked closed because my bladder was full.

Anonykat · 04-26-2007, 07:03 PM

Quote:

a full bladder puts pressure on the cervix, which makes it look closed. I wish I'd known that before losing Rivi - his foot was IN my cervix during my big U/S, and the idiot woman just said it was "cute." Then he pulled it out, and my cervix looked closed because my bladder was full.

OMGosh... I didn't know that could happen.

I just wanted to give Manders a hug... I could have written some of these posts myself... the sheer terror, the knowing too much info to just be able to relax and enjoy the pg. I was soooo sure I was going to get IC bc of the weight of twins, then I didn't and just ended up with a bunch of other problems.

As others have said, 3.2 is not a bad measurement, so hold on to that. Are you working right now? If not, I think you should put yourself on at least partial bedrest as Viv said. I was put on bedrest at 10 weeks for placenta previa and a placental abruption, and did "mostly good" at staying on it. But we were selling a house at the same time and I had to be up sometimes with signing papers and such, last minute cleaning, etc. At 15 weeks I had a huge bleed, gushing tons of blood and clots. (which I think would not have happened had I stayed truer to the bedrest... it happened the Saturday after a particularly busy week) The ER doc told us there was no hope, and at the u/s my cervix was 2.8... the shortest it had been til that point. The word terror doesn't even begin to describe what we felt. Needless to say, I followed the bedrest stuff to the letter after that, and with subsequent u/s's, my cervix just kept getting longer. I think it was the bedrest, I really do. It kept the weight of those little tubbies off of it. Metalmama is another example of bedrest success... little cervix left, but babe has not come out yet. So, it can't hurt, it might help, and I think it would set your mind at a little more ease, too. I think you should do it.

And I love Metalmama's description of how she told her dr how things were going to be. Do that, if you have to.

sweetums · 04-27-2007, 03:07 AM

Kerry, thank you for sharing your experience with me. It definately helped to calm me some. I've been so scared I've been making myself sick.
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I'm definately going to be talking to my Dr.....I want to tell him that he either does the cervical ultrasounds for me every 2 weeks or I find someone who will. I am not going to risk my babies' lives just because he doesn't think this is anything to be concerned about.

MetalMama, thank you for sharing your story with me. I can't decide if this is actually mother's intuition or if I'm just scared because of everything I've heard and read. But I guess that's all the more reason to keep a close eye on things. I'm so glad that things are looking so good for you now! Those are the kinds of stories I need to hear!

Viv, I know you aren't wanting to freak me out, but hearing these things does freak me out. Nature of the beast in wanting the information, I guess. Comes with the territory. I guess the thing I'm most worried about is my cervix shortening too quickly and that by the time I have my next appt in two weeks, that it'll be too late, kwim? I suppose it depends on the person how quickly it shortens, if at all, huh? Is sitting ok or should I always be laying? I've been laying on my left and right sides as much as I can stand to. When I do it up, I try to make sure that just my back is propped up so I'm not actually "sitting", but I wonder if that's enough?

AK, thanks for the hugs. I desperately needed them. I actually quit my job on Tuesday after hearing the length of my cervix. My Dr told me several times it was fine, but I know it's at the low end of fine and that worries me. I've been hanging out on the couch since after the appointment, laying on my left and right sides as much as I can stand to. When I "sit up" I try to make sure I'm still reclining and I'm mostly just propped up by my back and not actually sitting. Do you think that's ok?

I looked at my hospital's website and they don't have any high risk ob's or peri's listed. Where do I go from here?

Manders

LaurAnnHere · 04-27-2007, 04:03 AM

Always follow your intuition, even if your doctor makes you feel like you're being silly. Seriously, IC can happen lightening fast. There's no harm in the trans vag u/s. Manual checks aren't good enough. It shouldn't be such a big deal for a doctor to give them. Maybe hard to get some insurance companies to cover them, I don't know.