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gmcas2

cervical cerclage ?

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gmcas2

Hi

 

here is some history:

Hubby and i fell pregnant naturally after 9 months, all was well until i miscarried traumatically at 15 weeks. several tests and review of scans showed a possible incompetent cervix; however could not be 'diagnosed' until i fell pregnant again.

 

hubby and i were struggling to conceive and sorted a FS. We tried assisted conception, IUI's and finally resorted to IVF ICSI. on our 3rd transfer (2nd FET) we fell pregnant… i am currently 12 weeks today.

 

Currently:

All of my bloods and scans are looking good. I have had two major bleeds, that could not be identified, but baby is fine.

at 10week 2 days my OB (referred by my FS, diff to original OB from first MC) advised that my "cervix looked suspicious" and is shortened. I was booked in for my cerclage the next week.

 

11week 2 days i was admitted and had the procedure. there has been some significant and mild pain. still taking 400mg of progesterone pessaries. Follow up post op appointment is not until Friday.

 

all my OB told me when i came out of the general anaesthetic is that i needed to cerclage as my cervix was soft, short and opening.

 

I am terrified.

 

Loss and infertility is bad enough, now i am facing further concerns in carrying my child. Im hoping to converse with other women who have been through this - i can't find anything thus far on any forums other then old posts.

 

if anyone has been through this please let me know the outcome of your pregnancy and what i should expect i feel completely isolated and in the dark.

 

all iv been told is bed rest for the next 6 months ;/

p.s sorry for the essay

 

 

thanks

G

Edited by gmcas2

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Shaynavyre

Oh gmcas, I'm really sorry for everything you've been through and the prospect of 6 months bed rest!

 

I haven't had mine done as yet, and DH and I are thinking we will go for the transabdominal route straight off the bat (multiple prior cervix surgeries, there isn't much left). I too am stuck on the IVF treadmill and I can't imagine getting that far only to lose a child because of my damn dodgy cervix!

 

From the discussions with my OB, vaginal cerclage often results in bed rest from 18 weeks, and strict bed rest (ie, in hospital) from 26 weeks. The transabdominal one is only if you are showing signs of something going wrong that you'll be placed on it.

 

 

I will be watching this thread with interest in the hopes that people with experience chime in! Hang in there!

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jobo77

Hi I have had 2 successful outcomes with cerclages - it can be done! We lost our 1st baby at 21 weeks when my waters suddenly broke and I went into premature labour shortly after. I was told by my ob that I most likely have an incompetent cervix and that future pregnancies would involve a cervical stitch.

My pregnancy with DD I had the stitch placed at 14 weeks under a GA. I had fortnightly scans from 16 weeks measuring my cervix and at around 21 weeks I was admitted to hospital on bedrest as my cervix had shortened. I was on bedrest for 3 weeks in there, allowed up for a shower and toilet. At around 24 weeks another scan showed my cervix had grown and my ob allowed me to go home where I was under instructions to rest. So rest I did. I had scans until 28 weeks that showed no changes and from then on I was able to live a somewhat normal life but was still very scared to do too much. At 35 weeks I had a bit of a scare with some contractions but they fizzled out and then at 38 weeks the stitch was cut in the delivery room under gas and she was born a few hours later. 6 years today in fact!

My pregnancy with DS I had the stitch again at 14 weeks and regular scans. I was really conscious of my "danger" period and so scared of going into hospital again so I put myself on "lounge rest" at home from about 17 weeks, taking a few weeks off work (I was working 2 days a week). Thankfully with his pregnancy my cervix never changed and I had a pretty normal life. Again induced at 38 weeks with the stitch cut in labour ward - DS was born less than 15 mins after it was cut.

My stitch was a modified Shirodkar I think so able to be removed vaginally. I had a friend have one however that was permanent and she had a c/s for both her babies with it being removed after her final DD arrived safe and sound.

Sorry for the long story but I hope it helps somewhat hearing a positive story. 6 years on and some of the little details are blurry now but I still remember that fear and really, until I had a living healthy baby in my arms, it was so hard to believe it could be successful. I am thankful every day that my story had a happy ending. I hope you both have the same outcome xx

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gmcas2

Thank you both so much for your replies, its nice to know i am not alone.

 

Shaynavyre: I heard the transabdominal cerclage is the most effective.. i however wasn't given an option ;/

 

Whatever you do good luck,and please keep us in the loop !!

