What is Cervical Shortening (or Cervical Insufficiency)?
Posted by: vsakotai on: July 16, 2008
The cervix is the narrow, tubular, lower end of the uterus that extends into the vagina. When you’re not pregnant, the cervical canal remains open a tiny bit to allow sperm to enter the uterus and menstrual blood to flow out. Once you become pregnant, secretions fill the canal and form a protective barrier called the mucous plug. During a normal pregnancy, the cervix remains firm, long, and closed until late in the third trimester. At that point it usually starts to soften, shorten (efface) and open up (dilate) as your body prepares itself for labor.
Cervix is located in the lower part of the Uterus. (source: A.D.A.M and Medline)
Normally, in the late second and early third trimester the cervical length measures anywhere between 3 cm to 3.5 cm (30-35mm) and decreases progressively as the pregnancy advances, in preparation for labor (source: Obstetrics and Gynecology Board Review Manual).
In cervical insufficiency, the cervix becomes softer and weaker than normal or is abnormally short to begin with. It may efface and dilate without contractions in the second or early third trimester as the weight of the growing baby puts increasing pressure on it. This condition can sometimes result in second term miscarriage, or premature rupture of the bag of waters, which can then result in preterm labor, especially before the 34th week.
Several studies have indicated that the likelihood of preterm delivery increases with decreasing cervical length. A cervical length of 25–30 mm before 32 weeks gestation seems to increase the risk of preterm delivery. If examination and ultrasound show that you have an abnormally short cervix, and you’re less than 24 weeks pregnant, your practitioner may recommend “cerclage”, a procedure in which she stitches a band of strong thread around your cervix to reinforce it and help hold it closed. However, there’s a lot of controversy about whether cerclage should be used in this situation.
Some recent research questions the effectiveness of the procedure at preventing miscarriage or preterm birth except in a small number of circumstances. And the procedure itself can lead to preterm delivery caused by uterine infection, ruptured membranes, and uterine “irritation” leading to contractions.
In certain other conditions, the benefits of cerclage can outweigh the risks. Women who seem to benefit from cerclage include those who’ve had three or more unexplained second-trimester losses or preterm births. If you’re in this group, you’re likely to get a cerclage at 13 to 16 weeks, before your cervix starts to change. A cerclage done then appears less risky than one done later in pregnancy, after your cervix has started to change. Once this procedure is done, you will be continually monitored by your obstetrician, until about 37 weeks, when the stitches can come out, and you can wait for labor to begin.
If this condition is discovered in the third trimester, bed rest or modified bed rest, would be the preferred choice, as opposed to cerclage. Although there’s no solid evidence that staying in bed is effective, the theory is that keeping the weight of the uterus off of a weakened cervix might help.
After going through a lot of recent research and literature, I have put together some recommendations for expectant mothers who are diagnosed with cervical shortening.
- Women with cervical measurements exceeding 26 mm should be just observed, and reassessed in 2-3 weeks.
- Women with cervical lengths between 21-25 mm should be placed on reduced physical activity, with re-measurement in 2 weeks.
- Women with cervical lengths between 16-20 mm should be placed on strict bed rest, with re-measurement in 1 week.
- Only women with cervical lengths of 15 mm or less should be considered for therapeutic cerclage.
- At this time, no evidence supports measuring cervical length or placing cerclage in the low-risk patient. This means, no scans and no other physical checks or interventions are recommended in the absence of symptoms and/or high risk in the expectant mother.
While this is probably a good point of reference to start, it obviously needs to be taken within the context of the rest of your physical examination findings, and your obstetrician’s recommendations. In addition, your obstetrician will decide what the best intervention is for you, depending upon when your cervical shortening is diagnosed. For more details on this particular topic you can look at information available in the following websites:
- www.obgmanagement.com
- www.pubmedcentral.nih.gov
- www.apa.org
- www.nichd.nih.gov
As always, please write in any queries, concerns or thoughts that you might have.
Dr. Vijaya Krishnan
vsakotai [at] yahoo [dot] com
369 Responses to "What is Cervical Shortening (or Cervical Insufficiency)?"
August 8, 2008 at 12:14 pm
Priya,
Cervix length of 3.2 cms at this stage of your pregnancy, in itself does not indicate major risk. Your obstetrician will continue to monitor you over a period of time. Aproximately every 3 weeks or so, your cervical length can be measured through scans. If it continues to shorten, she may recommend placement of sutures around your cervix (cerclage) and reduced physical activity or bed rest depending on the amount of shortening. However, if your cervix continues to maintain its length, nothing further needs to be done, and you can enjoy the rest of your pregnancy. Hope this helps.. good luck!
Dr. Vijaya Krishnan
August 11, 2008 at 1:22 pm
My obstetrician had given me option of cerclage or to wait for continuous monitoring. Your kind response has given me confidence to wait and monitor for some more time. Thank you very much Sir.
August 15, 2008 at 6:25 pm
I am 23 wks preg. and my cervix is 2.8cm, I have have 3 previous D&Es before I was 24. I am now 27. The baby also has his head resting right againts my cervix according to mu u/s yesterday. What do you think will happen?
August 18, 2008 at 6:56 pm
My daughter, 35-2/3 is expecting twins. She had 3 leep procedures and had a cerclage @ 14 wks. She is on modified bedrest and is in her 32nd week. Cervix shortening from 4 to 3 last week. They are removing the cerclage 9-11. Does the shortening of the cervix in that weeks time period signal impending birth?
August 19, 2008 at 4:18 am
Hi Tracey,
Your cervical length is in a region where it would require very close monitoring, coupled with reduced physical activity and/or bed-rest. It would also depend on whether your previous D&Es were elective procedures, or whether it was a medical requirement.
Since you have quite a few weeks to go before delivery, your obstetrician will most likely recommend cerclage.
If you want to discuss further, you can e-mail me.
Best wishes,
Dr. Vijaya
August 19, 2008 at 4:41 am
Hi Kathy,
Since your daughter is carrying twins, there are chances that she will deliver sometime soon after her cerclage is removed. However, since her cervix has shortened even with the cerclage in place over one week, she will need to be constantly monitored. Complete bed-rest would most likely increase the chances of carrying the babies longer towards her due date/date of removal of cerclage.
At 36 weeks , the babies lungs are mature, and they would be ready for delivery. If with monitoring over the next weeks, your daughter’s cervical length further decreases, her obstetrician will most likely give her injections to help the babies lungs mature.
Best wishes to you and your daughter,
Dr. Vijaya
August 19, 2008 at 6:10 pm
Thank you for your quick response. Her husband is in Iraq so I plan to fly up next week.
She is going twice a week, once for non stress tests and then for ultrasound. She said the babies were “practice breathing” in the ultrasound yesterday. She also is having contractions at the rate of about four per hour.
She is on modified bed rest and monitored frequently
August 21, 2008 at 7:42 pm
3 cm cervical length is on the borderline of normal range. Most research indicates that no special precautions need be taken at this particular point of time. However, considering that you are in the 29th week, I am sure that your obstetrician will want to monitor you with repeat ultrasounds every 3 weeks or so. In case, further shortening does occur, you may be advised reduced physical activity and/or modified bed-rest to increase your chances of carrying your baby to term.
One of the moms in my program was diagnosed with cervical shortening (less than 2 cm) in her 34th week of pregnancy. With modified bed-rest and reduced physical activity, she has now carried her baby to term, and is now eagerly awaiting for her labor to start 
Hope that you have a safe and healthy pregnancy…
Dr. Vijaya
September 1, 2008 at 9:43 am
Dear Dr. Vijaya,
My sister-in-law is 10-11th week pregnant and today she got a cervical cerclage. As you have suggested to Luveena that having 3.0cm cervical length is on the borderline of normal range. I am confused that though my sis-in-law has 3.2cm cervical length, why cerclage was the option. She is asked to have bed rest for a week. Previously, she had two miscarriages first at 2 months and 2nd was at five months. Could this be the reason to undergo for a cerclage despite having normal cervix length? or is it because of having 3.2cm cervical length at 10-11week pregnancy?
She is travelling on 9th september from india to france (pretty long flight). Is it risky to travel on air for long hours? I am terrified because I am myself due on first week of october and she will be here for three months. she will bring her medicines enough for three months but is it enough visiting a doctor once a month in such case?
Please suggest!!
Thanking you.
September 1, 2008 at 5:23 pm
Dear Manju,
Most likely reason for your sister-in-law to have had cerclage would be because of her two previous miscarriages. Although the first one was pretty early in pregnancy, the second one was a second trimester loss of pregnancy. This is usually a pretty good reason to perform preventative cerclage, especially with her borderline cervical length.
In terms of whether it is safe to have a long air travel, this would depend upon how well she does with her bed-rest over the next week. If there are no adverse effects from the cerclage placement, her obstetrician will probably give her the green signal to go ahead. Since she is only at 10-11 weeks, air travel should not have any other impact at this stage.
Once she is in France, yes – once a month appointments should be good enough. I do suggest that her first two appointments be done at 15 day intervals since her cerclage procedure has just been done. Once it is established that her cervical condition is stable, then usual once a month check-ups will do just fine. Hope this answers all your questions.
Good luck with your own pregnancy .. Enjoy the last few weeks before you have newborn I am sure all will go well for both you and your sister-in-law.
Wishing you both good luck …
Dr. Vijaya
September 2, 2008 at 9:54 am
Dear Dr. Vijaya,
Thank you so much for your advice. I will definitely consult you in future if in case any complication arises.
God bless you.
with best regards,
manju
September 11, 2008 at 4:14 pm
Dr. Dr. Vijaya,
Of all the articles that I have read, yours has BY FAR been the absolute most helpful! I now understand why they do not want to place a cerclage yet.
I am 20.5 weeks pregnant, and last week, I had a small Y funnel with cervical length of 3cm, and it did not open further with pressure. Now this week, my u/s showed cervical length of 2.6 cm (although, doctor remeasured the u/s photo and changed it to 2.8), with the funnel being a deeper V, opening further with pressure.
Is that a huge change in just one week? And they are not prepared at this time to place a cerclage, stating it could actually rupture the membranes.
Could you please give my chances straight to me? Like 25% I’ll deliver before 24 weeks, or 10% chance to make it to 36 weeks, etc. etc.?
I have been placed on bedrest and will have the cervix checked via u/s every week.
Thank you soooo much…
Stacie
September 15, 2008 at 7:02 pm
Dr. Vijaya-
Your emails to the others have been useful, but I’m not reading anything that’s similar to mine. So I hope you have some information/advice for my situation. I’m 25w3d with twins and just got back from the doctor where he did a vaginal sonogram to measure my cervix. At first it measured 3.5cm but then it was as if my cervix relaxed and he said it was funneling (outside to in) and remeasured at 1.98cm. He said that if it gets to 1.5cm he’ll put me in the hospital.
I’m already on a modified bed rest because of contractions and dark discharge, but on a stricter bed rest now. I also have a check-up with my perinatal nurse on Thursday where my doctor has asked that I be remeasured.
What are my chances of hanging on for several more weeks?
What are my boys chances of survival this early?
Thank you.
Miranda
September 16, 2008 at 12:12 pm
hi i am 26 weeks pregnant today and at 24 weeks my cervix measured 26mm, my consultant wont see me again until im 32 weeks is this right? i had cone biopsy 6 years ago
September 17, 2008 at 6:53 pm
Stacie,
Thank you for your kind words .. I was out attending a Lamaze conference and hence could not reply immediately.
A further shortening of the cervix, coupled with greater funneling with trans-abdominal pressure definitely needs to be monitored rigorously. Strict bed rest is the only dictum to follow at this stage.
I wish I could tell you what percentage chances you have of hanging in there – there is only one study that I came across trying to predict premature birth and this was done in moms carrying twins. For them, they found that the chances of having premature labor was 17% in women with cervical length of 2 cm, and 12% in women with cervical length of 2.5 mm.
Hope that your cervix stabilizes with the strict bed rest.
Do write if you have any further questions/concerns.
Heartfelt good wishes,
Dr. Vijaya
September 17, 2008 at 7:33 pm
Miranda,
In terms of your chances of hanging in their for several more weeks, I would definitely wait and watch what effect your stricter bed rest has on your cervical condition over the course of the next couple of weeks.
In my response to Stacie, I mentioned about a study that I came across which specifically looked at the risk of premature delivery in twin pregnancies. Skenton (2001) studied 464 twin pregnancies between 22-24 weeks. With average length of cervix measuring at 36 mm (3.6cm), the findings with respect to women with cervical shortening were as follows:
Chances of premature delivery before 33 weeks:
With 6 cm length – 2.5%
With 4cm length – 5%
With 2.5 cm length – 12%
with 2 cm length – 17%
with 0.8 cm length – 80%
This is only one study, and I do not know how applicable it may be to general populations.
Has your provider recommended a fibronectin test? In expectant mothers where cervical funneling and shortening are accompanied by preterm contractions, a fetal fibronectin test can sometimes provide a clue. In this test, a swab of the vagina is obtained from near the cervix. Fetal fibronectin is a glycoprotein that acts like a “glue” between bag of membranes and cervix. Normally, this is not released until late in pregnancy/near delivery. In women who tend to deliver early, this can become positive much early in pregnancy.
Having said that, studies have also found that though this test is highly accurate when negative, it may not be as accurate when positive. What this means is that, even if you test positive for fetal fibronectin, it does not mean that you will absolutely deliver prematurely. What studies have found is that, a positive fetal fibronectin, coupled along with further shortening of the cervix, may be predictive of preterm labor.
Some providers will start giving steroids to try and mature the babies lungs, as well as prescribe tocolytics to slow preterm contractions, especially if these are occurring regularly.
I am also curious to know if your provider has done “stress testing” to assess status of funneling?
Hope this information helps. In the meantime, definitely follow the “strict bed rest” prescription very seriously to give you and your babies the best possible chance of pulling along as far as you can.
All the very best to you – take care.
Dr. Vijaya
September 17, 2008 at 7:45 pm
Nicki,
It seems like an awfully long time between your provider visits. Even with pregnancies without any particular concerns, provider visits are usually scheduled for once every month to ensure continued good prenatal health. I am not sure why your gap is almost 8 weeks? I would definitely check with your provider regarding this, and question their standards of practice.
Now, especially with regards to your cervical length, it is recommended that you be reassessed every 2-3 weeks (26 mm length). So again, I would question them as to why they are not following research based guidelines of good prenatal care.
In terms of your cone biopsy, it is one of few known factors which may have predisposed you to cervical shortening.
Hope this helps.
Dr. Vijaya
September 18, 2008 at 11:07 am
thnkyou so much for your reply, and i will do as you say and follow it up.
seeing as i am ment to be high risk so they say i have only had 2 midwife visits which i thought was bad.
nicki x
September 19, 2008 at 1:00 pm
Thank you Dr. Vijaya!
The good news is (and hoping to provide hope to others in the same boat) after a week of strict bedrest, the funnel is still there, but now does NOT open with pressure and is back to 3.1 cm!! I know that could change for the worse again, but this week, I am encouraged.
It was discovered that I had a UTI. I treated over the last week with a course of macrobid. I know UTIs can cause preterm contractions, but could it also change the cervix the way it did?
Best regards,
Stacie
September 23, 2008 at 2:32 am
Stacie,
I am glad that your bed rest has had positive effects. Do continue with this for some time to come.
I am not aware that UTI necessarily causes remarkable changes in the cervix.
Hope this helps.
Good luck,
Dr. Vijaya
September 24, 2008 at 2:42 am
Dr. Vijaya,
I recently got a comment from a woman who read my blog, and she said that her cervix (at 19 weeks) was at 11mm and her doctors have recommended bed-rest. She had been very active up to that point, and is willing to slow down but doesn’t want to “stop” totally. She had a cerclage put in. While I’ve answered her to the best of my ability, I know I wasn’t able to help very much. For my own curiosity, I’m wondering what the likelihood that *anything* would help, with her cervix so short so early in pregnancy. Most of what I’ve read says that cerclage and/or bed-rest don’t help much at all, and I was wondering if there was any research done that would be applicable to her.
Thanks,
Kathy (different Kathy from above)
September 25, 2008 at 3:08 am
Hello Kathy,
You are right – with her cervical length being so short, so early, all that can be done is trial of preventative measures such as cerclage and bed rest. I have also not come across any definitive studies that have addressed her particular status.
I am sure that you have come across 2 studies that were done relatively recently:
1. A study done by Daskalis et al in 2006 – Cerclage prolonged pregnancy by 8.8weeks, whereas without cerclage the mean prolongation of pregnancy was 3.1 weeks. However, only 29 women took part in this study.
2. Study done by Pereira et al in 2007: Larger group of women studied. International cohort. 225 women took part in the study, 152 had cerclage placed. They were between 14-26 weeks of pregnancy. Cerclage prolonged their delivery to >28 weeks. They concluded that cerclage led to prolongation of pregnancy, increased rates of neonatal survival and birth weights >1500 gms.
8% of all women naturally have a cervix that is only 8 mm long, and they can carry their pregnancy to term. I hope this is the case with your mom!
Hope this helps.
Dr. Vijaya
September 25, 2008 at 3:12 pm
Dr. Vijaya,
I’m currently 22 weeks 5 days pregnant, and had a cerclage placed in week 18. Up until week 18, I had no reason to be alarmed. I haven’t had any uterus/cervical related procedures in the past, but upon going to my ultrasound (at 18 weeks), the technician found that I have a short cervix. Within two days of the ultrasound, I was wisked away into surgery getting a stitch. Mind you, I’m one of 7 sisters, and all of my sisters (besides me) have children. Three of my sisters were diagnosed with a short cervix, and I informed the doctor of my family history; unfortunately, the pattern didn’t click to me…
I had the cerclage on 27 August, saw a high risk specialist (fetal and maternal medicine ob doctor) two weeks later, and was told by him that I must be on strict bed rest and that I should stop coming in to his office. He wished me good luck, and that he would notify my regular OB. I felt…. so low after this appointment, because I believe he gave up on my ability to hold this baby. My cervix was 2 cm at that time, and seriously considering switching doctors and hospitals; as I believe that my regular ob appointments should be more frequent than the normal pregnancy once a month visits. My doctor called me to reiterate the bed rest plan, and said there is nothing else that can be done at this point. Also, she asked me to make an appointment to come in within the next two business days. When I called to make an appointment, the receptionist told me about the times in which the doctor isn’t available, and when I told her that the doctor told me to come in, she said “For What?” Am I being unreasonable to think that my case requires frequent appointments?
September 26, 2008 at 4:56 pm
Dear Tasha,
Several things popped right out at me:
1. Your cervical length is short, but I am wondering why the doctor did not want to try you on strict bed-rest first. All research points to <1.5 cm being the mark at which cerclage maybe required immediately. Cerclage carries with it the risk of preterm labor, uterine infection and such – so I wonder why they did not explore the non-intervention option first. However, I am really glad that you have gone almost 4 weeks after cerclage without any more complications.
2. Did all of your sisters with shortened cervix, carry their babies to term without any external intervention (including cerclage)? If this is the case, you may be one of the few people who will carry your pregnancy to term , without any procedures.
3. About 8% of all women have a naturally short cervix ( as short as 0.8 cms) and they carry their babies to term naturally.
4. Although with a cerclage placed, less frequent monitoring (than no intervention) is ok, it makes sense to have you get thoroughly checked every 2 weeks for at least the first month,a and then every 3 weeks or so depending on how stable your cervical length is.
Hope this answers all your queries .. and good luck finding a good OB/hospital.
Dr. Vijaya
October 3, 2008 at 3:54 pm
Hello –
At 25 weeks pregnant I had pain that appeared to be contractions. Monitoring at the hospital revealed only uterine irratibility and I was sent home and told to drink lots of fluids and take it easy. A follow-up u/s at 26 weeks indicated a short cervx, 0.5-0.6cm. I’ve been put on strict bed rest, was in hospital one week and now at home. No signs of any contractions or uterine irratibility since then. Now at 28 weeks, my cervix measured about the same, 0.5cm. There is funneling though I don’t know how much. I am really scared. This is my second pregnancy – my first was early, water broke at 35 weeks. Is there anything else I should be doing? Any signs I should look for?
Thanks,
October 5, 2008 at 3:40 am
Vickie,
You are probably doing all the correct things right now. With your cervical length so short, I can understand why your OB did not want to do anything else. Cerclage could have caused further uterine irritation and premature contractions.
Bed rest and reduced physical activity have helped to keep the cervix from shortening further in some moms. Keep up your spirits and try to relax as much as you can.
Signs to look out for would be 4 or more contractions within an hour’s time – this would indicate preterm labor.
Hope this helps.
Wish you all the best going forward ..
Dr. Vijaya
October 5, 2008 at 3:56 pm
Hi Doctor,
This is my first pregnancy..
At 24 weeks (3-Oct) my cervix had an opening from inside(funneling). After funneling my cervix length is 1.87 cm. Tomorrow, I am going for Fetal Fibronectin test though i have no vaginal discharge. Since Friday (3-oct) i have been on bed (anti gravity) with getting up only for toilets. I am extremely extremely worried as I am carrying fraternal twins. …..What are my options ?.
(1) Do you think I should talk to doctor about Cerclage
(2) Or may be hospitilazation ?
Also, I am feeling localized hardening of my tummy which goes away very quickly. Their is no pain. This happens around 5-7 times in a day. I was ealier thinking it might be some baby part, but now I am thinking this could be contractions. Do you think this is Braxton Hicks ?
Please advise..Thanks a lot.
October 7, 2008 at 6:12 pm
Shilpi,
Sorry I could not respond earlier. The correct choice of treatment is strict bed rest in your case, especially since you are carrying twins, and so would have greater pressure against your cervix. I am not sure whether your doctor will recommend cerclage, since your cervical length is pretty short, and you do not want to risk too much uterine irritation.