 

Jobo77: Its good to hear success stories :) sometimes all the medicalisation of this process can be overwhelming.

 

I won't know where i am at until i have my post op follow up this Friday… il be sure to leave updates….

 

Sometimes it all feels so surreal. i have had to go on maternity leave (which my work doesn't want to give me) as just before my op my cervix had already softened and shortened… and to think I'm only 12 weeks !!

 

i guess all i can do is what i can do and hope that its enough x

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Shaynavyre

I think that transabdo needs to be placed prior to pregnancy or at the 10 week mark, no later - so the ship may have already sailed - which is why it wouldn't have been offered. I'm guessing it's got to do with the size creating a bigger risk.

 

Bed rest is going to be hell!

 

I'm already anticipating it - and it's just a suggestion, but it might be worth making a plan / project for your time on Bed Rest that can keep you sane..... We're not facing it yet, but we've got some plans already.

 

Projects like: learning a new language

Writing a book

Starting a blog

Scrapbooking all those photos you mean to but haven't yet!

 

Plans for management:

Starting grocery shopping online, or doing lite n easy

Hire cleaner / gardener

Schedule regular catch ups / takeaway nights at home with friends.

 

 

Best of luck with it.

 

I hope work doesn't give you too much crap - you should be allowed to use sick leave for this pre-birth component, even unpaid if you can manage financially.

 

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Riotproof

Hi there.

 

My last pregnancy was under similar circumstances to yours. I had a previous late miscarriage, and so they monitored for infections and my cervix length quite regularly. I had one stitch at 14ish weeks, which failed to hold, but my cervix was sufficiently long so, they just kept monitoring. Then at 23 weeks, my cervix had gone down to mm's so I had a rescue stitch placed. This too failed to hold, and I was advised to rest at home, only getting up for bare essentials. A week later, I had a change in discharge and was admitted. I had steroid injections just in case, and spent three weeks in hospital before I had bleeding and the stitch removed to prepare for potential labour. I was 5 cm dilated and hind waters had broken a day before. During an Ultrasound, it was found that there was quite a lot of cord in the cervix, which explained some results of the ctg monitoring, so it was an "urgent" csection that day. She was born at almost 30 weeks At 1.29 kilos, and is doing really well. She's only 4 weeks corrected age Atm, so we don't know if there will be a developmental worry, but she passed Her eye and hearing tests and she's gaining weight well.

 

Best of luck, I know it's such a scary time.

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gmcas2

during my Fertility treatment my FS arranged for me to meet the specialist ob to see wether a transabdominal cerclage would be preferred…which the ob decided it wasn't based on my history and how my cervix looked at the time (post miscarriage)

Its rather frustrating because i wasn't even aware that there were three types of stitches that could be performed until after i had the pop and researched it.

prior to this i was researching pregnyl injections, egg retrievals, FET etc, and when by some miracle we actually fell pregnant i suffered morning sickness, loosing 6kg and unable to do much at all let alone prepare for the cerclage...

 

just wish i was more informed and was apart of decision making process aware of their pros and cons !!

 

shaynavyre: thank you for the suggestions they are wonderful ! i think i might learn a language and pick up my studies :)

 

work are being difficult, i asked for unpaid mat leave and every time i call to follow up i get " HR are looking into it"…

 

 

riotproof: Congratulations on your healthy baby girl !!!

how stressful though… after your stitch were you on moderate bed rest or resumed normal activity?

also when you say your stitch failed.. what do you mean?

 

im afraid mine will fail and will really appreciate your input xx

 

thanks

G

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Riotproof

Gmcas2, thanks. For my case, there was very little risk getting the stitches placed. It was believed that without them, I would just go into preterm labour like I had previously. What they did was gradually ask me to do less and less. At first it was, "rest when you feel you need it - housework is okay", then it was "no heavy lifting", then "only toilet and shower". I was also advised not to swim or have baths, and no sex or orgasms.

It failed because it didn't stay put. My cervix shortened and dilated in spite of the stitches. My understanding is they work very well for women who haven't dilated previously, but know they have issues with their cervix because of previous surgeries. Though, there are plenty of women who have had previous labours and the stitch works for them.

In my case, without the stitches I wouldn't have reached viability, so I'm grateful for them. But yes, it was such a stressful time.

 

Are they putting you on preventative antibiotics? Infection is another risk because your cervix can open without you realising, and travel up to the baby.

 

I wish you the very best of luck.

 

P.s. There is a group Incompetent cervix australia on facebook. They are a group of trememdously passionate, supportive women who have been through cervical issues.

Edited by Riotproof
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gmcas2

thanks riot proof i have just joined this group :)

 

I got a course of antibiotics during the op but nothing to take home after.

i guess its just a waiting game ;/

 

i will update this post on the outcome of my pregnancy.. hate reading posts that have no resolution… but thanks to everyone who responded and made me feel sane during this stressful time xx

 

G

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gmcas2

Just to update for the many unfortunate women who have been diagnosed with incompetent cervix...

 

At 11wk my cervix has shortened to 2.5cm and i had a preventative mcdonald cerclage placed... this failed. Cervix dropped to 3mm admitted to hospital at 16w for emergency stitch.

On strict bedrest with bulging memebranes (trendelenberg position, antibiotics, bed pans, bed baths, pogesterone and clexane)

Membranes ruptured in the middle of the night at 20weeks.

20 w 3 days both stitches were removed due to risk of infection.

Still on strict bed rest

21w 1d my son who we have named Eric was born alive and died shortly after in his fathers arms.

 

Goodluck to you all xx

 

G

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Lisa G L

i am 19 plus 1, with baby number 6. I had a preventative cerclage inserted under a general at 13 weeks.

 

In Jan '14 i fell pregnant naturally with baby number 4 after a tubal ligation reversal (one tube opened only) at my dating scan at 6 weeks there was a 3.5cm submucosal fibroid located on the left anterior wall of my uterus, bleeding began a few days later and continues for 9 weeks with no reason discovered. at 14 weeks I went into labor (yes actual, labor, not a 'mini version that some medico describe with miscarriage) I labored for 9 hours, my water breaking on the way to hospital and our son Charlie slipped out of me in the lift going up to delivery.

 

I needed an emergency D & C to remove the placenta which was wrapped around the fibroid; six weeks later I had the fibroid removed, which was larger than first anticipated in fact was closer to 6cm, no growth during the pregnancy.

 

In September '14 we conceived our 5th child naturally and was monitored from 8 weeks for IC, due to the 2 D & C's, I had no change at all, with my last scan at 16 w 5 d on 29/12, On 4/1 I woke and went to the toilet and felt a pop, my membranes had not ruptured but were protruding from my vagina, instinctively i gently pushed them inside my vagina and we left for hospital.

Our OB was shocked at how rapidly my cervix had changed, we were given a 5% chance at a live birth, I was placed on IV antibiotics for 48 hours and on strict bed rest, not even able to shower. I went in for the emergency surgery on 6/1 and woke in recovery to be told my membranes ruptured during the surgery.

Our daughter Eva was born 30 minutes later.

 

I turned 40 yesterday, given this we knew we had a very short period of time to conceive naturally, we waited until the second cycle and conceived. We have been monitored very closely, in particular since 15 weeks, I have had no cervical change until this past week, with funneling and shortening, I have 1.7 cm below the cerclage and 1.8 above the cerclage (funneling down to the 1.8), I also have a bladder prolapsed, my bladder is prolapsed into the vagina and sitting against the opening.

 

I had planned bed rest beginning 31/7, but due to funneling on 22/7 was put on immediate bed rest, which is modified, but I have put myself on strict because I'm taking nothing to chance.

 

I am using 100mg progesterone pessaries 2x daily, high dose folate and cartia, weekly Ob appointments and f/nightly cervix scans, our goal is 28 weeks, anything after this is a bonus. Not sure how I am going to cope with 9 weeks of bed rest but what ever it takes

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gmcas2

hi lisa,

 

I just want to say god bless and good luck its a hard road you are on.

My moderate to strict bed rest was from 11 weeks (only shower and toilet privileges no longer then 10 min each) which then became strict bed rest (was not allowed up for anything) in hospital at 16 wk and i remained their until 21 - i understand what your facing :/

i honestly can not tell you how i managed other then focussing on why i was doing it, feeling my baby move and asking the midwives to let me hear his heartbeat as often as they could arrange.

My first loss at 15wk was the same as yours, full blown labour lasted 8 hours dilated to 8 cm and had no medication (was in vanuatu on a baby moon). Unless you go through it its hard to understand.