If you can hang in there with STRICT bed rest until your 28th week, then monitoring you on a weekly basis, and perhaps administering steroids to mature your babies’ lungs will help to take you and your babies forward from thereon. If you think remaining at home will not let you maintain strict bed rest, then you could think of hospitalization. However, remaining in the hospital presents risks of hospital-based infections, and this is something you should be aware of. It would be best if you could get someone to help you, and be around you at home.
As far as the tightening of portions of your stomach, it could be Braxton Hicks, or it could be premature contractions. What did your OB find at your subsequent check up, and what was the result of your fetal fibronectin test? Both of these would indicate how to proceed with your care going forward.
Hope this helps.
Best wishes,
Dr. Vijaya
October 8, 2008 at 3:27 am
Thanks for your reply Doctor.
As you said, Cerclage was ruled out because i am too far into pregnancy.
The fetal fibronectin results were negative. I was kept for 1 day in hospital for monitoring. They already went ahead and gave the steriod shots. Terbutaline (5mg) was given every 4 hrs (while in hospital) to stop the contractions. It did stop the contractions, though it was causing my pulse to go beyond 120. Now i am bk at home with a reduced strength of Terbutaline (2.5 mg). This is helping me with my pulse rate, but the contractions have started and it keeps coming & going. It is spread around with no fixed patterns. In 1 hr i had live 4 but in total i had like 7 in the last 5-6 hrs.
A monitoring machine has been placed at my home, but they would not panic until its like 6 in an hr….
I don’t know what to do now ? We have next appointment with OB in 2 days time. What would you advise ?.
Thanks..
October 8, 2008 at 5:57 pm
I am currently at 29 weeks. My cervix length was measured as 1.8cm and 1.5cm (to confirm the first measurement) at 28 weeks, but no funneling and with negative fFN. Is this a very short cervix length? I am very healthy and has no miscarriage history. And this is my first pregnancy. As early as 17 weeks, I had contractions (no pain). Since 25 weeks, I had a couple of times frequent contractions without known reasons. Now, I am following my OB’s recommendation, doing bedrest, having internal check every week, and having fFN every two weeks. I still have contractions from time to time, but not too often. And OB has already given me steriod to help baby’s lung grow.
Doctor, I am wondering if cervix shortening is related to contractions. Is it possible that one causes another one? What can I do now besides bedrest? Do I have great chance to hold the baby till the full term? What can I do to avoid this in my next pregnancy?
Thanks, doctor.
October 9, 2008 at 1:20 pm
Hi Dr. Vijaya! Thanks again for your support!
I am hovering around 3.2 cm, and the OB is very happy with it. But I’m not so confident in the older woman who has been doing my u/s. When the specialist was doing them, she would push on the fundus or have me bear down to get the true measurement. This other lady at the regular OB office is not having me do that.
Should I ask the older lady to take the picture when I bear down a little to see if it’s opening with pressure?
I assume we should be encouraged at the holding steady at 3.2 at 24 weeks!
Thanks so much!
Stacie
October 9, 2008 at 1:26 pm
Shilpi,
I think you are pretty much doing all you can. Terbutaline acts by trying to relax the muscles of the uterus. While it can temporarily decrease or even stop preterm contractions, it may not be able to stop preterm contractions indefinitely. So you and your OB will have to just wait and watch (as you are doing now). Having the monitoring machine at home will be helpful to get you to the hospital quickly, in case your number of contractions per hour suddenly increase.
Keep up your patience with this … you will be needing a lot of it, as well as good, positive, supportive people around you. At the risk of sounding “non-medical” I would advise you to try meditation and relaxation. Pregnancy is as much a psychological process, as physical. In addition, relaxation techniques , breathing, meditation etc. are known to provide muscular relaxation – and the uterus is a muscle. Listen to some soothing music. Finally, try deep breathing. Imagine the air going into your lungs, and reaching in all the way to your uterus in the front and tail-bone in the back. Then exhale out slowly, as if imagining that you are blowing a candle that is far away (maybe an opposite wall). Do not hold your breath at any time. This kind of breathing is very calming, and can do wonders. If nothing else, it is delivering good clean oxygen to you and ultimately your babies.
Please do not hesitate to write back – you can definitely use me as your “virtual” support system. If you would like to communicate personally with me, you can always write to vsakotai (at) yahoo.com
My good wishes are with you.
Dr. Vijaya
October 9, 2008 at 1:47 pm
Hello (az),
Yes, your cervical shortening is probably what is causing those contractions. Having said that, not all expectant moms with a shortened cervix will have preterm contractions.
You are probably doing all you can. You should continue to be on strict bed rest. And steroids have been given to mature your babies lungs, so that’s one part of the equation that has already been taken care of.
On the positive side, you are not having too many contractions, and have negative fetal fibronectin test results. Added to that you are at 29 weeks, so I am hopeful that you will be able to cross your next pregnancy milestone – which will be 32 weeks. After that it will be wait and watch – and each week that you go forward will be an added bonus. Be patient, and keep a positive frame of mind.
I am not sure you can do anything to prevent this in your next pregnancy. There is nothing wrong that you did in this one either. This is just one of the concerns some women have to face in their pregnancy. Having said that, some women carry their pregnancies to term with lengths that are shorter than yours! So let’s hope for the best in your case as well. And, who knows, in your next pregnancy this concern may not arise at all!
Keep up your spirits, and all the patience that you are showing as you go along.
All the very best to you -
Dr. Vijaya
October 9, 2008 at 2:01 pm
Stacie,
I am very glad for you – Yes, you should definitely feel encouraged that you are holding on at 3.2 cms
Have you asked the other lady who does your ultrasound why she is not applying pressure on the fundus to check for funneling? I am not sure whether you want to bear down when the specialist is not there with you – your effort may be wasted, if this other lady does not know what she is looking for. And, if she is not comfortable with applying fundal pressure, you can perhaps let your specialist know about this, and she can check you every other time? Or she can communicate what your check up needs are better to the regular US lady. I think this would be the safest thing to do.
Thank you for communicating your encouraging results here – I think it will give heart to a lot of the other moms who are in similar situations as yours
Dr. Vijaya
October 9, 2008 at 2:06 pm
Hi there. I was just diagnosed with a cervix that is 0.8 cm in length with no funneling, but dialated 1cm. i have been put on moderate bedrest with weekly appointments to keep an eye on my cervix, as well as nightly vaginal inserts of progesterone. Do you think I have a chance of holding this baby much longer? I feel like alot of the stories I read are women with ICs that are around 2cm. I am really scared and want an opinion on my chances of carrying this baby and how long?
Thanks,
Wendy
October 9, 2008 at 2:24 pm
Hello Wendy,
You have not mentioned what week of pregnancy you are in?
Research has shown that 8% of all moms with 0.8 cm cervical length will carry their pregnancy to term. I hope this is true in your case!
I also wonder what is the rationale behind having you on moderate bedrest versus strict bedrest?
Good luck ..
Vijaya
October 9, 2008 at 2:26 pm
Hi there! Sorry, I am in my 24th week of pregnancy. Moderate bedrest is allowing me to get up for a daily shower, bathroom, and dinner. I was wondering that too. Do you think that is strict enough?
October 9, 2008 at 2:28 pm
Also, he said I could sit on the couch..do you think that is not advised due to the shortness of my cervical length?
October 10, 2008 at 11:22 am
Wendy,
With your cervix length being so short, there is not really any definitive research which suggests that any stricter bed rest will help. If you were perhaps slightly earlier in your pregnancy, cerclage might have been an option, but even then there have not been many studies showing either major positive or negative effects on carrying pregnancy to term.
I think you should be ok with your current out of bed schedule. Do try to strictly adhere to it. No straining at stools, no activities that involve increase in intra-abdominal pressure, such as lifting. In terms of sitting on your couch, I would not recommend it if it is low. When you get off it, you will certainly increase intra-abdominal pressure, which is not advisable. If your couch is high, if it can recline/semi-recline and/or you can make the sitting surface higher using some pillows, it might be ok to use occasionally. If you do increase the height of the sitting surface, you may want to make sure that your feet are still supported – if you need to put a small wedge/stool under your feet. That way, you will still have a good sitting posture and will not end up with a backache.
Hope this helps ..
Dr. Vijaya
October 10, 2008 at 11:24 am
Stacie,
One more thing I forgot to mention in my post yesterday – a better way to check for funneling would be to have you cough. This is better than asking you to bear down. You can perhaps check with your specialist re: this?
Dr. Vijaya
42 | Pre-term Birth « Woman to Woman Childbirth Education
October 11, 2008 at 12:02 am
[...] avoided in retrospect, but at the time they were not able to have been avoided) — such as incompetent cervix, in which mothers and doctors tried to avert a preterm birth using every way they could, to no [...]
October 13, 2008 at 7:22 pm
Thanks Dr. Vijaya for both posts! I will suggest the coughing!
October 17, 2008 at 8:28 pm
Hi,
What a great summary. Very succinct.
I was found to have cervical insufficiency with my first pregnancy at 21
weeks. My cervix measured 1.6cm, and funnelling was detected.
I was placed on strict bed-rest (only got up to pee, seriously) by my MD,
and he avoided a cerclage procedure. I was monitored weekly with
ultra-sounds until 34 weeks, and my cervical condition did not change. I
went off bedrest at 38 weeks, and delivered my healthy daughter (7 pounds,
14 ounces) at 40 weeks (full-term), with a long labour that lasted 14 hours.
During the pregnancy, at the 24 week mark, we had discussed steroid therapy
with my doctor, but never proceeded with any medications. Everything worked
out well!!
Well, I am know pregnant with my second child. My first MD retired, so I am
under the care of a new physician. Because of the full term pregnancy, long
labour and realtively big baby, he was initially reluctant that my cervix
was insufficient, probably just short he believed.
He did start measuring my cervix at 18 weeks, with weekly ultrasounds.
He did not think cerclage at 13 weeks was necessary. My first three results
were solid, cervix measuring 3.0cm. At my 21 week test, my cervix was
measured at 2.0 cm, and severe funnelling detected. My doctor wanted to
proceed with cerclage that day, but my husband and I were reluctant because
of the risks involved. He was very understanding, and sent me home under
strict bed rest to be re-assessed in 3 days. The next ultrasound my cervix
remained at 2.0 cm, and the funnelling dissappeared.
He recommended continued bedrest, and to monitor my cervix in two weeks. He
did not recommend cerclage at this time, saying that the bedrest seemed to
be helping things. I am now 23 weeks pregnant, and on strict bed rest. I
just saw my doctor two days ago and my cervix looked unchanged, and no signs
of funnelling. I am going back in two weeks for another ultrasound. So far
things seem to be repeating as my first pregnancy. I am very happy with my
physician so far in terms of the treatment I have been recieving and his
opinions. My question is, in your opinion, am I at a greater risk for
pre-term labour the second time around? should I consider any other
interventions? would steroid therapy be highly recommended, or not necessary
as it was avoided the first time around? and what would you recommend the
course of action should be for my next pregnancy?
Sorry for the long email,
Thanks again for all your help
October 18, 2008 at 12:20 am
Hello. I am currently 24 w 5 d. I had a cerclage put in around 18 weeks. At my one week check up after the cerclage, my cervix was 4 cm. As of 24 w 2 d, my cervix was 1.12 cm. My doctor sent me to the hospital where they gave me steroid shots to help the baby’s lungs. I was only in the hospital for 24 hours or so. After my release, I was put on modified bedrest until my next appointment which was about 5 days away. My doctor is saying that I maybe able to go back to work or do a modified schedule of working from home some days and working some days. Is there anything else that I can do or that I should recommend to the doctors? I want to make sure that I have all of my bases covered.
October 18, 2008 at 12:22 am
My doctor also said that 28 weeks is a really good benchmark. Why is that?
October 18, 2008 at 12:33 am
Being that I have a cerclage, does this put me in a different category and I should worry less. The reason why I ask, my maternal fetal specialist sent me home after telling me that cervix was at 1.12. Luckily, I had an appointment with my OB immediately after that who sent me to the hospital.
October 18, 2008 at 2:56 pm
Iva,
I too would have been inclined to believe that you just have a short cervix and not cervical insufficiency. However, with the funneling that showed up on your 21st week US, it points to some measure of insufficiency.
With your history of carrying your first child to full term, and then having a length of labor which would be in the normal range, I feel that you will probably have a repeat of the same again. Your labor may be shorter though .. and won’t that be great
You probably took the right decision in not going in for a cerclage, especially as you had crossed 20 weeks; strict bed rest is the only treatment of choice at this time. Regarding steroids, my sense is that you could still afford to wait for some time. If there is any further shortening, you may be at risk for preterm labor, and in this case, you could probably go in for steroids. If you continue to maintain your cervical length (as you are doing now), you may not need steroids at all.
As for you next pregnancy, it may be worthwhile exploring the option of preventative cerclage. Not so much because of risk of preterm labor, but just so you don’t have to be under strict bed rest, and can actively enjoy your pregnancy. Typically if done early enough (13-16th week), after being on bed rest for 2 weeks, and being monitored, preventative cerclage will let you be mobile and active for the rest of your pregnancy.
Hope this helps … Good Luck for the rest of your pregnancy!
Dr. Vijaya
October 18, 2008 at 3:19 pm
Hello (LaToya)
Occasionally, it does happen that cervical length decreases even after cerclage has been put in. However, since cerclage is protective, cervical dilation and premature delivery should be less of a worry for you. This is probably why the maternal fetal specialist sent you home. Having said that, your OB probably did the correct thing to get steroid shots administered to you, as there is no way to predict whether or not you may still go into preterm labor.
Modified bed rest, and not doing any activity that increases intra-abdominal pressure would be appropriate in your case. I would also recommend least possible travel (even to work), at least for 2-3 weeks. After this, if your cervical condition remains stable, you can probably resume a little more travel and out of bed activity. This will also get you to your 28 week milestone.
The reason for the 28 week milestone:- with the steroid shots the baby’s lungs will be relatively mature for survival outside of the womb. This is in case of preterm labor only. Otherwise, you may well carry your baby to term (as may of my moms have) – your OB will usually remove your cerclage at 37 weeks and wait for your labor to start.
Hope this helps .. if you have any further questions or concerns please feel free to write in.
All the very best to you ..
Dr. Vijaya
October 19, 2008 at 6:27 pm
I am 23 weeks pregnant today. At my last OB visit my doctor informed me that my cervix was 1.9 cm. I have to see him now every week. There was also some slight funneling present. He did not put me on any kind of modifications or restrictions. Everything that I read says that I should be on some type of bed rest. What do you think. I have an appointment next Thursday and would like to know what to ask when I go in.
Renee
October 20, 2008 at 8:07 pm
Hello Renee,
I am surprised that your OB did not put you on any type of precautions/bed rest. With your cervix measuring around 1.9 cms, research indicates the benefits of bed rest in limiting further shortening. In fact, in the past, many of my moms have shown some improvement in their cervical condition with strict bed rest.
Definitely do ask your OB what his rationale is behind not putting you on modified activity levels.
Good Luck,
Dr. Vijaya
October 22, 2008 at 1:15 pm
Hi Dr. Vijaya,
I had previously written you with a short cervical length of 8mm. I have still remained the same and taken your advice about the strict bedrest instead of the modified. However, I now have funneling in a u shape that I did not have before and yesterday was told that I now have polyhydramnios at a level of 30. I did not know what that really meant yesterday when I was there-they told me the baby was healthy and it was of no threat to the baby. Since I have been home I have read different and feel my chances of preterm delivery are so much greater now! I am 26 weeks today and so scared for my baby! What do you think my chances are of making it to at least 28 weeks with a healthy baby?
Thanks,
Wendy
October 24, 2008 at 1:52 pm
Dr. Vijaya,
Thank you so much for your comments last time. Your words are always so clear and encouraging, which really relieved me a lot. Thank you!!
Unfortunately, I met the new issue this week. I started to do bedrest since 28 weeks due to the short cervix and had weekly check since then. Nothing changed in 29 and 30 weeks. But in this week, i.e., 31 weeks, the doctor found that the cervix is dilated by 1cm and her description is 1cm/80/-1. I think 80 means effacement is 80% and -1 means baby position is low. Is it right? Given my short cervix (1.8cm from one ultrasound check, 1.5cm from another ultrasound check), do you think how long I can hold my baby? My baby is only 3 pounds 6 oz at this moment. I really wish I could hold him a little bit longer. Based on your experience, do I still have great chance to hold till 37 weeks? By the way, I still have contractions, but not frequent and no pain.
Look forward to hearing from you soon, doctor, and thank you in advance,
az
October 24, 2008 at 2:56 pm
Dear Wendy,
Polyhydramnios is increase in levels of amniotic fluid that surrounds your baby. Normal levels vary greatly – with a range of 5 – 25 being normal. So, 30 is on the upper limit, but it would not have been that much of a concern if your cervical length had not been short.
The increase in fluid levels is probably putting more pressure on an already compromised cervix, and that may be part of the reason behind your funneling.
Just remain watchful for preterm contractions .. if you start having any, it is time to get to the hospital and get yourself checked immediately.
Hang in there … you are doing all that you can possibly do. Every week that goes by makes your baby a little more developmentally mature; You will just need to remain patient and wait to cross the 28 and 32 week milestones.
Good Luck,
Dr. Vijaya
October 24, 2008 at 3:47 pm
Dear (az),
You are correct in reading your cervical measurements – it looks like your cervix is 80% effaced (thinned out) and that your baby is moving lower into your pelvis. I wish I could tell you how long you can hold on … no two moms are same, and even delicate changes in hormonal balance can set off changes leading to preterm labor. In your case, the good news is that your contractions have not increased in frequency or intensity. I am hopeful that you can carry on for at least a bit longer.
In terms of your baby, by 32 weeks the baby is almost fully developed, and is performing rhythmic breathing. But this is still practice breathing, and the lungs are not fully mature as yet. However, with steroid shots (I am sure your OB has already given them), the baby can survive outside of the womb. The baby has 95% survival chances if born now. And, with good intensive care, there are very few chances of any long term complications. Also, know that you can still interact with your baby, touch your baby, massage your baby and talk to your baby even if he is born now, and needs to be in intensive care nursery for some time. Do take this time to find out your hospital protocols regarding whether/for how long they allow parents to be with their babies in the nursery. Research has shown that premature infants who are touched and massaged for 15 minutes, 3 time daily, have less complications, and are discharged home up to 6 days earlier than those who do not get this kind of interaction.
Yes, you do want to hold on for as long as possible… this is to let baby add all the fat he needs at birth, and so all his organs can mature and function effectively, and so he can breastfeed without difficulty.. .. so, continue being on strict bed rest, and keep up your spirits. Next milestone to look forward to would be 32 and 34 weeks. After that each day you can hold on, would be a good bonus.
I can share with you that my older son was born by emergency c-section at 35 weeks and 6 days. He is 10 years old now, and doing just fine
Hope this helps ….. all the very best to you
Dr. Vijaya
October 24, 2008 at 4:46 pm
Dr. Vijaya,
I really appreciate your prompt response. Yes, I had two steroid shots three weeks ago, so doctors said there is nothing we need to do, but just wait/monitor at this moment. I guess nothing I can do now but do bedrest and cross fingers.
Thanks for your encouragement,
az
October 25, 2008 at 11:47 am
hi dr
I am 21wks pregnant with my 3rd child. My 1st was born at 31wks and with my second they were monitering my cervix and at 21 wks with a shorten cervix of 15mm they put a stitch in, I then went on 2 40wks and had to be induced. Now with my 3rd at 21wks my cervix was 25/28mm with slight funneling, they didn not want to put a stitch this time saying my cervix is not showing of one which is incompitent and they just want to continue monitering me. Should i insist on having a stitch before its to late, I dont no what i should do. Thanks Shivon
October 25, 2008 at 1:59 pm
Hi Shivon,
My question to you is: are you seeing the same provider/practice that you went to in your last two pregnancies? If so, I would be inclined to go with their judgment.
Usually, previous preterm deliveries and tendency to cervical shortening, would be a good indication to put you on preventative cerclage. However, this is more effective (and less risky) if done between the 13th-16th week. Because that time has come and gone, in your case, the better option right now would be to wait and watch, because the cervix is showing only borderline shortening. I am slightly concerned about the funneling, but hopefully is your cervix does not show any further signs of shortening this should not be too much of a concern.
If it is the same OB/practice that saw you in your previous deliveries, they would have a good idea about your overall condition and tendencies, and my suggestion would be to go along with just monitoring for now. If not, then you can monitor for a week or so more, and if further shortening occurs, then you can ask for a stitch to be placed – that way, you won’t be too late.
Hope this helps,
Dr. Vijaya
October 26, 2008 at 9:04 am
Dr Vijaya
Thank you for responding so quickly, i will take your advice on board and it has eased my mind for now, thank you once again and I will let you no what happens.
Shivon
October 27, 2008 at 7:22 pm
Hi there Doctor! Hopefully you can answer this question for me before Wednesday. I had my first ultrasound 2 Fridays ago. I was told I was 7 weeks at this time. It was discovered that my cervix is on 2.7 cm long. The PA wants me to have another ultrasound this Wednesday to double check and THEN if they still come up with that length they want me to go to a specialist because their equipment is better to triple check. I’m not sure if this is necessary as back in 01 I had a leep and .3 cms of my cervix was removed. I found this paperwork last week and gave it to my doctor’s office. Do you think it is necessary that these additional ultrasounds be performed? My insurance isn’t the greatest and I don’t have money to be throwing away when we already know that I am short.
Any input/advice you may have would be greatly appreciated! Thank you, Lisa
October 28, 2008 at 2:20 pm
hi dr
i am 22 weeks pregnant today and i went for my Anomaly scan today, everything with the baby is great but they looked at my crevix and it measures only 15mm, im very worried they said it should be a minimum of 25-30mm. because i was so worried i didnt ask any questions about it i just wanted to get out the hospital, im just wondering are my chances high at having a premature delivery this is my 4th pregnancy, i had 1 termination 2 years ago and i had a miscarage this january and another in april, im very worried about this baby
October 29, 2008 at 6:06 am
Hi Lisa,
Hope this information reaches you in time for your doctor’s visit. I am sorry it took me a couple of days to respond – it is festival season here in India, and I did not log on for a couple of days.
To answer your question, since you already know that your cervical length is on the shorter side, it makes sense to keep monitoring on a every two to three week basis. And if the length keeps decreasing, then you are probably better off in deciding a course of action at that point of time. Since you are only 7 weeks pregnant, and since your length is borderline short at this point, research shows that it is better to adopt a wait and watch rather than do anything right away. If in 2 weeks time, there is dramatic reduction, it would still be early enough in your pregnancy that one can opt for cerclage. On the other hand, if there is only marginal/no reduction, one can assume that you can safely be just on monitoring, and perhaps you can even carry through your pregnancy without any intervention, cerclage, rest or otherwise.
In terms of equipment, I am not sure what additional information it would give? I think it depends on the skill of the person doing it rather than the equipment. And, sometimes just having a full bladder before getting your ultrasound done, will give a better reading than any special kind of ultrasound. You could check with your PA’s office and ask them, what kind of specialized ultrasound are they looking for and why.
Hope this helps .. if you have any other questions or concerns, please feel free to write in.
Good Luck
Dr. Vijaya
October 29, 2008 at 6:21 am
Hi Laura,
It is hard to pinpoint and say what your chances of premature delivery are at this point. Since you are at 22 weeks, cerclage may not be an option. However strict bed rest and monitoring on a weekly basis would be highly recommended – and many moms are known to carry their pregnancies to term, or close to term, with this alone.
I am sorry to hear about your previous miscarriages. I would like to know if they happened in the first or second trimester each of the times? If they had happened in the second trimester or “late” first trimester each time, it would have been good with that kind of history, if your OB had advised you to go in for a preventative cerclage.
Having said that, try not to worry – I know this is easier said than done. But, try and focus on getting through each week. That way, you are looking at weekly milestones rather than focusing on all that can go wrong in the rest of your pregnancy. The first milestone that you want to get to is 28 weeks .. at this point (you will be given steroid shots) your baby’s lungs will be relatively mature.
Wish you all the very best …
Dr. Vijaya
November 11, 2008 at 6:37 am
Hello Dr. Vijaya.
Thank you for sharing your expertise on this sight. It is the most helpful forum I have found on Cerclage.
I am just over 14 weeks pregnant (12 weeks gestation), and I am scheduled to have a cerclage done at the end of this week. Though I do not have the exact measure, my doctor assures me that my cervix looks perfect. My history of miscarriage is why he leaned toward using a preventative cerclage on me.
This is my 6th pregnancy. The 5 previous pregnancies were all early miscarriages, save 1–my second pregnancy. This one resulted in a loss at 5 1/2 months. Unfortunately, I was with another doctor at that time, and I have no concrete diagnosis as to the cause of that miscarriage. It is assumed however that my cervix was compromised by the presence of several large fibroids that were in and around my uterus. I think they assume I had a painless dilation since there were no contractions or warning signs.
The fibroids were all successfully removed 2 years ago. I am also taking Lovenox coupled with a daily baby aspirin to prevent any blood clotting. (I was diagnosed with a potential blood clotting issue recently that might be the cause of the early miscarriages.)
From the recommendations you gave in the article published at the top of this page, I am assuming that you would not have felt a cerclage was needed in my case. Is this true?
And do you believe that bed rest is needed in my case? My doctor has said I do not need that after the first few days following the procedure.
Lastly, do you believe that airline travel is a risk for me based on my circumstance.
Thank you so much. Alexis
November 11, 2008 at 3:04 pm
Dear Dr. Vijaya,
What a wonderful website you’ve put together – with such thoughtful questions and responses. I found everything really helpful, but didn’t see an answer to a question that I had in my mind. My Dr. doesn’t seem to have an answer either…either that, or he believes I shouldn’t be thinking too much about this – which might right!
In any case, what I wanted to know is what is the normal rate at which the cervix begins to shorten? I am 21 weeks pregnant now. One month ago my cervix measured around 5 cm, but last week it measured closer to 4 cm. I don’t know enough about IC to know how it happens, or how quickly. I think I’ve lost nearly 1 cm – perhaps a bit less – in a month. Is that ok? Will I continue to lose at that rate, or could it accelerate? I have another appointment at 24 weeks, at which time he will measure the cervix again. Should I just relax until that next appointment? I would just hate for something to happen within a month that could be prevented with more careful monitoring.
Not normally neurotic, but somehow still have a lot of questions about this topic.
Thank you so kindly for your time and attention to my email.
Kind regards,
Karin
November 11, 2008 at 6:29 pm
Hi Alexis,
To the contrary, I think that what your doctor is suggesting is probably the best course of action in your case. Granted that we do not know the exact cause of your previous miscarriages – it could have been a combination of your uterine fibroids, clotting disorder, and or compromised cervix. Although evidence does not exist in favor of placing cerclage for previous first trimester miscarriages, it is definitely better to treat unexplained second trimester miscarriages by preventative cerclage.
Following placement of cerclage, it is recommended that you be on bed rest or modified bed rest for around 10-20 days. The time that you are asked to be on bed rest will depend on the particular obstetrician. After this initial phase, you can go on with your regular activities. Most doctors will still ask you to avoid much lifting, or anything that causes an increase in intra-abdominal pressure.
As far as airline travel goes, you would need to follow the same precautions as any pregnant mom, and not fly after the seventh month. Other than that, nothing related to your specific circumstance/cerclage should impact greatly on your air travel, especially once you are through with the initial phase of bed rest.
Overall, I think that your plan of care is correct based on my understanding of your circumstances so far. Once initial phase after the cerclage is past, you can enjoy the rest of your pregnancy, and wait for the stitches to come off at week 37. Hope this helps ….
Wishing you all the very best,
Dr. Vijaya
November 12, 2008 at 3:26 am
Dr. Vijaya,
Thank you so much for your thorough and prompt response. I will go into surgery confident that this is the best course of action for me, with your valued second opinion. And I’m moving ahead into this next phase of my pregnancy filled with the hope that this will be our first child.
All the best to you!
Alexis
November 12, 2008 at 3:31 am
Dear Dr.Vijaya,
Thank you very much for sharing your experiences. Reading your responses have given me some insight. Iam 20 weeks and 3 days pregnant today. This is my second pregnancy, my first ended with a miscarriage at 6 weeks(cause:blighted ovum). Today, The doctor told me my cervix is 2.6cm,which is on the low range and that my cervix is closed. Is this something to worry about, that my cervix is in the low range? Am i at risk for premature labor. He only told me to come in for a followup ultrasound in 4 weeks. I will appreciate any advice you may have on this. Thank you so much
November 12, 2008 at 2:48 pm
Hello Karin,
There are not a lot of studies out there which tell us the normal rate of cervical shortening. The cervix starts to change and shorten in the second trimester and carries on all the way to delivery.
There was one study done in 21 healthy first time expectant moms, who gave birth at term. The women were examined every 2 weeks by transvaginal ultrasound from 24 weeks till delivery. They found that the average length of cervix in these women at 24 weeks of pregnancy was around 41mm (4.1cm) and it decreased to an average of 2.9 cm before delivery. However, there was variance in the rate at which this shortening occurred. While the shortening was steady and continuous, at an average rate of 1.1mm per week (range 0.6-2.4 mm) in 12 women, in 4 others the shortening occurred only at end of term, with rapid shortening of 3 mm per week. 5 women did not have any shortening until labor and delivery. (Source – Acta Obstet Gynecol Scand 2002)
As you can see, even in normal there seems to be a wide range. However, the study was small, and we do not know how applicable it would be to the population at large. Having said that, with your cervical length being around the 4 cm mark, you should not be worrying too much. I would suggest that you wait until your next scheduled check up. If the length remains the same, or it shortens slightly, you will not need to be continually monitored. If the length shows more rapid decline and if it touches around 2.4-2.6 cm, then you will need careful monitoring every 2-3 weeks or so.
For now, relax and enjoy your pregnancy ..
Please feel free to write in if you have any further queries.
Dr. Vijaya
November 12, 2008 at 2:59 pm
Hello Lubi,
At 20 weeks, 2.6 cm length of cervix is at the lower range of normal. Nothing to worry about yet, though. It might be worthwhile getting monitored by your doctor, every 2-3 weeks, rather than wait for 4 weeks. That way, in case there is a more marked decrease, you can be started on limited physical activity earlier, than if the change were picked up later. You can suggest to your doctor, that perhaps you could re-schedule your follow up at the 3 week mark, rather than 4 weeks from your last appointment.
It is too early to worry about premature labor. A lot will depend on what, if any, changes are there in the length of your cervix in the coming weeks and months. Depending on this, you follow precautions, that seem to be helpful in decreasing chances of premature labor.
Hope this helps … Good luck
Dr. Vijaya
November 12, 2008 at 7:50 pm
Dear Dr.Vijaya,
Thank you very much for your quick reply. I will definetly bring this up with my doctor on my next visit. I am really relieved by your words.
Thanks again:)
November 12, 2008 at 8:14 pm
Dear Dr. Vijaza,
Thank you so kindly for your prompt and thoughtful response. The research and information you provided was immensely helpful, and I feel I can relax a bit and just wait until my next appointment to revisit the issue.
Thank you again.
Kind regards,
Karin
November 18, 2008 at 10:22 pm
hello my name is sarah. I have been put on bed rest because of my cervix being meassured at 2.3 cm at 25 weeks. I am very nervous. This is my first pregnancy. Do you think i will go into pre term labor? What are my chances of carrying full term. What are other options besides bed rest. I dont know what to do. Please some advice.
November 19, 2008 at 12:19 pm
Hi Dr. Vijaza,
I am thrilled to have found your board but not so thrilled that I am in this cervical dillema. I am 30yrs old with first pregnancy at 16 weeks and am high risk because of thrombophilia (taking blood thinner) and crohns disease (in remission thank God – no meds). I had no issue conceiving but yesterday at my appointment doc told me and my husband that my cervix went from 38 mm to 30 mm in a 2 week period. Visibly concerned, he put me on modified bed rest and will examine me next week. Hopefully I won’t need a stich.
I am afraid. I am so early on and in fear of preterm labor. Could the shortening stop or progresss extremely fast in one weeks time? He mentioned that it could go back to normal (i.e. may have been caused by dehydration, inflammation, or stress), is this possible? Also, are there signs of cervical shortening, like pain or discomfort, if so I have had no strong feelings of either.
Thank you,
Catina
November 19, 2008 at 4:51 pm
Dear Catina,
The shortening that you have had over a two week period is rapid. However, no two moms are the same, and your cervical condition may show stability at your next check up. You can go through my response to Karin (Nov 12) for a study that I have quoted there, which shows average shortening of the cervix after 24 weeks.
In your case, it is very early. That it has been discovered may be a blessing in disguise. If your cervical length continues to shorten rapidly, then cerclage may be a better option, than to wait until it shortens to such a length where you may need to be on complete bed rest. If it stabilizes, then you can quit worrying, and go abut your pregnancy without further restrictions.
Dehydration, inflammation, stress etc are not known factors to cause cervical shortening.
No, there are no physical symptoms of shortening. It is only something that is discovered by physical/ultrasound exam.
Hope this helps ..
Dr. Vijaya
November 19, 2008 at 5:01 pm
Dear Sarah,
2.3 cms at 25 weeks is on the borderline for cervical measurements at 25 weeks. Modified bed rest (no physical exertion, no stair climbing, no lifting, no straining at stools) is probably the best option to manage the condition.
Check up with your OB/GYN every other week is very important to monitor your condition as well.
Finally, there is no way to tell if you will go into preterm labor. However, if you take the advice of bed rest very seriously, you should be able to carry on with your pregnancy – take each week as it goes. Take heart though – most moms who carry forward to 32 weeks, are able to take their pregnancy to term. And in your case, the shortening is only at the lower end of normal. Many moms have carried through most of their pregnancy with 2 cm or less, with good support, and strict bed rest.
Take care – Good luck
Dr. Vijaya
December 7, 2008 at 6:54 pm
Dear Dr. Vijaya,
Your explanations are quite informative.
I am at the age of 35 and in my 27th week of twin (also first) pregnancy. At 25th my CL was 42 mm and two weeks later (by the start of my 27 week) it has been measured as 30 mm. 5 mm per week shortening. My next visit to OB is after 3 weeks. My question is do you think 5 mm per week is an ongoing thing (I read that 0.8 to 2.9 mm per week is normal) if so at my next visit I will have around 20 mm by week 30 and will be in the risky position (?!). No special care has been asked from me – I go on normal living and working. If I will be in risky case I want to start taking precautions from now (like reduced physical activity or resting). Thanks in advance for your concern, Best regards Sammy
December 9, 2008 at 12:56 pm
Dear Sammy,
The shortening within a two week time period in your case, has been remarkable. However, if at your next check up, it stabilizes, you don’t have to do anything further. In case it continues to shorten at the rate it has done so far, you would need to be on bed-rest.
I do not think you need to do anything particular right now, as we need to figure out how your cervix behaves with normal physical activity. If it shortens further, a trial with decreased activity can be tried at that point.
Hope all goes well for you ..
Dr. Vijaya
December 9, 2008 at 2:08 pm
Dear Dr. Vijaya,
Thank you very much for your prompt reply.
Best regards, Sammy
December 19, 2008 at 3:20 am
Dear Dr. Vijaya
My wife is 21 weeks pregnant and her 5 month ultra sound revealed her cervix was 1.4 – 1.5 cm. After the ultrasound her OB has put her on bedrest. I was wondering if there is something that can be done to prevent the cervix from shortening.
Her Ob had put her on progestrone since 3rd month. Also she went into preterm labor in her first pregnancy at 32 weeks. Please advice.
December 19, 2008 at 1:00 pm
Dear Dr. Vijaya,
I thought I would post an update for you and anyone who has read the past posts. I hope that it will encourage others!
My cervix stayed stable at 3.0 cms after shortening and funneling to 2.6 cms. I am now 34 weeks, and the doctor is no longer concerned!
December 20, 2008 at 12:40 pm
Nick,
Bed rest would be the only way to manage your wife’s cervical shortening at this point.
I am just wondering if you are seeing the same obstetrician for your second pregnancy as your first? The reason I ask is because of the preterm labor the first time around. In cases of unexpected second or third trimester preterm labors/losses, it would have been an option to look into early cerclage (13-16th week), after which, your wife could have gone along her pregnancy with being monitored intermittently. Since she has been put on progesterone, am I correct in thinking that it was because of your wife’s previous history of preterm labor?
In any case, now, it would work greatly to your wife’s advantage, if she could be on as complete a bed rest as she can. She can and should do gentle arm, leg and foot movements, 1-2 times a day, just to make her feel better, and as well as to maintain good blood circulation.
Hope all goes well for you and your wife …
Dr. Vijaya
December 20, 2008 at 12:46 pm
Stacie,
I am so glad for you!
Thank you for coming back here, and writing an update .. It will be greatly reassuring to moms (and dads) who are in similar circumstances as yours.
And, I find it wonderful when moms come back and give updates, because I often wonder how some of you are doing! Do let us all know after the D-Day
Wish you all the very best .. hope you have a wonderful holiday season!
Dr. Vijaya
December 21, 2008 at 8:20 pm
Dear Dr. Vijaya
Thanks a lot for your earlier response. To answer your question, we are seeing a different OB/GYN + a High Risk Pregnancy specialist this time. And yes, the progestrone is to prevent her from going into pre-term labor. Do you think progestrone will really reduce the chances of pre-term labor.
Her OB/GYN thinks that by stiching the cervix at this stage it would increase the chances of pre-term labor. Her OB/GYN had studied her 1st pregnancy file and I remember her saying “First time u delivered pre-term because u went into labor & not because of weak cervix+ that you had a good outcome first time”. Also my wife was told that at the first sign of contractions/labor she will be give some kind of tycoloctins (not sure of this word) to prevent the contractions from kicking in.
Thanks a lot for everything.
Nick
December 22, 2008 at 5:47 pm
Hello Nick,
Progesterone does have some effect in sustaining pregnancy – as to how much it can prevent preterm labor, the research is not quite clear. However, under the circumstance, progesterone would be the only option in your wife’s case.
I do agree that at 21 weeks, cerclage (stitch) would not be recommended, because with the growing uterus, the chances of uterine irritation and premature labor are greater. However, with the previous unexplained preterm labor, I was just wondering if cerclage would have been a viable option if thought of early enough – around the 13th week itself.
In any case, since you and your wife have long crossed that point, I think that you and your obstetrician are doing pretty much all you can. Please tell your wife to monitor herself regularly – both for fetal movements, and for signs of premature labor. Anytime, she experiences more than 4 tightenings/contractions within one hour, it would be a good idea to get checked by your OB immediately. She will then most likely be put on tocolytics – which are uterine muscle relaxants. They can decrease chances of premature labor.
Hope this helps .. please write in, if you have any other queries/concerns
Good luck-
Dr. Vijaya
December 24, 2008 at 4:49 am
Hi Dr.Vijaya,
I am in 19 week pregnant and this is my second pregnancy. My first pregnancy was induced at 42 weeks my daughter was born after long prolonged labor. I realised that my body metabolizes faster than averge after my daughter had to be rushed to ER since she was non responsive when I was on painkiller Percocet.
This pregnancy, I had polypectomy at around 8 weeks and I had mysterious bleeding (with mucous) around 12 week. The ultrasound performed immediately could not trace the cause and the fetus as doing good. My obgyn did not worry about it after reading the results of ultrasound.
Now, in 19th week ultrasound, they found that my cervix has shortened and measured 24 mm. I am put on bedrest and on ibuprofen 600 mg X 4 times a day. I am scheduled for follow up ultrasound next week. At this point of time, I am not able to differentiate between contractions and baby movement, but i can feel that there is lot of movements going in there
What are the chances that I can make this time to full term? Also, keeping in view the effect of painkiller on my new born last time, I am very much worried about taking ibuprofen now. I also see articles on the internet about harmful effects of ibuprofen on the baby. I am worried sick now.
December 24, 2008 at 4:54 am
Hi Dr. Vijaya,
In continuation of my previous post above, I forgot to add that in both of my pregnancies, I was on Prometrium in first trimester as I have a history of hormonal imbalance. Thank you for looking into my issue.
December 24, 2008 at 6:52 pm
Dear Sangeetha,
I have a few of questions for you, before I am able to answer your queries completely:
1. In your first pregnancy, was Percocet given during labor? And how long was your labor? What medications were used for induction?
2. In your current pregnancy, where exactly was the polyp that was removed? If it was near the cervix, then that might have have been a predisposing factor as far as your cervical shortening is concerned.
Now, good news is that you are feeling a lot of movements – and that is great!
However, I am not convinced about the Ibuprofen protocol. There is no research which shows Ibuprofen as an effective line of treatment for cervical shortening. In fact, there are zero medications shown to be effective to either prevent or decrease the rate of further shortening. One of my colleagues who occasionally uses Ibuprofen (not for cervical shortening, though) is very wary of using it without proper monitoring. In fact, she usually monitors the patient daily, and slowly increases the dosage. I will get a second opinion form her regarding your specific circumstances tomorrow, and send in another response to you. In the meantime, please follow your maternal instincts (which I believe are very, very strong – and probably the best way to keep in tune with your body) and if the fetal movements are very rapid, or if you feel uncomfortable or feel “not quite right” – for lack of a better clinical term, you should probably get yourself checked out by your OB.
Treatment for your hormonal imbalance in the first trimester was probably needed, and should not have any effect as far as your current cervical shortening is concerned.
In your case, with a 24 mm cervix length, all research indicates that you can be on reduced physical activity and can get repeat measurements done every 2 weeks; complete bed rest at this stage is not really needed.
Hope this helps to some extent.. I’ll post another response after speaking with my colleague tomorrow.
Good luck – Take care.
Dr. Vijaya
December 24, 2008 at 7:53 pm
Hi Dr. Vijaya,
Thanks for your quick response. The are the details to help you in helping me:
1. I was given pitocin for inducing labor. I had epidural when I had dialated almost 7 cms and it was stopped during pushing phase. The total labor was for 13 hours out of which I was in pushing phase for about 4.5 hours. I was given percocet immediately after my first delivery as I had around 14 stiches due to episiotomy. I was also put on antibiotics (my newborn too was put on antibiotics on safer side) due to chorioamnionitis which might be possibly caused by frequent internal monitoring and/or due to meconium staining of amniotic fluid. The doctors in NICU as well as my Obgyn refuse to relate my daughter’s non responsive condition to percocet saying its a very safe medication. But, owing to nursing problems, I had consulted a lactation consultant who said she had noticed percocet causing similar issues before. Only a few months back a medical warning was issued relating Percocet with faster metabolism and harmful effects on breast fed babies.
Also, within weeks of my first delivery I also developed polyps along the episiotomy area which were removed externally and almost a year later due to pain, hysteroscopy was performed to remove some more polyps near cervix. I was told by then obgyn that I have real sensitive organs when I requested for an IUD to be placed and doc declined saying that she feels I am not right candidate for placing any external foreign bodies inside me.
2. This pregnancy, I had spottings regularly in the earliest stages and my obgyn (different one as we moved to diff state) found polyps near cervix and removed them. These polyps seemed to have formed due to hormonal changes during onset of pregnancy as I had an ultrasound peformed a few months before pregnancy to check whether there are any new polyp growth or not (I wanted to be sure about them before I was going to try to get pregnant!) After a month or so, I was nauseated while cooking and as I was vomiting, I had vaginal bleeding (with something like thick mucous plug) . An ultrasound (pelvic and not transvaginal) and phlysical exam was perfomed which showed no issue with cervix and with fetus. So, it was assumed that the bleeding was mysterious and I should not worry about it as baby was doing fine.
I am worried about Ibuprofen especially after knowing how I nearly lost my first baby due to Percocet. I know those are totally different drugs, but still I don’t know how my body treats them and pass it on to the baby. My obgyn says this is the usual protocol and asks me to give it a try atleast for a week. The other issue bothering me is the Cerclage as I do believe that my system is not going to handle that well. But, do I have any other option as my only priority is saving this child and keeping it healthy?