 

If you ever need anyone to talk too please just PM me.

 

i really hope all has and is going well for you thus far.. sorry for the delayed response i have been in a different headspace after loosing my baby to this terrible condition.

 

much love and hugs x

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It's a Mummy

Op, I am so sorry for your loss

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Milano

I am so sorry for your loss gmcas2 :(

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Lisa G L

My heart goes out to you. No one understands to devestation of losing your baby, no matter the gestation.

 

I'm 21+6 and what started as moderated bed rest only lasted a few days before it became strict bed rest, I have three weeks down so far and the worst so far is the feeling of isolation, hubby and kids in the same house but all off doing their own thing and I feel so alone.

 

I'm not enjoying the movement as I should, my little boy just loves kicking my cervix, hard!

 

My servic shorteded at 18+5 from 4cm to 2.7cm, at 20+5 down to 2.6cm, although dynamic during the scan, I'm funneling down to .9mm above the cerclage and quite frankly terrified.

 

Where I may need support through this, please, please don't hesitate to contact me while you are wading through this grief if you need to reach out, sometimes talking to a complete stranger is easier than someone close to you.

 

Take care xxx

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gmcas2

p.s in the hope to rest your anxiety.. i was 3mm when they put my emergency stitch in with funnelling and lasted 5 weeks at only 1cm of cervix. if your at 2.6cm and doing all that you are, God willing you will have a healthy happy bubba in your arms soon enough

 

p.s.s thanks for the love ill keep it in mind xx

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jobo77

I only just saw your update gmcas2 - so sorry to hear of the loss of your precious baby boy xxx

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mojos_mum

Hi G

 

Firstly, I am so sorry for your loss.

 

I would recommend that you contact Dr Alex Ades in Melbourne for a consult. He is the best doctor for incompetent cervix in Australia. He is an amazingly compassionate man, and wonderful doctor with a soothing bedside manner. I flew from Sydney to see him.

 

My first son passed away after an emergency cergclage at 20 weeks failed.

 

Dr Ades inserted a TAC (permanent stitch) and thanks to him I now have our miracle baby who was born full term.

 

I wish you well with your journey.

 

Cheers

MM

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gmcas2

MM thanks for your suggestion -

 

Albeit after reading this post i have met with Dr Ades who is an amazing man and have already had my LAPTAC :) recovering relatively well

 

Hopefully i will be able to carry full term with our next baby, god willing.

 

Congrats on your little miracle i hope all is well xx

 

G x

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cruzandmama

Hi gmcas,

 

Congratulations on your tac. That's one thing crossed off the list :)

 

Would you mind sharing your experience with the tac?

 

I am currently waiting for my ob to send me my history before I email Dr Ades, so i'll have everything prepared for him to assess me.

 

Did you go through PHI? If it's not too personal, how much did it cost?

 

TIA.

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OurTime

Agree completely re the TAC.

 

After a loss at 22 weeks, I had one placed by Dr Ades also. He really is lovely, as is Connie who looks after the office.

 

I am currently 21 weeks pregnant and everything is looking great :)

 

My loss was not 100% due to my cervix, however Dr Ades was most willing to place the TAC as I was well researched and confident this is what I wanted. Some OB's are reluctant to act until 2+ 2nd trimester losses - however I was not willing to take any chances and Dr Ades was very understanding in regards to this.

 

The surgery itself was not painful - with just a couple of days rest afterwards to be safe.

 

I think my TAC all up cost be about $3000 with private health - that was in 2011. Well worth it for this peace of mind!

 

Wishing you much luck in the future. And I am so very sorry for your losses.

 

I'm most happy to answer any other queries you have.

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gmcas2

thank you cruz and mama and OurTime for the kind thoughts :)

Dr Ades is a remarkable man ! and Connie the receptionist is wonderful. I have had a lot of deelings with ob/gynos due to our journey thus far and can honestly say that he is the most empathetic, understanding and professional that i have had the pleasure of dealing with.

 

I wish i knew of him and the options surrounding IC earlier then i did as i could have prevented loosing Eric. Sadly, not many Obs encourage the LAPTAC although statistically it is the safest and most effective form of treatment.