Thanks in advance for your patience and help.
December 26, 2008 at 6:57 pm
Dear Sangeetha,
Sorry for my slightly delayed response. After going through your history with your daughter’s birth and the current pregnancy details, it does appear that your cervical/vaginal areas are sensitive. It also does appear that your predisposition to cervical shortening could have been caused by the removal of polyps from near the cervix, similar to how a cone biopsy could predispose one to cervical insufficiency. The bleeding earlier on in the pregnancy does happen sometimes – and “mysterious” is the right word – because often there is no cause that you can pinpoint. Sometimes, when you are on hormones, that can become the cause of bleeding, which then quickly resolves itself as the hormonal levels stabilise.
I checked with my colleague, as well as did some extensive searches for any conclusive research on use of ibuprofen in treatment of cervical shortening. No research indicates any particular benefit of this line of treatment. The Cochrane Database, which is one of the most respected bodies of knowledge for evidence-based practice in medicine, does not give much support to this line of treatment as well. So, you might want to ask your OB the reason she is adopting this treatment with you, and could she provide you with some research which validates it?
As regards your faster metabolism, I am sure that this will need to be taken into account every time you are prescribed anything during pregnancy and in the immediate post-natal period. By the way, I was not aware of the advisory regarding the use of Percocet and breast fed babies. Thank you for this information; it will be helpful to my expectant mothers and new moms to know about this.
Especially in your case, it seems prudent to me, not to use any medication unless there is evidence-based proof regarding its effectiveness. Why put you on it, if it is just a trial? You might just as well respond to reduced physical activity. And, when you are put on medication AND bed-rest, if your cervical condition stabilizes how will we know which caused the positive effect – the medicine or the rest? As with any pregnant mom, my sense would be to go with least intervention first.
Finally, as regards cerclage it probably is not the right line of treatment for you. One, as you point out – your system nay not handle it well. But, more importantly, since you are already at week 19, there is an increased risk of uterine irritation and premature labor.
I still think the best line of treatment to follow would be for you to be on reduced physical activity, and to be monitored every 2 weeks. Hopefully, your cervix will stabilize, and you will be able to carry on with the rest of your pregnancy. I am sure you have gone through the posts on this blog, and I realize that each expectant mom is different, but you will find that in a lot many cases, the wait and watch approach seems to work the best.
Hope I have been able to help you somewhat – all the best to you. Do write in if you have any further queries/concerns.
Dr. Vijaya
December 27, 2008 at 3:51 pm
Hi Dr. Vijaya,
I appreciate your detailed reply. My husband was worried that I am over reacting to the treatment plan by my obgyn and your reply validates my concern. I will talk to my obgyn to modify her treatment plan. I am also glad to know that new moms /new borns in your care who face issues with percocet will be alerted.
You have been very helpful. Thanks,
Sangeetha
January 5, 2009 at 4:21 am
Hello Dr vijaya,
In my first pregnancy my cervical length was 2.8 in the 18th week & i was advised moderate bed rest. now in my 2nd pregnancy my cervical length is 2.7 in the 21st week & the doc has advised strict rest ( i am in singapore now) & has also asked me to travel soon if i want to go for delivery in India. Could u pls tell me that is travelling fine in this stage & condition & is 2.7 at this stage ok or something to be really concerned about.
Thanks.
January 6, 2009 at 6:07 am
Hi Dr.Vijaya,
Happy new year to you. I was reading thru the topic and thought to put my concerns over here and if you can guide me.
I am 22wks pregnant. My cervical length is 3.2 cm and doctor told me that my external OS is opened. So my doctor advised me to go for circlage (OS tightnening) to have a safe and risk free delivery. is this okay? This is my first pregnancy though. Is there any issue after circlage? Please advise. Thanks very much in advance for your help and advise.
Smita
January 6, 2009 at 2:19 pm
Sorry typo mistake..17 weeks pregnant. Please let me know what you suggest. Thanks – Smita
January 8, 2009 at 5:22 am
Dear Dr. Vijaya,
I am currently 22 weeks and 3 days along in my 5th pregnancy. Prior to this pregnancy, I have had 2 early term (5 week) miscarriages, but have also delivered 2 healthy children! Given that my first child was born at 35 weeks, and that I have had a cone biopsy, I was monitored by a prenatal specialist quite carefully with my second child. With this child, I was put on strict bed rest at 23 weeks due to cervical shortening, but was able to carry the pregnancy until nearly 33 weeks.
With this pregnancy, I have been on strict bed rest since 16 weeks. I am also given weekly progesterone shots. In the past 3 weeks, my cervix has shortened from 29mm to 20mm. At this point, I am going in for weekly ultrasounds. My doctor has told me that we just need to wait and see what happens week to week. I am wondering, however, if you could help me understand if I am doing everything I can? I currently shower daily, get up to go to the bath room, and walk between my bedroom and our family two times a day. Throughout the day, I have also been sitting (at a 45 degreen angle) in a reclining chair (working with a laptop, etc.). But I am worried now, that this position might not be the very best. Would you please let me know your opinion on the reclining (Lazy Boy style chair) and also if I should limit my activity further? I am worried sick and would be glad to stay in bed entirely if this is better for the baby.
Thanks so much for all of your posts. They are such a big help to people in this nerve racking position!
Melissa
January 10, 2009 at 3:25 am
Hi Dr. Vijaya:
I am 21 weeks now. I have had some contractions since 17 weeks. My ob asked me to scan my cervical length today and the scan result is that mine is 3.2 cm. Do you think I need to take some more rest since it is really near the borderline? And how often should my ob monitor my cervical length?
Thank you and have a great weekend,
Linchun
January 11, 2009 at 7:42 pm
Hi Dr. Vijaya,
I am 23 preganant with my second child. First baby was delivered only 3 days early with a very good pregnancy. With this pregnancy at 12 weeks I was seen to have a cervix measuring 2.7cm, my doctor gave me a cerclage the next day. I am now 20 w 5 days and so far have had a good pregnancy, still quite active taking care of my 2 year old and doing things around the house. I am on 1 ml of Salbutamol twice daily. I need take a 7 hour flight at 27 weeks and am very worried about the flight. Is there need for concern? My doctor tends toward being fine with everything and that worries me more! Are there risks I should know about? Thank you so much.
Rachel
January 12, 2009 at 4:27 am
Dear Dr. Vijaya,
My cervix was 11mm on my 23 week ultrosound and 12mm the next week. I am given a weekly shot now. I didn’t have any earlier measurments of my cervix so it’s hard to compare how much shorter it is now than before.
I am 34 years old and had 5 early abortions (within 50days) before. This is my first time to carry the baby to the 2 trimister. I had a Batholin’s cyst drained twice 07′-08′.
I know my cervix is rediculously short. But the doctor didn’t put me on bed-rest. He didn’t even mention the bed-rest and I didn’t know I need to until I did some research on the internet. I was still doing excercises for days like running (slowly) and riding on stationary bikes, even after the ultrosound. Now I am all nervous coz’ all the activities are with no doubt on the NO NO list. I put myself on bed-rest now anyway and I am certain it’s a must given my situation.
Do you think my short cervix has anything to do with my previous abortions and the cyst cut?
Today is my first day into the 25th week. I know I have a long way to go and am very worried how long my baby can stay inside me.
I am not sure the name of the injection I am given as I didn’t know it was so serious when my OB called me on the phone. I remember he said it’s for preventing preterm birth so I assum it’s some steriods. I am seeing him in 10 days and there is no further ultrosound monitoring in the future as fas as I know. Do you think I need more intense monitoring?
I am all by myself now coz’ my husband is overseas and my family is not coming until end of January. I am so scared I may come in labor before any of my family could be here!
I am calling my OB tomorrow as I have so many questions now after all my internet research. Do you have any suggestions about what I should ask to my OB?
And what else I could do besides taking the shots and bed-rest?
Thank you so much for being so helpful!
Sabrina
January 15, 2009 at 3:55 am
Dr Vijaya
To continue our discussion my wife’s doctor now feels that she should take a drug called nifidefine to quieten her uterus. She is 25 weeks pregnant and has no signs of contractions/pain etc. They recently conducted a FFN test and came back negative. We are wondering if we should accept her doctors suggestion to start taking nifidefine when she has no symptoms of any kind.
Please let us know your thoughts around the use of this drug if you feel its necessary at this stage. Is this drug safe in general. Appreciate all your help and guidance.
Regards
Nick
January 15, 2009 at 11:01 pm
Dear Dr. Vijaya,
I am so glad that I came across this website! I would really appreciate your feedback about my situation.
I am currently 23 wks pregnant with twins. At 20.5 weeks I began to feel a lot of pressure and cramping, and went in to labor and delivery. It was determined that my contractions, while at times very strong, were irregular, and so the peri is calling it irritable uterus. I also had a trans-vaginal ultrasound, and unfortunately my cervix was measuring 2.5cm. Since that time, I have been on strict bed rest at home. I have had two more ultrasounds: after one week of bed rest, my cervix was measuring 3.0 cm! But we had another ultrasound a week later, and it had dropped again, to 2.6 cm. Thankfully, there is no funneling at this time. I am still having a lot of irregular contractions, but no more than 4/hour. My perinatologist is calling this “dynamic, incompetent cervix.” He seems very confident that I will make it to at least 28 weeks.
I am trying to stay hopeful, but this is my 4th pregnancy after 3 first trimester miscarriages. This is also an IVF pregnancy. None of my miscarriages were related to cervical incompetence. However, I did have to have D&C’s for my 2nd and 3rd miscarriage. My question is, do you think that the D&C’s might have damaged my cervix in some way?
Additionally, one of the twins has her head pressing right on my cervix. Could this be contributing to extra pressure?
My peri says that there is no evidence that it helps to do a cerclage this late in the pregnancy with twins, and that there would be danger of rupturing the membranes, especially since baby A’s head is right up against the cervix.
Is a cervix that is dynamic, with the length varying back and forth, any different than one which steadily decreases? I am going to a high risk practice, and feel that I am getting good treatment. However, I would greatly appreciate your professional opinion on my situation and its causes.
Thank you so much,
Paula
January 18, 2009 at 12:53 pm
First of all, I want to wish all of you a very HAPPY 2009!
I am sorry that I have not responded to your queries for the last 15 days or so; we were away on vacation
I will be replying to each of you individually in my next posts.
Take care,
Dr. Vijaya
January 18, 2009 at 12:59 pm
Dear Rajni,
Since you were able to carry through with your first pregnancy with similar cervical length, I don’t think there will be much issues going through this one either. Having said that, it is still prudent to get yourself monitored every 3 weeks or so. And, strict bed rest is probably better if you are planning to undertake travel in the near future. I would agree that the sooner you travel the better. Not so much because, travel in itself causes any increases in cervical shortening, but because the later you wait, it will become more risky for preterm labor with a shortened cervix.
Once you get to India, after your initial check up, if your cervical length remains around the same 2.7-2.8 range, you can indeed be back on moderate activity levels, and just avoid anything that puts strain on your abdominals.
Hope this helps,
Dr. Vijaya
January 18, 2009 at 1:26 pm
Dear Smita,
Your cervix length actually is not too much of a concern in itself. However, with opening of the external OS this early in your pregnancy, it may be better to get a cerclage done.
Although it does carry a small risk of uterine irritation, being able carry on without any physical restrictions for the rest of your pregnancy might outweigh the risks.
And, when you get to 37 weeks, the cerclage will be opened, and you can then wait for labor to start!
Hope this helps,
Dr. Vijaya
January 18, 2009 at 6:43 pm
Dear Melissa,
You are doing everything you can! And no, you don not need to completely restrict yourself to the bed – your activity level seems okay for now.
However, I am not a big fan of the LazyBoy type recliners in pregnancy. First, in case your recliner does not have a manual or an mechanical option to bring it upright, I would recommend that you stop using it altogether. This is because, if you have to get yourself upright from an reclined position, you will land up increasing your intra-abdominal pressure, which is not recommended in cervical shortening. If your recliner can be brought upright, then I would recommend using it no more than 1-2 times a day for short periods of time. The reclining position is the exact opposite of the position that promotes natural childbirth.
I would instead recommend that you try a propped up position on your bed or sofa (provided it is not too low). Another option would be to try the “Butterfly” position which happens to be a great position that promotes natural childbirth – You can have a pillow for back support, a pillow under each knee and then you can use your laptop by placing it on something like a breakfast tray. Let me know if you need more help with this or trying out any other positions within your home.
I do have a question though – with your past history of cervical shortening and preterm deliveries, did your OB discuss with you the possibility of early (13th-16th week) preventative cerclage? This might just be an academic discussion at this point in your case, but you may be able to point out something that might be of help to other moms who are in similar circumstances as you.
Keep your spirits up – Good luck
Dr. Vijaya
January 18, 2009 at 6:48 pm
Dear Linchun,
At this point, you need not be on any specific precautions. And, your OB checkups can be at the regular monthly intervals. In case, there is more shortening at your next check up, then you can think about reducing physical activities. All research indicates that anything less tan 2.6 cm needs monitoring once every 3 weeks.
Do let me know if you have any other questions/concerns – take care
Dr. Vijaya
January 18, 2009 at 6:51 pm
Dear Rachel,
Looks like you are doing good
You need not worry about the flight. No particular precautions need to be taken at this stage in your pregnancy specific to flying, since you have already had a cerclage placed.
Enjoy your trip!
Dr. Vijaya
January 18, 2009 at 7:09 pm
Dear Sabrina,
I am not sure why your OB did not advise at least a trial of bed rest. Granted, that with your cervix length being so short, so early in your pregnancy, there are chances that even complete bed rest may be only of limited use. However, research shows that there may be some prolongation of pregnancy with bed rest, thus allowing you to carry your baby closer towards your due date.
Did you need to have a D&C done for your previous miscarriages? Although the early miscarriages in itself do not predispose you to having a short cervix, multiple D&Cs, as well as the cyst drainage could be predisposing factors.
Finally, you should be monitored every week by your OB – I am really not sure why this is not being done. You can probably bring this up to him when you see him for your next visit.
I would recommend that you continue with your bed rest. You can get up for bathroom and shower activities, some walking around your house is okay too. Do not have prolonged periods of sitting/ standing. Do not lift anything heavy and also avoid constipation/straining at stools.
Hope this helps -
Dr. Vijaya
January 18, 2009 at 7:21 pm
Hello Nick,
Nifedipine is primarily used to decrease chances of preterm labor, and primarily in expectant moms with hypertension. Though it is generally a safe drug, it does increase maternal Heart rate, and can cause decrease in blood pressure. This can become more in case of moms who have normal blood pressure, and can lead to dizziness and sweaty palms. It is also known that Nifedipine causes the baby’s heart to beat faster as well.
With your wife not showing any signs of contractions at this stage, it would make sense to wait and monitor on a weekly basis rather than start off with Nifedipine right away. Also, there is no research pointing to the efficacy of use of Nifedipine with regards to cervical shortening. Having said that, in case preterm contractions occur, then it would be worth while to start her on any of the tocolytics to prevent going into preterm labor.
Hope this helps -
Dr. Vijaya
January 18, 2009 at 7:26 pm
Nick,
Also, that the FFN test is negative is a good indicator that your wife is not going into preterm labor. Another reason to not rush with the Nifedipine line of treatment.
Cheers,
Dr. Vijaya
January 18, 2009 at 7:46 pm
Dear Paula,
Your length of cervix varying between 2.5-3.0 cm, is actually borderline. Were you not carrying twins, and not experiencing the contractions, I would have recommended that you be on regular activity levels, and just be monitored by your OB. However, since you are experiencing uterine irritability, as well as one of the twins’ head being directly on your cervix, bed rest would definitely be the way to go.
As regards your previous D&C’s, it may have predisposed you to this – but we cannot be sure.
Your OB is right, doing a cerclage this late in your pregnancy has more risks than benefits.
Finally, your cervix can sometimes show those variable lengths. Since the measurements are highly dependent on the skill level of the person who does it, whether your bladder is empty of full, and how your baby is positioned sometimes the readings can get slightly different. I would definitely recommend that you go for your ultrasounds with as full a bladder as possible, because, this tends to push the cervix into a greater position of visibility, and can thus get you more accurate measurements.
As long as your cervix is fluctuating within this borderline range, you do not have to do anything more than following your bed rest precautions.
Once you reach your 28th week, then you can take each week as it goes. Who knows, you may carry the babies to term! Positive thinking, fingers crossed
Wishing you all the very best
Dr. Vijaya
January 31, 2009 at 10:25 pm
Hello Dr. Vijaya,
Thank you for your information regarding the use of the reclining chair. I have taken your advice, and cut the use of this chair almost completely out. Despite my very strict bed rest, since I last wrote, my cervix (week by week) crept down to 1.75. Just yesterday at my weekly ultrasound appointment, however, I measured 2.2. This was really encouraging news!
Throughout the pregnancy, I have asked my physician about doing a cerclage. Although it sounds as if this is a fairly common procedure with their clinic, in my case, they consistently wanted to “wait” another week before determining if I needed the surgery. Soon, I found myself at the outer end of the option. At 23 weeks, (when my cervix reached 2.0), they seemed to leave the matter in my hands, saying that they could do the surgery that day, if I wanted. Given the risks involved with surgery, and the possibility of further irritating my cervix, my husband and I opted to not go forward with the cerclage.
I’m not sure if this was the right choice, but at this point, I can only hope that it was!
Thanks again for your thoughtful advice… It has been a great deal of help to both me and my family!
Take care Dr. Vijaya,
Melissa
January 31, 2009 at 11:29 pm
Hello Dr. Vijaya,
Thank you so much for your reply! I just wanted to update you on my situation. I am now at 25 weeks, and at my TVU yesterday, my cervix was down to 2.0 cm. Thankfully, there is still no funneling. I am continuing with the strict bed rest, and hoping that I will make it to 28 weeks.
A quick question: I had an FFN test this week, and it came back negative. The doctor said I should find this reassuring. However, it is my understanding that cervical insufficiency does not necessarily go hand in hand with pre-term labor. In other words, couldn’t my cervix shorten, soften and dilate without my having symptoms of pre-term labor? I would appreciate your thoughts on this!
Thank you and take care,
Paula
25 wks along with boy/girl twins
February 1, 2009 at 2:31 am
Dear Dr. Vijaya,
My wife is currently at 25w6d of her pregnancy with twins. It is her first pregnancy.
At 23w1d she had a routine check with her perinatologist and it was discovered that her cervix was over 4cm, but funneling down to 1.5cm. So, the perinatologist suggested cerclage or observation for a few days in the hospital. I was out of town, so my wife chose to stay at the hospital for observation until she could find out more about the cerclage, where she was hooked up to a toco-meter to check for contractions. She didn’t seem to be having regular contractions (only occasionally ~4 per day), but the activity on the monitor indicated what the doctors called an “irritable cervix”. The perinotologist put her on a 72 hours course of indocin (2 pills per day, not sure about the dose). She immediately got clogged sinuses and would see blood whenever she blew her nose. This cleared up as soon as she stopped indocin.
After talking to 6 different doctors about the cerclage where only 1 thought it was needed, she declined the cerclage at 23w4d.
After a week in the hospital her cervix was again checked via ultrasound, and this time it was 4.5cm, but funneling down to 0.8cm. The perinatologist decided to keep her in the hospital until delivery on strict bed-rest. Again the perinatologist suggested indocin, but she declined given the previous side-effects.
Four days later with increasing mini contractions the perinatologist suggested a shot of terbutaline. That immediately calmed down the contractions (but made her very jittery and her heart race) and produced a nearly flat curve for 24 hours before a few small contractions happened again the following evening.
Taking liquid calcium magnesium, cramp bark, magnesia phosphorica pellets, and doing relaxation meditation, she seemed to be able to calm her contractions over the following 2 days (just a few each evening). Still we are concerned they might start again and would appreciate any advice you have.
In particular we are very concerned about the terbutaline and especially having her on the terbutaline pump for a longer period due to the potential side-effects on the babies such as autism and more.
We have heard about some alternatives to terbutaline which might have fewer side-effects:
– nifedipine: calcium channel blocker (her blood pressure seems to low for this ~90/50)
– atosiban: anti oxytocin receptor (not available in the US),
– magnesia phosphorica injections.
We asked the perinatologist about these or other alternatives. The perinatologist did know about nifedipine, but suggested terbutaline for now due to my wife’s low blood pressure. The perinatologist didn’t know of atosiban and magnesium phosphorica via injection, or any other options with fewer side-effects than traditional tocolytic drugs like terbutaline, magnesium sulfate, and indocin.
What are your thoughts on the risks and side-effects of terbutaline and other conventional tocolytic drugs, and do you have any advice about alternative methods to calm the uterine muscles?
Do you know of magnesia phosphorica injections or cramp bark and how effective they are?
We really appreciate your answers on the blog which has been a very helpful source of information.
Regards,
Bent
February 1, 2009 at 6:30 am
Hi Dr Vijaya,
I was just reading your article and replies to queries and was really impressed by your quick, personal and so very informative replies. Hope you can help me.
I am not sure if I fall into the low cervical length category.
I ve had an elective abortion(with D&C) 6 years ago and had a first trimester miscarriage last year. I am currently in my 25th week of pregnancy, starting 26th week tomorrow. I went to my gynaec complaining of gas like cramps and some discharge that I thought was thicker than usual. She got me admitted for observation, as at the time my cervix was soft and the external os allowed the tip of the finger in. The ultrasound showed a cervical length of 34mm. (It was 36 mm at 19 weeks)
She’s put me on duvadilan and progesterone along with drugs to stop gas pains, and asked me to get the cervical length checked after a week and follow up.
What should be done? Is her course of action correct? I ve been put on reduced physical activity and a modified bed rest.
Your advice will be greatly appreciated.
Thanks,
Pallavi
February 2, 2009 at 4:34 am
Dear Melissa,
Glad to note that your cervix is beginning to show some signs of stability .. it is very possible that this could start varying again, but for now – chin up and cheers
Thanks also writing in about your options regarding cerclage and why it was not done – it will be good information for other moms in similar situations. Finally, at 23 weeks your choice of not opting for the cerclage was probably the right one.
Good luck –
Dr. Vijaya
February 2, 2009 at 4:42 am
Dear Paula,
Happy for you that there is no funneling or signs of preterm labor .
To answer your question, yes, you can have cervical dilation without symptoms of preterm contractions. However, the FFN is a very sensitive test, and has a negative predictive value of as high as 99.7%. In plain language, this means that if you have a negative FFN test, your chances of going into labor within one week of the test, is as low as 1 in 333. So, I think your doctor is right that you should find your test results reassuring!
Wishing all the very best to you (and your twins) …
Dr. Vijaya
February 3, 2009 at 7:02 pm
Dear Doctor,
Today 03.02.2008, my wife was scanned on her 21 wks 6 days maturity. Results shown “Internal OS is closed. Cervix measures 2.6 cm in length. Cervix is short. There is no funneling of cervical canal at present.” Doctor, Is she is at risk part? Our Gyn prefers a Cervical Stitch and a strict bed rest. Doctor, do you have any recommendations? What shall we do sir. Please advice. Thanks. Sha
February 4, 2009 at 3:42 am
Hello Bent,
To answer your questions:
1. Nifedipine would probably have been a better choice, all things considered. However, due to your wife’s blood pressure being on the lower side, as you point out, it may not work.
2. Terbutaline – side effects are greater. Maternal heart rate will have to be monitored, and be kept between 90-105 bpm. If used, it should be continued until 35-37 weeks, when it can be slowly tapered off. However, a large analysis of literature, and studies has failed to find and significant benefit of oral maintenence therapy on this drug alone.
3. Atosiban – Not enough research yet. One study: 513 women were tested on Atosiban versus Placebo. There was no difference in the ability to inhibit preterm birth. The authors concluded that there is insufficient evidence for use of this medicine at present. In any case, it is NOT FDA approved yet.
4. Magnesium – In any form, (liquid, with calcium, or as Magnesium sulphate), there is not enough evidence for its beneficial use to prevent pre-term labor. A study of 2000 women reported by Cochrane Collaboration found that infant mortality and serious health problems in the case of mothers who had taken Magnesium Sulphate to prevent preterm labor, to be much higher.
5. Indocin – I am glad that your wife stopped taking Indocin. Many studies report that taking of this drug is associated with decrease in amniotic fluid levels, fetal side effects, as well as twice as much neonatal illness.
6 – I have not found any research and do not have any evidence-based experience of mothers benefiting from taking cramp bark and magnesium phosphorica pellets or injections.
In conclusion, I would still recommend that your wife try modified bed rest and relaxation techniques at this time and if need be, be on minimal dosage of Terbutaline if her uterine contractions increase.
regards
Dr. Vijaya
February 4, 2009 at 3:40 pm
Hello Bent,
I forgot to mention one more thing in my last post to you. Most good hospitals and teaching institutions will use strict criteria to qualify “preterm labor”. One such criteria is the “Creasy and Herron Criteria” of preterm labor. This is used between 20 weeks – 36 weeks+6days of gestation. Only if uterine contractions are 4 per 20 minutes or 8 per 60 minutes and accompanied by premature rupture of membranes (bag of waters), or cervical dilation greater 2 cm, or effacement (thinning of cervix) greater than 50% or changes in dilation and effacement detected by serial cervical exams is it qualified as preterm labor.
Otherwise, it is just uterine irritability and should be treated with as minimal intervention as possible. Anyway, almost all interventions including medications and/or bed rest have only empirical evidence for use, and in the end, work differently in each expectant mother.
All the best to you and your wife – hope this helps ..
Dr. Vijaya
February 4, 2009 at 3:50 pm
Hello Sha,
2.6 cm cervical length is borderline normal. Research indicates that just monitoring every 3 weeks or so should be sufficient at this point of time. Even bed rest is not really required. However, your wife should avoid any activities such as lifting that can increase intra-abdominal pressure.
In terms of cerclage (stitch), as your wife is past her 21st week, there is an increased chance of uterine irritation and preterm labor. You will have to take this into account if you decide to go in for it.
Hope this helps .. feel free to write in if you have any other queries.
Good luck -
Dr. Vijaya
February 6, 2009 at 10:35 pm
Dear Dr. Vijaya,
My question is actually about cervix dilation, hope you allow me to ask it here.
Once the cervix is dilated, say, to 1cm, at week 27 or 28, if doing bed rest and maybe do kegel exercise. Would the cervix every close again or it would just stay dilated till after birth? And once the cervix is dilated, can it still be stiched or not?
Thanks a lot!
Jane
February 7, 2009 at 5:14 pm
Hi Dr Vijaya,
Hello, I have just been reading through previous posts and have found all of your advice/info. to be the most helpful I have come accross thus far (and I have done A LOT of research). I wanted to give a bit of background before I ask questions. I had a previous full-term delivery with my daughter who is now 9. I did have a VERY irritable uterus, contracting all day every day about 10 times per hour for the last 10 weeks of pregnancy. Don’t know that this was truly pre-term labor though, and was on terb for many weeks. Ultimately I had to be induced. Shortly after this birth I had a LEEP performed.
Fast forward 7 years and I became pregnant with twins. Going in to this pregnancy, I was told that I would be watched a bit more closely due to the LEEP but that there was not too much concern. I started with the intense uterine irritability very early this time (about 14 weeks) and at 17 weeks was found to have a cevical length of 1.7 with significant funneling. I was on very strict bedrest from that point on and my cervix continued to fluctuate slightly but remained very short. I think the peri called it “dynamic.” I was also on procardia, terb, and indocin at various times throughout the pregnancy. At exactly 29 weeks my water broke. I was put on antibiotics. 3 days later I ddeveloped high fever and was rushed into delivery. My daughter survived, my son did not. He was born septic and died 8 hours post-birth. It was heartbreaking to say the very least. My daughter is now a healthy happy very normal 18 month old.
SO, currently, I am 23 weeks pregnant. This pregnancy was a tricky thing to deal with since no one was really sure if I truly had an incompetent cervix last time due to the LEEP or if the shortening was just a result of twins. I opted, and my peri agreed to do a cerclage at 14 weeks. He did tell me at the time that my cervical length was on the short side, about 3cm. Since the cerclage I have done well and have been monitored every other week. My cervix has remained between 3.3cm and 4.2cm, with the last measurement being at 22 weeks. I, however, am absolutely terrified given all that occured with the twins. I am also on the p17 shots weekly. I have started to have some uteine irritability which seems to be par for the course for me. So here are my questions for you . . .
1. Would you suggest being very proactive with my uterine irritability given that my water broke early last time? My instinct is to take every drug that I can for this to just make it stop since it scares me, but my doc is somewhat conservative about giving meds. He did give me a script for procardia but gave me strict guidelines as to when I should take it (like a certain number of contractions per hour). Do you think that terb is more effective than procardia? What about the terbutiline pump?
2. Do you think that my water breaking last time was caused by my cervix being so short? Can these two things be related? I know that I did not have a UTI at the time. Or can uterine irritability itself cause the water to break?
3.In your experience, does having a LEEP typically lead to incompetence? I do know that its a risk factor but I have never actually heard of anyone else developing cervical incompetence because of it. Clearly, my hope is that my problems were more “twin” related, than “cervix” related.
4. Would you suggest modified activity for me at this point?
I apologize for the length of my post and appreciate you time. Thank you,
Heather
February 9, 2009 at 11:16 am
Dear Jane,
I am not aware of anything that would make the cervix close again, once it starts to dilate. Mothers on strict bad rest have been seen to occasionally be able to halt funneling and drastic shortening of cervical lengths. However, whether this was in response to just decreased physical activity or whether this was just the way their body was acting, we cannot be sure. Bottom line is that we try everything possible in the hope that our moms can hold on to their pregnancies for as long as possible without going into preterm labor.
As regards the placement of a stitch, at week 27-28, there are more risks than advantages. I would not recommend this as an option in your case. Another thing is, you have not mentioned what the length of your cervix is; based upon this you can determine levels of activity that are appropriate for you. The writing at the top of these comments, should give you evidence-based guidelines regarding your possible activity levels for the rest of your pregnancy.
Good luck,
Dr. Vijaya
February 9, 2009 at 11:41 am
Dear Heather,
First of all, I just wanted to tell you what a brave mom you are!
As regards this pregnancy, I think you and your OB have probably done the right thing in going in for a cerclage. With your previous history, I think that this gives you the best chance for carrying your pregnancy for as long as possible. And, your cervical length seems to be very reassuring.
I also think that taking medicines should be only on an as need basis. I understand your worries based upon your past experiences; However, every medicine crosses over the placenta, and every medicine has some side-effects (both for you and baby) – some well-documented, others not. So, it would make sense to use only when needed, and as minimal as possible. Procardia seems to be the right choice for you at this time – especially if your blood pressure normal. If you tend to have B.P that is on the lower side, it can cause extreme low blood pressure, and you would have to be monitored very closely. Terbutaline is known to have more side effects (and more incidence of newborn illnesses) than Procardia, so I would go with Procardia if it works for you. From what you have told me, I would not recommend Terbutaline pump at this point yet.
As regards your query regarding the cause and effect of LEEP procedure on cervical length, research has found that there is some amount of increased tendency to shorter cervical lengths in pregnancy in mothers who have had this procedure done previously. However, in your case, as you point out, we will never know for sure whether it was that alone, or the pressure of the twins on your vulnerable cervix, along with your irritable uterus, which caused your bag of waters to break. It could have been one or the other, or both. However, we do know that Indocin has documented remarkable adverse effects – one of them being decrease in fluid levels. If this had happened, it may have further triggered more uterine irritation, which could have led to your bag of waters breaking. Again, this is only conjecture based upon what you have told me; I would like to know what was the rationale behind putting you on Indocin at that time, and what your OB thought about the early break of your bag of waters. This information would be good for other moms in a similar situation.
Finally, with having had a cerclage done, and with your cervical lengths being very decent at this point, I would not worry too much about being on modified bed rest. Definitely, do avoid lifting anything heavy, and anything that can cause an increase in intraabdominal pressure as well as sexual intercourse. The uterus is a muscle – and like any other muscle, it responds to active relaxation techniques. I have also had some wonderful results with moms doing relaxation therapy, meditation, music and breathing exercises. Granted, these do not take away the cause of the uterine irritability – but they do tend to decrease the rate of uterine contractions, which is what you want!
Hope this helps – please feel free to write in if you have any other queries.
All the very best to you -
Dr. Vijaya
February 10, 2009 at 2:34 am
Dr. Vijaya,
First, I just want to take a moment to express my thanks to you and to let you know how much I appreciate your thoughtful and detailed response to my post (and all of the other posts). When experiencing a high risk pregnancy it is so nerve-wracking and also so easy to begin to feel alone and unheard. This site and your caring and honest responses and information is so amazingly helpful and, unfortunately, hard to come by. So, again, thank you.
I am glad to hear that you agree with my doctor’s course of action at this point. It is comforting to have a second opinion on the matter.
In terms of the indocin given during my last pregnancy. To be honest I don’t know what the rationale was behind it. It was actually the first drug that was offered to me and I didn’t ask many questions. I was told about the risk of it affecting my fluid levels and I believe that my fluid was observed during my ultrasounds, which were done often. I will add that I have switched doctor’s for this current pregnancy and he will not give indocin for the reasons you stated. As far as my water breaking . . .it has remained a very frustrating and unnerving unanswered question. My current doctor has made the guess that perhaps it was linked to my very short cervix. At the time that it occured it just seemed very out of the blue. As I said, I did end up spiking a fever and developing an infection after three days of being ruptured (and this was in spite of all the I.V. antibiotics I had been getting.) My son died specifically of a septic e-coli infection which he was born with. So, no one was really certain what the hec happened. Of course, it was a question of; did infection cause me to rupture or did rupture allow for infection? No one was ever able to answer this and to this day I really have no idea what happened. I think that my doctors were as dumbfounded as we were. The unanswered questions surrounding all of it have made for a very difficult pregnancy experience this time. The obvious question I have had is; if we don’t know what happened last time, how can we prevent it from happening again? Not having answers is hard.
I did want to ask you, want to you mean when you say intra-abdominal pressure? I do have an 18 month old that I’m constantly hauling around. Would you suggest I stop doing this, or limit as much as possible? Also, you mentioned meditation and relaxation. Would you suggest certain CD’s to guide in this. I have never tried any of that.
Thank you again for your time,
Heather
February 10, 2009 at 3:43 am
Dear Heather,
Thank you for your kind words. I strongly believe that every expectant mom should feel well supported during her pregnancy; it just becomes doubly important for people with high-risk scenarios.
Also, thank you for your detailed response regarding the Indocin line of treatment in your last pregnancy; the information will help other moms and their families.
As regards music and meditation, any music that relaxes you will help; what I have found is that any music with repetitive soft notes helps with relaxation. Do take out time for yourself, and practice deep breathing techniques during that time.
As far as intra-abdominal pressure is concerned, I do think you should limit carrying your 18 month old. Other things that increase intra-abdominal pressure are straining at stools and coming up to sit from lying on your back, or raising yourself up from a recliner. You can try and limit these things as much as possible.
Good luck ..
Dr. Vijaya
February 13, 2009 at 2:43 pm
Dear Dr.Vijaya,
My wife is 13th week pregnant and she had the cervix length of 2.5cm and our doctor advised her with cerclage in 5th month. She had the history of mis-carriage in late 3rd month in her first pregnancy. we are bit worried for this issue. Kindly advise us about precautions to be taken to have a safe pregnancy this time.
Thanks&Regards
Aadi
February 17, 2009 at 6:11 am
Hello Aadi,
As per current research, 2.5 cm cervix length is at borderline lower end. If your wife did not have other risk factor, I would not have recommended anything except a wait and watch approach.
However, with her history of previous late 3rd month miscarriage, it may be worthwhile opting for the cerclage. Typically, for first trimester miscarriages preventative cerclages are not recommended. In your wife’s case though, late 3rd month miscarriage almost blends into the 2nd trimester. Hence, as with any unexplained previous 2nd/3rd trimester losses, it might be better to opt for a cerclage.
Having said that, I am not sure it is a good idea to wait until the 5th month. If your doctor wants to do a cerclage, the ideal time would be between the 13th -16th week. Once you reach the 5th month, there are definitely more chances of uterine irritation caused during and post-procedure, due to the pressure of the growing uterus on a shortened cervix. If this happens, it has the possibility of triggering preterm labor.
I would definitely recommend that you bring up this issue with your wife’s OB and find out why he/she is wanting to wait until the 5th month to do the cerclage. All current research recommendations indicate that doing preventative cerclage is better between the 13th-16th week; sometimes even as early as the 11th week.
Hope this helps .. please feel free to write in if you have any more questions or concerns.
Good luck ..
Dr. Vijaya
February 21, 2009 at 7:43 pm
Hi Dr. Vijaya,
I am almost 17 weeks pregnant at 15 weeks my cervix measured 3.0 cm and went to the dr. the following week, at 16 and my cervix measured 2,5 cm no funneling or dilation. I had a LEEP when I was 27 and I am now 33 and had a baby at 36 weeks because of PPROM with no contractions or any signs. With my first pregnancy at 21 weeks I was3.3 cm measure by a non-vaginal u/s.
The Dr, did not put me into any kind of rest or anything, I am supposed to be back to measure cervix in a week. If they see any shortening they will assess again. Please let me know, what would be your recommendation. It is possible for the cervix to increase in measure by itself?
February 23, 2009 at 5:47 am
Hello! I am in my first pregnancy. I had a LEEP procedure done about 5 years ago so my OB wanted to watch my cervix during my pregnancy. At 19 weeks I measured 36-37 mm and at 24 weeks I measured 31 mm. My doctor has suggested that I take it easy by limiting physical activity, not lifting anything, and avoiding any “bearing down” actions. She also suggested we use a condom if we are still having intercourse. I go back for another US at 27 weeks. How concerned should I be? How much should I be cutting back on activities? I tend to be fairly active and it is difficult for me to sit around while my husband does everything for me. Of course I realize that ending up on bed rest would be far worse. I appreciate any input or advice you can share with me.
Thank you!
February 23, 2009 at 1:31 pm
Dear Liat,
With your cervix measuring at 2.5 cm, you are borderline short. I think you need not take any particular precaution such as reduced activity at this time. However, I would recommend that you avoid lifting weights, and avoid constipation and straining at stools. If your cervix continues to show shortening at your next OB visit, modified bed rest may be required to stabilize the cervix. Although we do not necessarily understand the mechanism, many moms have stabilized cervical lengths and/or slight increases with modified bed rest.
Your PPROM at 36 weeks in your last pregnancy, may not be necessarily related to cervical shortening. So, at his point we should not be overly concerned about that – rather, we should base our next course of action dependent on the current situation as per your OB checkup.
Hope this helps .
Dr. Vijaya
February 23, 2009 at 1:37 pm
Dear Lily,
You are doing all you can .. I am glad that your OB is not too conservative. She is adopting the right course of action for now .. that being wait and watch. Limiting the activities that she has told you is perhaps all that will be needed. Other than that, you can be reasonably mobile, as long as you are not increasing the internal pressure in your abdomen (as would happen with straining at stools, or getting upright from a low recliner, etc).
In case your cervix shows further shortening at your next check up, you can then follow modified bed rest. Hopefully, you won’t get to that .. we’ll keep our fingers crossed!
Do write in after your next check up, or if you have any further queries ..
Dr. Vijaya
February 25, 2009 at 10:32 pm
Hello Dr. Vijaya,
I wrote to you just a couple of weeks back so I won’t go over my history again. Just had a couple quick questions. I am currently 25 weeks 4 days pregnant. I made my first trip to labor and delivery 2 days ago because my irritable uterus was acting up. I was having contractions, although irregular, so they gave me a shot of terb and that calmed things down. At the hospital my doc came and measured my cervix and it was 3.3. My bladder was empty, which he didn’t want but timing didn’t work out. So, the next day I followed up in his office and my cervix measured 4.1. This was with a full bladder. So my question for you is…which of these measurements is the true length? From what i understand, it is unlikely that my cervix grew overnight. Does having a full bladder add length and therefore give a false reading? I should add that my ultrasounds are always done over the abdomen and not transvaginally. I assume that this is because of the cerclage.
My other question is just about the contractions and irritability. I was sent home from the hospital on 10mg of procardia every four hours. Even taking this, however, I contract. i asked my doc about tebutaline and he didn’t want to give it to me. He said that there was more we could do with the procardia first and he wanted to give that a chance at this point. do you feel like this line of treatment is appropriate? Keep in mind my uterus is incredibly obnoxious and just likes to contract all the time. I decided to just go with what my doc is suggesting, although I could become more pushy if need be. I do feel like terb works better than procardia, however, the side effects are also much worse which is most likely the reason for my doc’s hesitation. I will be checked every two weeks at this point. Thanks for your time and input!
Heather
February 26, 2009 at 2:39 pm
Dear Heather,
I am glad that your cervical length is very reassuring at this point. To answer your first question, the measurement with the full bladder would be the more accurate measurement. We always recommend moms to go in for scans with full bladder, for the simple reason that a full bladder pushes up the cervix into better visibility, and gets the best measurement of length possible through an abdominal ultrasound. Of course, a transvaginal measurement would be the most accurate, but is not always possible, such as in your case. In fact, sometimes a transvaginal measurement triggers minor uterine contractions as well, and its risks have to be weighed against the benefits.
Regarding your second question: I would again be inclined to second your OB’s line of treatment and give the Procardia a chance. It would be equally easy to change to terbutaline, but knowing the increased incidence of maternal and fetal/newborn adverse effects, I think following the Procardia line of treatment would be the safer alternative, unless you feel it is having zero efficacy in managing your uterine irritability. By the way, how many contractions are you having in a hour and over a whole day?
Apart from this, I would like to suggest one more thing – a hot bath/shower can do wonders to calm an irritable uterus. Even though its effects may last only for a hour or two, I would think it would be worth your while using this as a physical relaxation measure, whenever you find that your uterus is contracting more than what it does usually. We use this very often with our laboring moms, when they have irritable uterine contractions that are not allowing true labor to progress. The effects that I get with something as simple as having the laboring mom sit on a chair and have her support person pour warm water over her belly for 10 minutes are remarkable. The irritability eases, and suddenly the contractions change to more rhythmic and meaningful contractions, and this lets her labor progress naturally. Granted that in your case, we are addressing a much different issue. However, since the physical part of the uterine contractions and irritablity remain the same, it might be well worth a try as your go forward in this pregnancy.