 

I was very nervous going in to the op and felt rather guilty... however the nurses were wonderful and when i woke up after it had all been done i was in some pain but was well controlled with meds. the first three days were rather uncomfortable with shoulder pain and bloating etc but a heat pack and meds again helped.

after the first week i more or less felt 'normal' with some sensitivity around the scars as expected..and took a little while longer to subside but could still wear skirts and pants etc

 

In my follow up appt dr Ades walked through the entire procedure and i felt very well informed and 'fixed' of this terrible condition, he is a miracle worker.

 

best decision i have ever made.

 

Cost wise:

Day procedure as i refused to stay overnight due to my anxiety.. have full cover BUPA so out of pocket for me was $3200 ($2500 odd for Dr Ades and $600 odd for the aneathitist ) hospital i paid nothing as private insurance covered it.

 

 

Now the TTC journey begins again, and although the stress and anxiety never passes it is at bay at the very least.

 

i hope i have answered your questions ! good luck and god bless xx

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mrsJacko

Hi GMCAS, I didnt want to read your story and not comment.

 

I am so sorry for your loss a few months ago I cannot even imagine what that must be live.

 

I also did IVF to conceive and from weeks 4-5 I had alot of bleeding. at 6+4 weeks I had a big bleed and my cervix opened, I was told that I was miscarrying, I had progesterone from my IVF so I went home inserted two progesterone and went to bed for 24 hours and miraculously the MC stopped and my cervix closed.

 

despite being nervous about stopping my progesterone and asking if i could have tests to make sure its ok my Dr's stopped my progesterone at 14 weeks.

 

at 17+4 weeks it was found that my cervix was only 29mm and I had to restart progesterone and have fortnightly scans and to 'take it easy'.

 

each scan seems to have dropped about 1mm down to the lowest was 26mm but I am told that this could be from human error in that it is very difficult to accurately measure.

 

I am now 22+2 and the results from my recent morph scan were really good and i was told i actually gained a few mm!

but I am again wary in case this was a miss measurement as the girl doing the scan seemed very new, young and most certainly hasn't been doing it that long, she lost all the data half way through and had to re measure everything and left the room about 4 times, to do what I have no idea.

 

 

Anyway I have my next scan this coming Monday and I am hopeful, I can feel my baby girl moving everyday and although it shouldnt it gives me some hope. I just keep telling myself if I can just hold out a few more weeks and she will be viable!

 

My Dr said I can still have sex but it does worry me so we limit it to once a week and I try not to walk too much as by the end of the day I get this painful heavy feeling like my entire uterus is falling out.

 

I have an office job so I am hoping I can keep working as long as possible or until the Dr's tell me I cant but it is hard already.

 

oh and my Hospital don't want to do a stitch unless it is absolutely necessary as it is not without risks this late term.

 

 

If I ever look to conceive again I will be looking up Dr Ades for sure!

 

 

I want to wish you all the best for your new TTC journey I hope everything works out well for you xx

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cruzandmama

Hi gmcas2, thank you for such a lengthy reply, i really appreciate it.

 

My laptac is booked for end of the month, and i am quite excited yet nervous.

 

My email conversation with Dr Ades was very brief and straight to the point. I opted not to have the consultation as Connie mentioned it wasn't really necessary for me. My ob faxed my entire file/history over to him so he has everything he needs to know.

 

I wish you the best of luck in ttc, i have read so many women either currently pregnant or have their babies from Dr Ades' wonderful tac so I'm feeling very hopeful that i can soon join these ladies.

 

 

 

MrsJacko, this is what I'm worried about also. This was my first ivf pregnancy, and I had moderate to heavy bleeds during my first tri as well, at 5 & 7 weeks. My FS put it doen to placenta previa at the time and I was told to have bed rest up until 12 weeks so i did that and went back to work at 13 weeks until i lost my babygirl at 19 weeks.

 

My FS loves progesterone so i think I'll be put on it again even though i despise it so much (prog gave me the worst acne I've ever had in my life)

 

You mentioned it is hard with a desk job, would you be able to elaborate? I work from home so I'll be sitting down a lot, only getting up to use the toilet or prepare my food. I am worried it might put too much pressure if i sat for so long? (I do 10hr shifts)

 

Anyway i hope the rest of your pregnancy goes well... :)

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mrsJacko

Hi cruzandmama, I mean it gets hard sitting for so long, my pelvis and tailbone get really sore and being upright sometimes puts a lot of pressure on my cervix that I can feel but I am being scanned fortnightly so I will just keep doing my daily routine until I am advised not too :)

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