Wish you all the very best .. do write in if you havge any more questions
Dr. Vijaya
February 26, 2009 at 4:16 pm
Hi Dr vijaya,
thank you for your response and suggestions. Just to answer your question. According to the home monitoring machine I have been using, I usually have about 3 maybe four contractions in an hour. But I have irritability and/or tightening many times an hour throughout the day. Some hours are better than others. I have been monitored and have been told to mark the tightening that I feel. More often than not, it is not considered true contractions, although I still worry and find it to be really annoying though not painful. I did expeience this with both my previous pregnancies. With my singleton (pre-leep) this cause no cervix changes and i went to 37 weeks and even needed help to progress my labor. With my twins (post leep) this may have caused cervix changes. The cervix most definitely shortened, but whether it was a twins thing, a leep thing, a contraction thing, or all three is unknown. So, obviously I worry this time because I just have no idea if all the tightening/irritability will set off changes to my cervix at some point. Ugh. It’s very frustrating. i will try your suggestion re: the warm shower. Thank you.
heather
February 27, 2009 at 5:36 pm
Dr. Vijaya,
Almost 18 months ago I gave birth to a completely healthy full term baby boy after having a completely healthy “textbook” pregnancy. I am now 24 weeks pregnant with my second child and have had nothing but trouble. I was diagnosed with Hyperemesis at 8 weeks and am still on Zofran to control it (though I have cut back to once a day.) At my 20 week scan it was discovered that my cervix was measuring 2.9 cm. (I have never had any cervical trauma or procedures done prior to this pregnancy…and was not diagnosed with having a short cervix with my first.) The doctor was baffled at my situation. Two weeks later I was remeasured at 2.6 cm and 2.5cm with pressure on my abdomen. My high risk doctor decided to have me come back the following week for a fFN test and another trans-vaginal ultrasound to remeasure. (In the meantime I was told to lie down as much as possible, but was not given any strict bed rest instructions. He also put me on 10mg of Procardia every 6 hours for the few inconsistent contractions I was having.) My fFN came back negative, which was a relief to me, but my cervix was measuring 2.3cm and 2.1cm with pressure applied to my abdomen. I was still having some contractions, mainly if I had been vomiting, and pretty consistent menstrual type cramping. He has me taking 200mg of Progesterone by vaginal suppository nightly. I go back in a week for another fFN and cervical measurement. I am still getting what I feel are Braxton Hicks ; is that normal? Last night I had one contraction, followed by another 10 minutes later that woke me from my sleep. Is this normal? Should my meds be altered? What are your thoughts? I am terrified as this is unchartered territory for me. I am a stay at home mom to my almost 18 month old son (and live in a two story home) and would like to know if there are precautions I should be taking. Thank you, Erin
March 5, 2009 at 5:04 pm
hello Dr Vijaya
i loved all your replies and found them very useful.
my question is, i am 29 weeks today have a cervical lenght of 2cm and funneling measuring 3.4 in length. i had a rescue cerclage at 21 weeks with no infections. was on bed rest but had to go on strict bed rest at 26 weeks when funneling increased to 3.4. i am only allowed to use the toilet but told but have been having bed baths and using a bedpan to wee. do you think this is too severe and i should be alowed full bathroom priviledges.
also at 26 weeks they satrted me on progesterone shots every week and take ventolin tablets twice a day to prevent contractions although i dont think i have contractions i ony told my doc that i was feeling pressure down there. but it is better now. i am puzzled at the fact that when i went on strict bed rest the funnelin was 3.2 but when i had a scan 3 days ago it had increased to 3.5. pls can u explain
my main question is that i would be travelin on a 6 hour flight at 31 weeks i only came on holiday to my native country and found myself in this predicament…is it safe to travel? and do i go straight to my hospital upon arrival. thank you
March 5, 2009 at 5:10 pm
one more thing my doc said he will be giving me some drugs to develop the babies lungs and liver because i am travelling as a precautionary measre. is that ok
March 6, 2009 at 6:20 pm
Dear Erin,
Sorry it took me a couple of days to reply. Several of my expectant mothers went into labor, almost in tandem; and it took a few days for things to settle down!
To answer your questions:
!. With your cervical measurements the way they are, I think limiting physical activity should be good enough. I do not think strict bed rest is warranted at the moment (which is good news for you since you have a 18 month old!)
2. Do not lift anything heavy; avoid lifting and carrying your older one; avoid straining at stools; avoid sexual intercourse; avoid coming up to sit from a lying on your back or reclining position – instead roll over to your side and use the support of your hands to get yourself up; avoid sitting on very low surfaces. As regards using the stairs, I would limit it to the extent possible – at this point you do not need to worry about completely avoiding it.
3. Ffn being negative is good news .. however, I am not sure what has triggered your uterine contractions. In any case, it looks like your high risk specialist is following appropriate lines of treatment. I would just check with him regarding two things:
– Is a transvaginal ultrasound absolutely required? Sometimes internal ultrasounds can trigger further uterine irritability. Since your cervical length is just borderline short, you may still be able make do with abdominal ultrasounds (with a full bladder) and a repeat Ffn to just be on the safe side.
- Why has he put you on Progesterone through vaginal suppository? Sometimes, this can trigger irritability as well. I am assuming he has done this because of your hyperemesis?? If this is not the case oral or even progesterone shots may be an option to look into.
Over and above all of this, I would encourage you to go through my replies (a few entries above yours) to Heather. Do try music, meditation, relaxation, breathing and warm showers with warm water running over your belly – all wonderful (albeit temporary) techniques that are useful to reduce uterine irritability from time to time. When you cannot alter the cause, you can at least try to minimize the effects.
Also, something you can try in order to reduce your nausea/hyperemesis – try chewing on a whole clove. (Clove is spice that should be readily available; if not you can try Indian grocery stores- they will most definitely have it). Clove has anesthetic properties; it numbs the oesophagus, and reduces nausea. May be worth a try as you are trying to cut down on Zofran.
Hope this helps .. please write if you have any more concerns.
All the best to you ..
Dr. Vijaya
March 6, 2009 at 6:51 pm
Dear Sade,
The ultra strict bed rest regime is because of your funneling. The length of the cervix, though definitely short is not alarming in itself; however, put together with the increased funneling, it is better to take all precautions.
Having said that, he complete bed rest does not seem to have arrested/reversed your funneling. This could be due to differences in the way of measuring, your fullness of bladder at time of measurement , or simply something that we do not understand or know. Bottomline – do continue strict bed rest for a while. However, you should be able to have full bath room privileges, provided someone is there to help you in case of need. 10-12 weeks is a long time to go without being able to use the restroom, and without having a shower! Obviously, I would recommend keeping the bathroom trips as short as possible. You can even have someone help you with pouring water over your body as you sit on a chair and finish bathing.
As regards your travel – ideal would have been not to travel. But, since it is unavoidable in your case, do take your tocolytic (medicine to decrease uterine contractions) before you travel. Also, it is ok to take the steroid shots to mature your baby’s lungs; but take them only just prior to travel . They are usually administered as two shots over a period of 24 hours. Research has found that the effect of the shots lasts only for 2-7 days, and that repeat shots are not that effective. So, in order to give your baby the best chance in case you have premature labor as a result of the travel, you should have one shot 48 hours prior to your travel date; and the second shot 24 hours prior to your travel date.
Finally, unless you are felling uncomfortable at the end of your journey, or feeling pressure downwards in your vaginal area, or experiencing periodic tightening/ contractions during or immediately after your journey, you need not rush to the hospital immediately. However, it would be recommended that you go to the hospital as early as possible after your trip in order to get checked. In case you have any of the symptoms that I mentioned above, you should straight get yourself to the hospital from the airport.
Hope this helps .. Good luck
Dr. Vijaya
March 7, 2009 at 9:47 am
Dr vijaya
thanks alot , yu have put mind at rest and i just wanted to say that i was allowed to shower and use the rest roo for the first five weeks until the funneling got worse, i hav been having bed baths since. your comment about not using the restroom made me sile and i said to myself i better correct this impression.
thanks this site has been most informative
March 7, 2009 at 7:09 pm
Dr Vijaya- after referring to my books and many many online resources, i found your article and comments the most useful. thank you very much.
my doc told me i have cervix shortening at my 31st week scan 10 days ago, and measured it as 3.3cm. he told me to reduce physical activity. would you give some more advice on what this means? does that mean i should avoid going on walks, or attending swimming classes for pregnant women? what about intercourse? he has not given me bed rest or any instructions to follow about reducing my activity level, so i am not sure what’s the right thing to do. i want to be more active so i’m prepared for the birth, but i wouldn’t want to do anything that puts my baby at risk.
thank you very much in advance.
March 9, 2009 at 7:34 pm
Thank you for the response Dr. Vijaya. My second fFN came back negative as well…so I am feeling good. After being put on bed rest after I wrote you (only up to eat and use the restroom) my cervix held steady at 2.1cm. I am not sure why my doctor put my on vaginal Progesterone. I will definitely be asking him about that at my next appointment on the 19th. I would prefer a different form of it since my insurance does not cover the suppository. Thank you for all of the advice. I appreciate it greatly! It’s always nice to get several professional opinions. You are doing a very kind and selfless thing by helping all of us anxious mothers!
Sincerely,
Erin
March 10, 2009 at 4:01 pm
Dr. Vijaya, I am 19 weeks and 1 day and at my appt yesterday my dr saw that i had some funneling from inside and my cervix is still 3.2 cm. I had a cerclage during 14 weeks. Should I be concerned about the funneling. My previous pregnancy I lost my son at 20 weeks and 5 days.
Natalie
March 11, 2009 at 2:29 am
Dr. Vijaya,
I just wanted to give you the latest update. I had my follow up ultrasound today with the same doctor who checked my cervix approximately 8 weeks ago. 8 weeks ago it measured 36-37 mm. 3 weeks ago it measured 30-31 mm. Today it measured 32-33. Good news! The reduced activities seemed to do the trick. For now the perinatologist said to continue doing what I have been and he doesn’t even think a follow-up check is necessary. I will talk to my OB about it at my appointment next week. As Erin said above, thank you so much for being such wonderful help to all of us. You helped put my mind at ease.
March 11, 2009 at 8:42 am
Dr Vijaya
i would also like to update you on my progress.
bed rest does help i had a scan done 2days ago on monday and the funneling has reduced and my cervical lenght is almost 4cm so i think i will continue with the programme till i fly out next week.
thanks for all the advice
March 13, 2009 at 12:04 am
Hi Dr. Vijaya,
I’m back. I hope that you dont mind me asking frequent questions. I like the second opinion. So, at my last cervical length check, at 27 weeks, 3 days, my cervix actually measured 5.0, which astonished me! I’ve never had that type of length before! So, I am obviously very happy about that as is my doc. The thing that I wanted to run by you is this; I went in to the appt. prepared to really try to convince my doctor to either increase my procardia dose or perscribe terb for my contractions, which are now pretty constant and uncomfortable and scary! But, after seeing my cervix length he wouldn’t go for it at all. He said that unless he sees a trend toward cervical shortening he won’t give meds. What do you think about this? I mean, isn’t there a point at which you want to control the contractions regardless of their effect? Do you believe that if the cervix remains stable it is fine to have contractions constantly? Do some people just contract until the end but never dialate?? I am just so worried that cervical change will occur and I wont know it! Thanks for your advice,
Heather
March 13, 2009 at 2:36 pm
Dear Erin,
I am glad for you! Do update us after your appointment; as always you can write in if you have any questions or concerns ..
Take care -
Dr. Vijaya
March 13, 2009 at 2:39 pm
Dear Lilly,
Great news:)
Just keep up with your reduced activity .. hopefully, that’s all we will require to keep you and your baby healthy and happy
Good luck
Dr. Vijaya
March 13, 2009 at 2:45 pm
Dear Sade,
Thanks for the update .. even though we do not know how bed rest helps in improving or stabilizing cervical lengths, research based evidence seems to suggest that it does help most mothers. I am glad that it has helped in your case too. Thank you for sharing your experiences; it will help other moms who are in similar situations as you.
Good luck with your flight – as always, please feel free to write in ..
Dr. Vijaya
March 13, 2009 at 3:03 pm
Hello Dr. Vijaya,
I wrote to you a couple of months ago and your suggestions and encouragement were very helpful! I just wanted to give you an update on my situation. I have been on bed rest at home for 10 weeks, only getting up to use the bathroom. I went on bedrest at 21 weeks due to a shortening cervix (it was 2.5cm at the time and very irritable uterus), and because I am pregnant with twins and Baby A’s head was pressing down very low on my cervix. I do not have a cerclage.
I am now at 31 weeks, and my cervix has gradually shortened to 1.7cm. It is fingertip dilated, and my perinatologist says it is extremely soft. Both babies are head down, and are exerting tremendous pressure on my pelvis. Thankfully, my FFN test this week came back negative. I will continue on bed rest at home for the remainder of the pregnancy.
Here is my question: at this point, my perinatologist feels that it is no longer useful to continue having regular transvaginal ultrasounds to measure cervical length. He says it is harder and harder to get an accurate measurement, and that now that I am past 30 weeks and carrying twins, my cervix will naturally be shortening quite a bit. He feels that he can get a better sense of what is happening (whether there is effacement and/or dilation) through manual/digital examinations. Do you agree? Is there a point at which precise cervical length measurement is no longer so important?
Thank you so much for taking the time to read this message. I really appreciate it!
Sincerely,
Paula M.
March 13, 2009 at 3:37 pm
Dear Heather,
Glad to have you back – Would have wondered how you were doing if you did not post an update!
Great news – cervix length of 5.0 – you astonished me as well
To answer your question –
1. Your cervix length is showing no reason for alarm whatsoever.
2. You have a cerclage in place.
3. You have had irritable uterus all the way through, in both your previous pregnancies. I understand that your anxiety in this pregnancy is because of the issues in your second pregnancy. However, as per the information that you gave me earlier, in your first pregnancy (which is what we should be going by because it takes away the added complexity of your twin pregnancy) you were contracting all the way through, were on Terbutaline, and had to be ultimately induced. This leads me to believe that your uterine irritability may not necessarily lead to premature dilation this time around as well. In addition, the cerclage is an added protection. I think your OB is doing all he can at this point to manage your pregnancy, without adding more medications than are required.
I do understand that these contractions take a physical and emotional toll. Although you would still need to monitor yourself closely at all times, with your current status, you can be reasonably sure that you are doing all you can.
Hope this has helped .. yes, and we want you back in this forum Do update us with your progress.
Best wishes
Dr. Vijaya
March 13, 2009 at 3:53 pm
Dear Paula,
Good to know that your Ffn is still negative.
I agree with your OB’s opinion – transvaginal ultrasound beyond this point will not as informative as an internal exam. In addition, transvaginal ultrasounds are known to sometimes cause uterine irritability and preterm contractions, esp with shorter cervical lengths.
Having said that, with the natural shortening of the cervix that accompanies twin pregnancies, I would also ask your OB if he would be comfortable limiting internal exams to maybe every other week or so, instead of every week. BTW, are you having weekly check -ups?
Paula, it is great that you have been able to carry your pregnancy thus far. It’s good news that both twins are head down – this will give you better chance for a normal delivery. Hopefully you will be able to hang in there for a few weeks longer .. please keep us updated as and when possible.
Good luck!
Dr. Vijaya
March 13, 2009 at 4:06 pm
Dear (Ozlem),
Sorry for the delayed response. I missed your post amongst the other posts that came in.
To answer your questions:
1. At 31 weeks – 3.3 cms measurement is not bad at all. Research indicates that you really do not need to worry much about reducing physical activity at this point.
2. However, you would need to be monitored every 3 weeks (instead of a visit to the OB every 4 weeks as per normal practice) – If further decreases are found at that point, you can look into decreasing activity levels at that time.
3. For now, I would avoid lifting heavy things, straining at stools, and intercourse just to be on the safer side. In case, there is no further shortening ( or even if shortening is there – but is not remarkable) then you can modify these restrictions again.
4. Swimming should not be an issue; nor should walking. You can continue with both these activities as long as you are not overdoing them. While swimming, I would recommend that you just do regular swimming, and avoid exercises in the pool for now.
Hope this helps .. please feel free to write in if you have any more queries.
good wishes -
Dr. Vijaya
March 13, 2009 at 5:23 pm
Thanks Dr. Vijaya, as always, your input is reassuring and appreciated!
Heather
March 17, 2009 at 7:01 pm
Dr. Vijaya,
I think your website is wonderful and I wish I had come across it sooner.
I just had a few questions and concerns and was wondering if I could have your input. It would be much appreciated.
First of all, I am 37 and had cervix laser surgery at 26 and a cone biopsy when I was 28due to displasia. At 34 with my first pregnancy, I was monitored by a maternal fetal specialist biweekly with transvaginal US to check CL due to these procedures. I was checked between 16 and 28 weeks. My CL did reduce at each visit, and at week 26, I measured 2.4cm and was placed on bed rest (laying on left side as much as possible with bathroom and daily shower privleges and I could grab qick bite to eat from the kitchen) until week 34. My efforts worked and my water broke naturally at 37 1/2 weeks. The only problem was that my cervix would not dilate past a fingertip. Many hours and midwife’s checks later, my OB examined me and found scar tissue holding my cervix together (I assume from my surgery). He cut through it and I immediately dilated to 4cm and gave birth 4 hours later.
Last May, I had a miscarriage at 6 weeks believed to be unrelated to my cervix.
I became pregnant in early October. We had an amnio done with the same specialist at 16 weeks as we dealt with during my first pregnancy. Because he knew my history and wanted to reassure me, he had the technician preform a transvaginal US to get a baseline. It measured 4.5cm. I returned back to the specialist two weeks later for my level 2 US and assumed they would do another transvaginal measurement. I had a specialist, but not the same one as before who told me that because I had carried my daughter to term technically, I would not need to be monitored with this pregnancy with a specialist, bit if my OB felt that he wanted to monitor me, we could do so at his office. Because the US looked great, I felt confident that I could wait the three weeks until my next appointment to discuss it with my OB.
Two weeks later, at 21 weeks I felt as though I was having some type of contraction and felt a heaviness in my vagina. It lasted two days before I called my OB. He told me to come in the following morning for an US. After a manual test of my cervix, he said it felt short, but the only way to determine was an US. I had one and I measured 3.2cm. I was checked again at my normal appointment a week later and measured 3.3 cm. I was also set up with biweekly checks with the US. I was told to take it easy (I have been on pelvic rest since the beginning), avoid lifting, standing for long, and rest as often as possible.
At my 24 week appointment, the technician who I know well and trust with her 30 years of experience told me that I only needed to have the abdominal US because she had gotten such a good view of my cervix. My bladder was full and it measured 4.3cm. My OB was impressed and said that whatever I was doing was working. He said that I still may be a candidate for bed rest later down the road, there was also a possibility of progestrone shots when and if my cervix begins to shorten. He said that we would just assess each measurement and decide what to do from there.
Although I was very happy with the news, I could not help but feel that the 4.3cm reading was incorrect. I know she measured my cervix at different places because she had 4.5 and 4.0cm reading and gave an average and she said there was no evidence of funneling. Could she tell all of that from an abdominal US?
My concern lies in the fact that although I feel very fortunate to have an OB that listens to me and does not want to rush the decision to put progetrone shots into my body and my baby until we really need to, as I get further away from my visits with good news, I panic when I feel pressure or possible contractions. I do feel comfortable with this wait and see mentality and feel fortunate that there are options if my cervix does get to the danger zone as it did in my previous pregnancy.I just want to make sure that I am doing everything possible to carry this baby to term or close enough to it.
For the past few weeks, I have had feeling of localized pressure in my abdomen usually on the right side. I can talk and stand through them (though I am usually laying on my left side relaxing at night when they occur). I have one or two a night when it does occur and sometimes it does not happen for three or four nights. They usually lasts no more than 5 seconds. I never have 4 in one hour. What could this be? I did tell my OB at my last visit and he said that it could be early contractions or the baby just pressing hard. Last night, I only had one as I was laying down on the couch. It made me get very warm throughout my body and the pain went around to the right side of my back. I also feel pressure in my vagina. I have felt this since I can remember and my OB can offer no reason. I have read that one of the IC symptoms is a feeling of a lump or something stuck in the vagina and I wonder if this could be what I am feeling.
I am a teacher and although it sounds crazy my job is relatively low stress even with my middle schoolers. I sit most of the day (my students really help me out and sometimes I feel that they think of this baby as their own little brother). I leave right after school and lay down on my left side as much as possible during the late afternoon and night. My husband is fantastic as he makes dinner and cares for our 2 1/2 year old at night time. Our house is one floor (as is my school), so I do not have steps to climb. A former distance runner, I have not do worked out or done anything physical since week 7. When I get stressed or worried, I usually try to meditate or pray to relax myself. Should I be doing more?
I also worry that the scar tissue that was preventing my cervix from dilating played a role in keeping me from going into labor. My OB tells me that since my water broke on its own that this is probably not the case. He believes that I will dilate faster this time because there is not scar tissue now. He believes that even though the scar tissue stopped me from dilating more than a fingertip, it wasn’t strong enough to hold off labor. I kept thinking the scar tissue was acting like a stitch that I hear a lot of women suffering from IC have done. He said no.
Any thoughts or opinions on my situation would be greatly appreciated.
March 18, 2009 at 4:21 pm
Hi Dr. Vijaya,
This is my second pregnancy. I had normal 1st pregnancy and normal delivery.Now I’m 18 weeks pregnant and my ultrasound reports says” Placenta is posterior 1.2cm from internal osand shows 0 maturity. My doctore advised me for bed rest and not to travel. Currently i’m in India and I’ve to go back to US. Please advice me if i can travel with precuation or wht should be done in my case.
Thanks,
Zari
March 19, 2009 at 8:37 pm
Hi Dr. Vijaya,
I wanted to update you on my progress. Good news! After being put on bed rest my cervix has climbed back up to 2.8cm! My meds and bed rest seem to be working! I continue to have negative fFN results which is great (though I am still waiting for my results from today…but I am sure it’s still good news.) I asked my doctor if he could change my form of progesterone and he said yes! I will now be getting the weekly shot (instead of the suppository) which is fine with me. Everything seems to working together for good! Thank you so much for your support! I will continue to update you as I progress, but thought you would like to hear the GOOD news!
Thanks again,
Erin
March 23, 2009 at 7:44 am
Dear Erin,
Yes, I am glad that you are doing good, and that things seem to be getting better rest and meds protocol.
Thanks for the update .. good luck going forward!
Cheers,
Dr. Vijaya
March 23, 2009 at 7:59 am
Dear Zari,
What your ultrasound report shows is that you have a low-lying placenta. Being that you are reasonably early in your pregnancy, there are very good chances that your placenta will pull itself up as the weight of your growing uterus increases. We just have to keep monitoring at regular intervals.
No research indicates that bed-rest is of any help in cases of low-lying placenta. I am assuming that you are not having any other symptoms such as spotting or uterine contractions. If this is the case, you can safely travel back to the US. Your OB may put you on some tocolytic to reduce the chance of uterine irritability during travel, and that should be sufficient. Over and above this, it is recommended that you not lift anything heavy and avoid sexual intercourse as a precaution.
In case you have spotting or uterine irritability, it is better for you to be on a period of bed rest and monitoring, before any decision for traveling is made.
Hope this helps – Good Luck.
Please feel free to write in if you have any more concerns.
Dr. Vijaya
March 23, 2009 at 11:38 pm
Dear Dr. Vijiaya:
My docor told me that my cervix is ” 50%
effaced” and baby is in ” negative 3″ position. She told me that I should avoid any long walk or any other exercise till the baby reaches full-term.
I am wondering besides the advice the resident gave to me, should I be morecareful and cautious? or Should I be on modified bed-rest? What is you
suggestion on this?
Thanks,
Linchun
March 25, 2009 at 11:32 am
Dear Dr. Vijaya,
Thank you very much for your response. That helped me a lot. I’m glad I came across this site.You were a great help.
Thanks again,
Zari
March 25, 2009 at 3:29 pm
Dear Dr. Vijaya,
Hello there.
I am currently 27 weeks pregnant and I am being monitored for a shortened cervix every two weeks. I had a cone biopsy 8 years ago. At my visit last week I measured 3.1cm with no opening or funneling. What is concerning me is that my 24 week visit showed the cervix at 4.3cm and at my 22 week visit my cervix measured 3.3cm. The 4.3cm was measured by abdominal US with full bladder, while the rest were measured with internal US. Could the 4.3cm be wrong or can the cervix shorten, grow, and then shorten again?
I have been on pelvic rest and modified bedrest since the beginning of my second trimester. I am still working full time, but sit as much as possible and I do not lift or carry anything. When I get home I lay on my side as much as possible and I do stay on complete bed rest on the weekends. Is it possible that my cervix will shorten at this rate every two weeks? My doctor said a more strict bedrest with no working will be the next step if I shorten to 2.5cm at any of my following visits. He feels that the progesterone shot would be ineffective to start at 28 or 30 weeks. Am I doing enough?
With my 2 1/2 year old daughter, I was put on strict bed rest at 26 weeks with a cervix measurement of 2.4cm. I delivered at 37 weeks. Any input would be greatly appreciated.
Thank you,
Sharyn
March 25, 2009 at 4:58 pm
Dr. Vijaya,
Do you remember me? I have been asked questions here last October about short cervix length and early dilation/effacement.
Thank you so much for your help and encouragement. I have been successfully held to 39 weeks and gave birth to my baby boy. I’d like to thank you in this forum and share my experience to encourage others who have similar concerns as me. Here is my problem list:
1. 25, 26 weeks: frequent contractions, no pain, once every 5 to 10 minutes, hospitalized, no reason, negative fFN, cervix was closed;
2. 28 weeks: found short cervix length, 1.5cm, by accident, no funneling, no dilation, still negative fFN, started bed rest;
3. 31 weeks: dilated 1cm, effaced 80%, -1 to 0 station, negative fFN, had shots to help baby’s lung grow, strict bed rest;
4. 34 weeks: dilated 2cm;
5. 37 weeks: dilated 3cm;
6. 28 weeks: failed 1-hour glucose test;
7. 30 weeks: failed 3-hour glucose test, started diet and self test at home;
8. 39 weeks: gave birth to my baby boy after 3-hour 1-minute push through vagina.
During the whole pregnancy, I gained only 4 pounds due to very heavy vomit and nausea from the beginning to the end, but my baby was 6 pounds 12 oz and 19.5 inches at birth!!!!!
Hope my experience can encourage others and thanks again, doctor,
az
March 25, 2009 at 5:05 pm
Dr. Vijaya,
I do have another question. Do you have any suggestions for my next pregnancy in the future? Do you think all problems I had during my first pregnancy will happen again? Is there a way to avoid them?
Thanks in advance,
az
March 31, 2009 at 1:38 am
Dr. Vajaya,
I have enjoyed reading this blog and the responses. Thank you.
I have had 2 second trimester miscarriages due to incompetent cervix. The first was a complete surprise. The second happened 3 days after a sono that measured my cervix at 4cm, and one day before the cerclage placement. I mention this because I am a clear example of how fast a cervix can change in length.
Good news! I am 16.5 weeks pregnant. The cerclage was placed 13 weeks 3 days. I stayed in full bedrest for two weeks before and after it just to be careful. At the time of the cerclage placement my cervical length was 4cm.
Today I went in for a cervical check and they found my cervix to be 1.5cm and holding at the stitch and funnleing.
My questions are:
1) Isn’t 1.5cm low for a cerclage? What possible reasons are there for such a low insertion?
2) I am now on p17 shots once a week. I have no symptoms of preterm labor. Is this just a precaution based on “well, we have to try something?” I’ll still do it either way, after all I gotta try something!
3) They said to take it easy. I said “What is easy”. They said “just take it easy”. I am tempted to stay in bed in trendelenburg position, except for fear of blood clots and muscle loss. What does “take it easy” mean?
4) I can’t find any stats on what my changes of going to term are. With a cervix of 1.5 with funneling is it accurate that I will most probably go into labor 31.5 weeks + or – 5 weeks if I am lucky?
5) Is this pregnancy in real trouble- or is my cerclage doing exaclty what it is supposed to do?
The baby is very active, strong and seems genetically fine.
April 5, 2009 at 8:51 pm
Hi Dr. Vijaya,
I’m back! After receiving good news of my cervix returning to 2.9cm, two weeks later (even with bed rest) my cervix has gone down to 1.9cm (at just over 29 weeks.) My doctor said if I reach 1.5cm he may admit me to the hospital. What do think about this? He said with the increased weight of the baby I was bound to lose more length, but an entire cm in two weeks is too much (especially since I am on bed rest.) Being in the hospital is the last thing I want, since I have an 18 month old son. I am just curious as to what your protocol would be for a patient like me (with no prior history or cervical issues.) I am also now taking Terbutaline (1.25mg every 6 hours…which he will increase to 2.5mg in two weeks) in addition to my 10 mg of Procardia every six hours and weekly Progesterone injections. I am so worried. I just want to make it to 36 weeks! (By the way, every one of my Fibronectin tests so far have come back negative.) I would like to get your opinion on my situation before something like hospitalization happens for me. Thank you for your time once again!
Sincerely,
Erin
April 8, 2009 at 12:19 pm
First of all, sorry for the prolonged absence from this forum! I am still here – just had a very busy couple of weeks!
Will reply to each of your queries individually …
Dr. Vijaya
April 8, 2009 at 12:26 pm
Dear Linchun,
You have not mentioned which week you are in .. 50% effacement is not bad in itself; sometimes women can go for 2-3 weeks with even 2cms dilation. However, if you are still not at term (37 weeks), it would be prudent to minimize exercises and activities. Short periods of walking around the house (along with periods of bed rest) should be sufficient to keep you active, and yet not precipitate further dilation and/or contractions.
Good luck,
Dr. Vijaya
April 8, 2009 at 12:48 pm
Dear Sharyn,
Again, sorry for the delayed response. Here are my thoughts -
1. Your internal US measurements are probably more accurate, and hence the ones to go by. The cervix does show some positive increases in length with rest, but not by the extent that you have written, and not in such a short period of time. Finally, sometimes internal measurements can cause more uterine irritation; so you may want to check with your OB if he/she would be ok to measure with abdominal US going forward.
2. You are doing enough with your restricted activities at this time. Even at 2.5 cms, modified bed rest should be sufficient, as long as the rate of reduction is not too rapid. Do ensure that while you are sitting, it is on slightly higher surfaces and not reclining backward, because coming to stand from both a low and/or reclined positions, causes increase in intra-abdominal pressures, which should be avoided in your case.
3. Progesterone shots are not really helpful at this time.
4. What is pelvic rest? I am hearing this terminology for the first time.
Hope this helps …please feel free to write in if you have any other queries, and I promise to be more prompt in my reply next time
Good luck -
Dr. Vijaya
April 8, 2009 at 1:02 pm
Dear Az,
CONGRATULATIONS!!!
And, thank you for the detailed update – it will most certainly be useful and encourage other expectant moms in similar situations.
As far as your other question – no there is nothing particular that you need to do (or not to do) in your next pregnancy. We do not know what precipitates many of the issues in pregnancy; and who knows – your next pregnancy may be completely “textbook”! Wouldn’t that be great! Obviously, your OB will maintain a much closer check on your cervical length measurements from early on. Another option may be to go in for a preventative cerclage between 11-13 weeks, which will give you a better chance to go through your pregnancy more actively.
Congrats again – Enjoy your baby!
Dr. Vijaya
April 8, 2009 at 1:16 pm
Dear (Prov)
1. Your cerclage placement is doing just what it should be doing. The sudden change in length also correlates well with what happened in your last pregnancy.
2. p17 shots are ok to take. They are given to sustain your pregnancy a bit better. They have nothing to do with premature contractions/labor.
3. “take it easy” is a real scientific term Unscientifically, it means avoid lifting anything, avoid straining at stools, avoid intercourse, and avoid too much walking as well as climbing stairs. Short periods of walking (up to 5-7 mins, slow pace) as well as occasional stairs are ok to do.
4. No, there is no accurate way to predict how far you will be able to carry your pregnancy. However, with the cerclage placement and no preterm contractions thus far, it is good news. I would suggest meditation and relaxation techniques, and looking forward 1-2 weeks at a time, so that you are not overly anxious.
Hope this helps – Good luck
Dr. Vijaya
April 8, 2009 at 1:25 pm
Dear Erin,
With 1.9 cms, you should be extra cautious about what activities you are doing at home. Are you still on strict bed rest?
Even if you get to 1.5 cms, this does not mean that you need automatic hospital admission. You could still manage it at home – However, if your contractions increase in intensity or frequency along with the increased shortening, you may have no other choice but to get admitted, and to be monitored more closely.
Finally, if you do get admitted, it does not neccesarily mean that you have to stay there for the remainder of your pregnancy. It may be possible to monitor you for a few days, and then discharge you if your cervical/uterine condition stabilises.
Hope this helps- good luck going forward
Dr. Vijaya
April 8, 2009 at 4:59 pm
Dr. Vijaya-
Thank you so much for your response. Great information and it is reassuring that my doctor is saying similar things. Pelvic rest is simply a nice way of saying no sex!!!
I do have another question. At my last visit three days ago, my cervix did measure at 2.7cm with an internal US. This is down 0.4cm from my visit two weeks ago. Is that too much of a drop? Is this dangerous for 28 1/2 weeks? My doctor does have me coming back next week for another check.
Also, he mentioned that I was funneling only slightly and that he was not too concerned about it given that I had given birth previously and for the fact that I was already on modified bedrest, so he did not place any other restrictions on me. I was not too sure what he meant by this and did some research on my own and everything I am reading tells me that when the cervix begins to funnel that strict bedrest is a must. I plan on discussing this with him at my visit in a few days, but should I be concerned and call him beforehand?
I am still experiencing the tightning of certain areas of my abdomen that last about 15- 30 seconds. Some days I get 3-4 in an hour or only 2 or 3 in a 24 hour period. Are these contractions and could this be causing the funneling and shortening cervix or vice versa? They are by no means painful just uncomfortable. My doctor says that this is okay as long as they do not become consistent and develop a pattern or occur more than 4 an hour. It just troubles me.
Thank you ever so much for your help. It is really appreciated.
Sharyn
April 9, 2009 at 12:17 am
Hi Dr. Vijaya, I’m back! Just wanted to give a brief update and get any thoughts/feedback you may have. I am currently 31.3 weeks pregnant. At 29.3 weeks my cervix was at 3.1 and today at 31.3 weeks it was 2.93. Not much change over the course of two weeks but I will admit that I begin to freak a bit when it drops below 3. My doc. wasn’t especially concerned by it. He said that basically it had held steady these past two weeks and my cerclage is in place and holding. Also, my baby is quite large, measuring 4lbs 15oz today, which I am happy about! I have been pretty miserable with constant contractions, about 6 an hour, and just getting huge, inability to sleep, etc… I am currently (and have been for two weeks) taking 10mg of procardia and 2.5 mg of terb every four hours. Even with the meds I contract. Today, my doctor said that there was no need to increase meds, move to the terb pump, do an ffn test, or get steroids for baby’s lungs; I asked about all of these things.
I guess I am just looking to get some feedback from you now. If I were your patient, what would you do with me at this point? Also, being that I constantly contract what would your advice be in terms of when to go to L&D? If I followed the standard protocol of “more than 4 contractions per hour” I would be there daily. Thanks so much for your input!
Heather
April 13, 2009 at 5:57 am
Sharyn,
At 2.7 cms, just the precautions that you are taking should be sufficient. In case of further funneling or drop in lengths you may need to be more strict with your bed rest.
We can really not say for sure which leads to what – contractions giving rise to shortening or shortening irritating the uterus, or both happening concomitantly. Some mothers go through shortening, but barely any contractions at all; and some have just an irritable uterus with contractions happening, but no signs of cervical shortening, funneling or effacement. However, do keep monitoring them, and in case they become more than 4 times per hour ( some hospitals use 6/hour as a guideline), they active management would be recommended.
Good luck -
Dr. Vijaya
April 13, 2009 at 6:06 am
Dear Heather,
Welcome back!
I think everything is going as well for you as can be expected at this juncture. I am very happy with your cervical length at 31+ weeks, and that your cerclage is doing what it is meant to do.
Except monitoring regularly and adjusting med dosages as needed, I would not recommend anything else either. There is really no point in going to L&D at this point in time. Nothing different will be done in terms of managing your condition there versus being at home – which I think is a whole lot more comfortable than being in the hospital.
Hope this answers all your queries.. Good luck!
Dr. Vijaya
April 13, 2009 at 8:45 pm
Hello,
I am a 30year old G3P2 and currently 13w3d pregnant with #3. My history is as follows:
First baby: 19 week CL of 3.0cm, no follow up. 29 weeks, PTL, terb given, FFN negative. Manual cervical exam noted “shortened cervix, but closed”. Dilated at 34w to 2cm/80/0. Induced at 37.0 weeks due to AFI less than 5. 4cm/90/0, and 4.5 hour labor with induction.
Second baby: Contractions early 2nd trimester. 19 week u/s showed CL 1.5cm with funneling membranes. They placed emergent cerclage, and CL remained at 2cm throughout pregnancy. Used procardia for irritability. Cerclage removed at 36 weeks, dilated immediately to 3cm/80/0 and stayed there for 6 days. Delivered at 36w6d in 2 hours.
Now pregnant with #3. Moved from DC to Maine, and have whole new team of providers. They are aren’t convinced I need a preventative cerclage, but want to avoid an emergent cerclage down the road when the risks are higher. Since I have two girls, ages just 3, and 16 months, and can’t really be on bed rest, they are thinking the cerclage is the best option for me.
I am in agreement for the most part, but I am wondering how necessary this is. The consensus is that I probably have a normally short cervix, but we are unsure if we want to take the risk. I have no history of miscarriages or losses.
April 14, 2009 at 10:26 pm
Dr. Vijaya,
You have to know that this site is amazing and a true gift for someone like myself and obviously for all of the women that you have helped here. I would so appreciate it if you could answer a few of my questions so that I to can be rest assured in my pregnancy journey. Here is a brief run down of my history.
1. Years ago when I was in my early 20’s I had a LEEP and Cone procedure on my cervix. I Later on I got married and at 29 years old got pregnant (last March) I had a rough pregnancy from the start. I had hyperemisis until the 14 th week with on and off spotting. Baby was however great. and healthy. All was well until my 18th week when at my anatomy scan my CL was down from 4.0 cm to 2.0 cm. I pleaded for a cerclage but my Peri decided to watch and wait, Well sadly it was too late and at 19w2d my membranes ruptured and I was admitted to the hospital with antibiotics and held off labor for 20 days. I lost my little girl as she was just to premature and with the lack of fluid she was born still. It twas devestating to say the least and still gieve so hard over her.
2. I am now pregnant again and THIS time my peri put in a cerclage at 13.5 weeks, The pregnancy has been great so far in respect to no hyperemisis and I feel well. I started P17 shots at 16 weeks and take Lovenox for a slight clotting disorder, At my 18 week anatomy scan we discovered that we were having a lil boy and all looked well. As far as my CL an ABDOMINAL U/S SCAN was done with a full bladder and the length was 4.5 cm.
3. Today at my 21 week visit a TRANSVAG U/S was done and the length was down to 3.3cm. *worried*
4. Dr. Vijaya, Could you please explain to me how in just two weeks I am down a centimeter with the cerclage? I know that the first U/S was done abdominally and the second one was Vagianlly but why the big difference (4.7 to 3.3)
5. Which one is more accurate? abdominal u/s with a full bladder or vaginal u/s with an empty bladder? Is my cerclage failing? The CL has changed in just two weeks….???? Is a 3.3cm length worrisome to you at only 21 weeks withe my history of rapid change?
I have put myself on bedrest since the cerclage and for the most part I get up just to use the bathroom and eat. I do however sit up (is sitting up ok). I know I seem worried and I am. I dont know what I would do if I lost another baby. Also, what is your opinion on how often I should be going in for cervical length checks? Bed rest and what not???
Thank you so very much and I really look forward to your answer…
Tera
April 15, 2009 at 6:06 pm
Dear Steph,
I really do think cerclage would be the way to go for you. If you look at how consistent your shortening, uterine irritability (PTL in st pregnancy) and rapid effacement and labor/delivery have been through both your previous pregnancies, it makes no sense to wait for things to get worse before you take action.
As you point out, with two other children, I am sure you would want to be as mobile as possible, without having to worry each time what it is going to do to your cervix.
I would think that the benefits having a preventative cerclage in your case, definitely seem to outweigh the risks.
Hope this helps -
Dr. Vijaya
April 15, 2009 at 6:33 pm
Dear Tera,
First of all, congratulations on your pregnancy!
I cannot pretend to even fathom what it must be to go through a loss – you are a wonderful courageous mother-to-be, going through what is obviously an anxious time in your current pregnancy.
To answer your queries-
1. Sometimes, there is really no explanation for why there are such wide differences seen on abdominal and trans-vaginal ultrasounds. It makes sense to stick to either one or the other, so we can have some consistency in measurements.
2. In women with cerclage placements, the trans-vag US is probably more accurate. However, we have also had many moms with irritable uterine contractions after internal US. So, which method to continue with would vary depending on how the mother does after her internal US.
3. 3.3 cms by itself is not bad. If further internal US shows more dramatic shortening, only then we can comment on how well your cerclage is holding up. Right now, we may be comparing apples to oranges – or at least Washington apples to Granny Smith apples.
4. Am I correct in assuming that you are not having any uterine contractions/irritability? Without this, you do not need to be on strict bed rest precautions. Avoiding lifting things, avoiding sexual intercourse, avoiding increasing intra-abdominal pressure as in straining at stools, decreasing number of times that you take the stairs and generally avoiding coming up to stand from low surfaces, should be all the precautions that you need at this time. Further limiting your activity levels may lead to unnecessary loss of muscle strength/tone.
5. With your history, it would be worthwhile to get a check-up with your Peri once in every 2 weeks.
Hope I have answered all your questions ..
All the very best to you!
Dr/ Vijaya
April 15, 2009 at 7:37 pm
Dr.Vijaya,
Thank you for the quick reply. As I lay here resting I have been checking in for your reply and i am so thrilled to get a response. This site is a miracle and I wish you could be here as my Dr. or at least for a hug. Your caring and compassion is so what I needed.
I wanted to ask after reading your reply… is Cerclage effective? As the baby grows I am assuming the cervix is supposeed to shorten with the Cerclage correct? Once shortening gets to the stitch does all shortening stop? Even with a cerclage can my lCL get lets say down to a 1.0 and still be OK, or will the cerclage rip? Is that likely?
I guess I am just very confused on the Cerclages role…I have a very busy Peri who is not into answering my “dumb” questions which makes it so much more harder. S you have no idea how much your insight meas to me.
Also, in reply to your question, no I dont have contractions or irritablity after the TVU (knock on wood)I will continue to get serial TVU’s. I worry about infection so I take a probiotic ( thoughts on that)?
My reasoning for taking it very easy as I am is to get through the danger zone of the 18-22 week mark, which I have one week left, but am resting and trying to make it to get for the ffn test. Like you sugested, I make weekly milestones and i have a big poster counting down each day til my next milestone.
I will post my updates
Thanks so much.
you truly ae a God send to woman like me
who have faced so many challenges just tring to be a Mother.
I am so glad that I am in good company here
P.S. where can i read about you and your background…very interested
Tera
April 16, 2009 at 1:17 pm
Dear Dr Vijaya,
I came across this website as i was doing my research on incompetent cervix and i must say your comments/advice/answers have been comprehensive more than all other material i’ve read.
Having said that, i’m 31 yrs old and i’m 17 weks pregnant.
Previously i have lost two babies.One at 18 weeks and the second at 22 weeks.In the first pregnancy i woke up and my waters were leaking.The second one i went to my OB with protruding membranes and both with absolutely no pain or contractions at all.
Consequently, i have been diagnosed with a classic case of IC.
This time round my OB put in a cerclage at 12 weeks.I was on moderate bedrest for two weeks and after that i’m now back to working.
Having given my background, i have some concerns which i hope you’d be kind enough to address and hopefully it can also be of help to women going through IC.
1.My work involves sitting for long hours:9 hrs.Is this healthy for me? is sitting better off than standing?
2.My office is on the mezannine floor(no access to lift) and i usually have to use the stairs about two trips a day.Is that safe considering my condition?
3.When i had my cerclage at 12 weeks my OB prescribed no antibioticts and even when i requested he said i dont need them.So far everything has been fine but i’m very scared because i’ve come across many cases of infection.Should i be concerned?
4.I have also been diagnosed with multiple uerine fibdoids measuring between 1.5-2.4,am.Does this make my IC case worse?
5.So far my cervix is closed but short.Measuring 2.5 cm.Is this too bad at 17 weeks
I hope to hear from you soon Dr.And once again your comments have been of immense help to me and i believe to many others.
Nina
April 16, 2009 at 6:37 pm
Hello Dr. Vijaya,
I just saw my dr 3 days ago, I am 20 weeks. My cervix has shortened to 2.9cm, I had a LEEP almost a year ago my doctor only advised me to rest and I will see him again next week. I am nervous that rest alone might not work… Is there anything else I can do? Or something I should ask my doctor to do?
Jessica
April 16, 2009 at 9:29 pm
Dear Tera,
You are welcome! Ultra-long distance hug to you!
The nature of cervical shortening is such that sometimes the cerclage works super-effectively, and mothers go post-dated into labor, post removal of cerclage! In other cases, no matter what you do, even with a cerclage, pre-term labor can start. Unfortunately, there is just no way to know for sure if cerclage will be 100% protective in a particular mother.
To answer your particular question, your cervix can get really short and hold up, provided there are no uterine contractions at that point. The efficacy of the cerclage can become much lesser with constant pre-term uterine irritation/contraction. Having said that, many a mom has held up with cerclage, uterine contractions and medications all the way to term. So, overall – when done under appropriate circumstances (yours definitely qualifies as appropriate), the cerclage has a good chance of doing what it is meant to do.
I have one question though – why the Ffn? Without signs of PTL it is unlikely that Ffn will be positive. Is it just being done to cover all bases, because of your previous history?
Countdown is a good way of keeping your spirits up! I know it sounds crazy, but sometimes it is good to try and look at all the positive aspects of your pregnancy; that way you are also counting up to something. Along side your check off calender, each day try and write one positive thing about your pregnancy to your baby – perhaps one day you can share them with her/him.
All my good wishes to you – chin up and cheers!
Dr. Vijaya
April 16, 2009 at 9:50 pm
Dear Nina,
I am so sorry about your previous losses, and am really glad that you have had a preventative cerclage put in this time, and that it is holding up reasonably so far.
2.5cms at 17 weeks is borderline on the shorter side, but with your cerclage, it should hopefully hold up.
To answer your other queries:
1. Prolonged sitting really does not have anything to do with cervical length. However, as with any pregnant mom, I would not advise sitting continuously for more than a half hour at a time. You need to get up and move around for a bit, so that you promote circulation and decrease incidence of backache, especially as your tummy grows. We also know form experience, that if you sit in semi-reclined or backward tilting positions (as is done by leaning back on office chairs) for long periods of time, it predisposes you to carrying your baby in a posterior position, which then prolongs the length of labor. So, ensure that while sitting, you use a pillow behind your back and sit as straight as possible, and ensure small stretch breaks every half hour or so.
2. For now, your staircase trips are ok. In case there is any dramatic shortening in your next visits, then we can revisit this issue at that time.
3. Antibiotics at 5 weeks post-cerclage, are not required. If any infection were to set in, it would have happened by now.
4. Uterine fibroids can place more stress on an already compromised cervix, if they are big. It looks like your fibroids are comparatively small in size, and so should not cause you too many issues, unless they grow bigger during your pregnancy. Again, you would have to wait and watch as your baby’s weight increases, as to the combined effect of that and your multiple fibroids.
Hope this has helped – Good luck!
Dr. Vijaya
April 16, 2009 at 9:52 pm
Hi Dr. Vijaya,
Wanted to update that at 32.3 weeks my cervix measured 4.1….yippee! This is even with non-stop contractions. I am beginning to allow myself to be hopeful even though, truthfully, the worry will not cease until I hold my baby and know she’s OK……and, actually, that’s probably a lie too, because I have a 10 year old who I still worry about, but now I’m straying from the point a bit Anyway, just wanted to check in. I read all of the questions and posts that come in here and I appreciate all of the info./advice that you offer.
Heather
April 16, 2009 at 10:02 pm
Dear Jessica,
2.9 cms at 20 weeks is not that bad at all. In fact, if it were not for your previous LEEP procedure, I wouldn’t be even inclined to put you on bed rest. Research shows that no restriction of activity is needed at this point.
Having said that, in case there is further shortening at your next check up, you would have to take the bed rest advise seriously and restrict your levels of activity depending on the amount of shortening seen.
Cerclage at 20 weeks plus is not really recommended in women with 2.6+ cervical lengths, and with no previous history of second or third trimester losses. Having a cercalge doen at this stage in your pregnancy can actually trigger uterine irritation and this is something that you don’t need.
So, all in all your OB is doing all the right things; he will need to monitor you every 2-3 weeks for the rest of your pregnancy.
Good luck -
Dr. Vijaya
April 16, 2009 at 10:13 pm
Dear Heather,
Great going I am sure other moms reading this can take heart .. non-stop contractions, and cervix is still holding up! You must be using all your mental strength to tighten that cervix and hold it!!
I know about the worry part – I have a 11 year old and a 9 year old; only the focus of the worry changes – anyways they will be all grown up soon.
Thanks for the update … good luck!
I am going to sleep for a few hours .. it’s 3:45 am in the morning on my side of the world!
Dr. Vijaya
April 17, 2009 at 10:08 am
Dear Dr Vijaya,
I cant thank you enough for your response on my queries.I was soooo excited when i saw it!
I’m a big fan of yours and the first thing i do when i get online is to look up any new postings.
Will keep you updated on whats happening to me.
Nina.
April 17, 2009 at 3:24 pm
Dear Nina,
Most welcome ..
Yes, please keep us updated and feel free to write if you have any further queries, concerns, or just to let us know that all is going along well!
Dr. Vijaya
April 20, 2009 at 11:47 pm
Dear Dr. Vijaya,
This website has been such a wonderful resource! I wanted to get your opinion on my case. I am 21 weeks along with my second child. I had a miscarriage at 5 weeks before my daughter who is now 3 and had a missed miscarriage that necessitated a D&C. I went into preterm labor with my daughter at 35 weeks, but after a shot of terbutaline she held on for 2 more weeks until my water broke at 37 weeks. After 12 hours of pitocin and contractions, my cervix never dilated and I had to have a c-section to deliver my daughter.
After my daughter I suffered 2 more missed miscarriages. One at 12 weeks and the other at 6 weeks. I had to have D&Cs after both of them after waiting for a month for each to pass after fetal demise. It was difficult.
For this pregnancy, at my 18 week anomaly scan the dr noticed that my cervix was “short” at 3.3 cm with a slight bulging/funneling of the internal os. Since then I have been going weekly for transvaginal scans to and external scans to see if my cervix is shorter and it has stayed the same. I have been on modified activities since 18 weeks.
Should i continue weekly checks on the cervix if it is showing 3.3 cm? IIs 3.3 cm short at 21 weekss? Is there a danger of incompetent cervix because of the 3 D&C’s? My dr seems to think that if the cervixis the same at 22 weeks then we can go to every 2 week checks and then just worry about pre-term labor and not IC. thanks for your thoughts on this!
Annie
May 4, 2009 at 7:02 am
Annie,
I think you are on the right track with your OB’s recommendations. 3.3 cms is really not “short” as in “cause for concern”. However, due to your previous history greater monitoring is definitely worth it, until you get to 22-24 weeks. After that, every 2-3 weeks of monitoring should be pretty much what would be required.
Hope all goes well for you: All the very best!
Dr. Vijaya
April 23, 2009 at 3:42 pm
Dear Dr. Vjaya,
I am writing on behalf of my wife. We are 22 weeks pregnant and received word last week that my wife has a shortened cervix. The measurement was 2.5cm, cervix is closed, and there is was no signs of funneling. What we were told by our doctor was that this is a borderline case. She actually even indicated that we have the option of putting in a cerclage, but from everything I have read, it seems this is a risk not worth taking at this point. What is your opinion? My wife has been remanded to bed rest, with the exception of getting up to go to the bathroom and shower. Is this really necessary at this point and how does this exactly help? Are we still at risk for pre-term labor? We have decided to switch care to a high-risk OB/GYN as we feel they are more qualified to direct us through this. Would you agree? Please tell me what you would prescribe at this point and how often should her cervix be measured? Finally, at what week when can a FFN test be performed? Thank you so much for your care and help.
May 4, 2009 at 7:26 am
Hello Sam,
2.5 cm is borderline short. With no previous history of procedures or miscarriages, monitoring every 2 weeks would all that would be required. Switching to a high-risk specialist is not an absolute requirement, but probably makes sense, in case the condition requires more stringent monitoring due to decreasing cervical length.
At this point, just reduced physical activity is ok to follow – this means: that your wife can walk about in the house, but should avoid stairs, long periods of standing or sitting, lifting anything, as well as coming to stand from low furniture. She should avoid straining at stools and anything that increases her intra-abdominal pressure. Barring this, strict bed rest at this point is not really needed. With further check-ups, in case there is more shortening, she can be on complete bed rest at that time.
Finally, with your wife’s current status, Ffn is not really needed. Only if the cervix shortens remarkably, and starts to dilate, or your wife starts having symptoms of preterm labor, would an Ffn need to be done.
Hope this helps ..
Dr. Vijaya
Dr. Vijaya,
Thank you very much for your response. We definitely found it helpful. We are no under the care of a high-risk doctor and will be measured every week. Our measurement this week came back at 2.8cm. So the cervix actually lengthened from 2.5cm a week prior.
It was our understanding that cervix can not lengthen but only stay the same or shorten. Does bed rest help to lengthen it as well?
Finally, how reliable are the cervical measurements taken via the ultrasound? Is it possible for the tech to get it wrong and we actually are still at 2.5?
Thank you again so much for your guidance.
Sincerely,
Sam
April 27, 2009 at 5:26 pm
hi doctor im 27 weeks pregnant and have a cerclage placed in since 12 week because of imcompetent cervix and pretem labor and preterm birth.A week ago the doctor said my cervix is thinning already even with the cerclage in place im having alot pain in my private area and a lot of pressure and lower back pain my first was born at 27 weeks because the water broke even though i dont know why probably because my cervix couldnt hold and i had a cerclage with her to i was just wondering what do you think are my chances of the same thing happening again with this baby. my doctor checks me but says that its thinning but its still closed im just worried because my first was born early at 27 weeks and dont know what to expect with this baby thanks ahead of time
May 4, 2009 at 7:33 am
Dear Zuleyma,
Sometimes, in spite of all we do, the cervix continues to thin out and dilate, and/or the bag of waters breaks. I would just recommend very strict bed rest, and following all the precautions that your OB recommends. Are you having check ups weekly?
I wish I could be of more help – but I think other than resting and monitoring yourself very closely, nothing more needs to be done at this point, esp since you already have a cerclage in place.
Good Luck – please do write if you have any other queries or concerns ..
Dr. Vijaya
April 28, 2009 at 11:55 am
Hi Dr Vijaya,
I wrote to first about two weeks ag(April 15th) seeking your opinion.
I’m currently 1 day shy of 19 weeks having had a macdonald stitch done at 12 weeks.So far all has been well-knock on wood except for a few concerns which hope you can address.
1.I’ve not had sexual intercourse since the cerclage.Lately i’ve been having orgasms in my sleep causing me alot of tightening around my stomach,accompanied by contractions which i can feel around my cervical area causing me a very uncomfortable feeling which i can describe almost as pain for lack of a better word.I’n very worried about this because i have a feeling it could have contributed to my earlier rupture of membranes at 18 weeks when i woke up ina pool of water.I spoke with my OB regarding this during my 17 weeks appointment and he seemed to down play my concern.However experience has taught me to heed my inner voive and thats why i’ve had to talk about such intimate details in this forum because i need someone else opinion.Dr, have you by any chance come across this or are you familiar with this?
If i were you patient,what would you recomend?
2.At my 12 week ultrasound my CL was 2.5cm.This last friday i went in for onother U/S and this time round my CL was 2.05cm(initially the Dr did a normal one which showed 1.6cm but i insisted on an intra vaginal one which read 2.05cm).Should i put myself on moderate bedrest or can i still continue working 5 days in a week?
Is there any risk of getting an infection from having an intra vaginal U/S as opposed to the normal one?
Being a day shy of 19 weeks i know i’ve entered the danger zone(i’ve had 2 losses between 18-23 weeks) and i’m very scared.Sometimes i wish i could just hibernate and resurface after week 24!.I hope you can understand my fear/concern and help be the best way you know.
Awaiting your most honest response Dr Vijaya.
Nina.
May 4, 2009 at 7:41 am
Dear Nina,
Sorry for the delayed response. We have had a few high risk moms in our hospital, which have been leaving me with time for little else. We have also started our own birthing center, dedicated to natural childbirth, and this has taken quite some time and effort to get things into place.
To answer your questions:
1. Yes, and no. Yes, I have heard some of my expectant moms talk about not only vivid dreams and nightmares during pregnancy, but also of orgasms in sleep. Typically though, it is more towards the end of their pregnancy. However, I have not had anyone have uterine irritability, repeated contractions or breaking their bag of waters as a result of this.
2. At 2 cm or so, you should be monitoring yourself extra carefully, and would recommend that you be on modified bed-rest. Which means that you can walk about in the house for very short periods of time, should avoid stairs, long periods of standing or sitting, lifting anything, as well as coming to stand from low furniture. You can be semi-reclined on the bed for short periods of time, and alternate between this position and sitting, along with lying down. Have lots of fluids as usual. A dehydrated uterus is not a happy uterus and can start getting irritable. And, get your check ups done every two weeks.
3. Going to work at this point, does not seem like a good idea; work form home if you can. It makes sense to take the maximum precautions at this stage, especially considering the time period within which you have had your previous losses.
As always – cheers and all the very best..
Dr. Vijaya
May 2, 2009 at 9:38 pm
WE HOPE OUR STORY INSPIRES AND GIVES HOPES TO MANY ON THIS FORUM >>>>
Just wanted to do our 2 cents for this forum by posting our experience with this forum and how it kept our hopes alive. So here is our story in nutshell.
Till 21st week our pregnancy was cruising till we went for our 3 month US where the technician pointed out that my wife’s CL is 1.4 cm.
OB puts my wife on complete bedrest was not very hopeful about the pregnancy in general. My wife was shattered and we almost gave up hopes.
Wife was put on Niphidipine and progesterone shots. Was the best thing that happened to us. Niphidipine proved very useful in our case and so did the shots i suppose.
Come 26th week our OB switches hospital and we followed her and the new High Risk specialist thinks the CL is normal ie 3.5 cm and closed. The first C-section mark was misunderstood by the technician and Cervical Shortening.
Several close moments where wife’s would have back pains and tightness of stomach plus all the complications resulting from bed rest. Week after week passes by and we finally reach 36 weeks and wife is finally 3 cm dilated. Pregnancy continues till 39 weeks and our beautiful baby boy was born April 20th. Cant thank enough Dr Vijaya and everyone on this forum for all the tips and assurances that kept our hopes alive in this long and bumpy ride. A big thank you!
Nick
May 4, 2009 at 7:38 am
Hello Nick,
First of all Congratulations to you and your wife!
I know how hard it is for families to go through a high risk pregnancy, so I must say, hats off to you all who sustain your hopes and energies and go through what is definitely a trying and often tiring process.
Thank you for coming back to this forum and updating us – it is stories like yours which help other families in similar situations to get the courage and the strength to go through their pregnancies with hopefulness.
Also, thank you for your kind words. It is always my belief that the more the mother and father feel supported during the antenatal course (high risk or not), the outcome for both baby and mother become better, come time for labor and delivery. This forum, is really a very small part in trying to give some amount of that support.
Cheers and good wishes to you all..
Dr. Vijaya
May 3, 2009 at 7:40 am
Dear Dr. Vijaya
I found this page by checking the Internet for the issue of short cervix. I found your answers really helpful and since I am living in China far away from my home in Switzerland I’m always a bit helpless with all the questions and worries I have about my pregnancy.
I am currently 24 weeks pregnant with my second baby. I had my first daughter in February 2008. With my first pregnancy I felt fine until about week 28 when I thought I had a lot of contractions and got checked out. My cervix was 1,5 cm and soft. They put me on bed rest and gave me terbutaline 2,5 mg oral. My contractions never stopped – I had them about every 10 minutes sometimes even more. I had another measurement of he cervix at week 36 and it was still 1,5 cm. I stopped the medication and got of bed rest by week 37 and had my daughter at 39 + 3 days. Labor was 5,5 hours.
Now with my second pregnancy the contractions started around 19-20 weeks – now at 24 weeks I have about 4 sometimes more contractions or uterine irritability – I don’t know what I should call it – per hour. They are the same contractions as in my first pregnancy – painless tightening of the uterus. Mostly more on the right side than the left side – also like the first time. They measured my cervix abdominal at 18 weeks 3 cm, at 21 weeks 4 cm (I had a full bladder then which I didn’t the first time) and at 23 weeks 2,75cm – but this time they didn’t measure abdominal but vaginal bit not inside my vagina just from the outside – I think they did it this way since I had an empty bladder. What measurement do you think I can count on? I’m really confused about this different numbers since I was so happy with the 4cm at 21 weeks.
I started with the terbutaline oral again but it doesn’t seem to help – like it didn’t help in my first pregnancy with my contractions/irritability. I’m not sure if I should take the medication anyway or if my uterus is just contracting and I have to get used to it. It is really hard for me since I always concentrate on the tightening to see how much I have per hour.
They didn’t put me on bed rest but said to take it easy and lay down often. What do you think should I be on bed rest more strictly? I am just afraid that I don’t do enough to calm down the contractions. Have you heard of a uterus just contracting all the time and never stop until delivery? I asked this my doctor here but she said that she didn’t have a case of uterine irritability from so early on.
She also checked my cervix last time at week 24 and said that it was kind of soft. Is this really bad or can it be soft anyway since it is my second baby and it was soft the first time too?
We also would like to travel home in 4 weeks – do you think this is a problem if the cervix stays stable?
Thank you so much for you answer. I just feel so alone with my problems sometimes.
Susann
May 4, 2009 at 8:01 am
Dear Susann,
1. There are many moms who go through this uterine irritability and do just fine, just like you did the last time around! (Also read Heather’s entries on this forum – I think you will find a lot of similarity in what you are going through).
Sometimes, I wish we could just leave expectant mothers like you alone and not give any instructions for medications/ bed rest and see how the pregnancy progresses. Truth is, we cannot do that, and we have to try and do our best to ensure that these contractions do not intensify and predispose you to preterm labor and/ or fetal distress.
2. Meds may or may not have any eff\ect on the degree of irritability. So you have to ask your OB to perhaps play around with your meds and see which one works best to decrease the irritability for you. Nifedipine would be one option, which has worked out well in many moms. One of the things that would have to be monitored with this, is your blood pressure since it can become a bit low at times.
3. Cervical length measurements – I would any day go with the full bladder measurements. Having said that, the more accurate measurement can be obtained intra-vaginally, but has to be done by a skilled technician and be read by a good sonologist/ high-risk specialist. Whichever way you go, I would keep it constant – so that you know how stable your cervix is.
4. Even if we go by the 2.75 measurement, at this point there is no need to restrict activity. Just be careful to not overdo physical activity, take ample rest, and avoid sexual intercourse for a few weeks until you know how stable your cervix is. In case, the length shortens further, we can then think about reduced physical activity or modified bed rest.
5. If your cervix remains stable, and more importantly, your contractions do not intensify, then there should be no harm in traveling home. Your OB may prescribe some tocolytic (muscle relaxant) a day before the start of your journey, to be continued until you are back home to avoid increase in contractions while you travel.
Hope this has helped –
Dr. Vijaya
May 4, 2009 at 12:40 pm
Dear Dr. Vijaya
Thanks so much for you answer. It made me feel much better and hopeful that I can do it again. Some days it is really hard to remember how I did this the last time.
I will have my next appointment on May 18th and will keep you posted.
Thanks again
Susann
May 4, 2009 at 7:56 am
Dear Dr Vijaya,
Thank you for your response.
I’m scheduled to see my OB this coming Wednesday.Currently i’m not on any medications.Is there some medication you would recomend for me considering my condition?
Thanks so much for everything.
Nina
May 4, 2009 at 8:07 am
Dear Nina,
No, not really. Since you do not have any signs of preterm labor (great going, keep it up!) it does not make any sense to put you on any meds at this time.
Please come back and update us after your check up.
Good Luck!
Dr. Vijaya
May 4, 2009 at 4:13 pm
Hello Doctor, Vijaya,
I am 21 weeks pregnant with twins. I’ve had two UTI’s and currently on amoxicillin. I went in to the doctor and they said my cervix is 3.2 and a pelvic exam showed it hard. What is the “normal” and safe cervical length for someone with twins? This is my first pregnancy. The UTI is causing pain in my abdomen and tightening. They said once clear the UTI, this should stop. Is this true? Should I be concerned that the UTI can cause preterm labor? Thank you very much. Laura
May 4, 2009 at 7:29 pm
Hello Laura,
3.2 cms at 21 weeks, with twins is very reasonable. No softening of the cervix further indicates that it is not predisposed to thinning and dilation at this point. This is good news. Once the UTI clears up, there should be no further irritation, and therefore not much chance of preterm labor. Having said that, many mothers with twins pressing on their cervix will go into preterm contractions even without the UTI. But, an equal number of mothers have no such symptoms as well! So, we will have to wait and watch in your case. With no other predisposing factors, you have a good chance of all this clearing up once your antibiotic course is complete.
Hope this helps ..
Dr. Vijaya
May 4, 2009 at 4:46 pm
hi and thanks Dr. Vijaya for your response well i go once a month and im very worried because i have alot of pressure in my area and alot of back pain at times i feel like i have to use the bathroom but when i go nothing i just feel alot of pressure in my area and alot of tighning (sorry for the spelling) in my uterus and my belly is always rock hard. im very uncomfortable cant sleep at night and my doctor every time i tell him about my concerns just doesnt seem to care. i believe i should be seen weekly or every two weeks but he doesnt think so. he didn’t tell me to be on strict bed rest just to try and hold at least until 30 weeks even though he wants until 36 i dont know what to do i dont trust my doctor and dont think somebody else would see me due to the fact that im almost 7 months. what could i do? i would appreciate your opinion thanks
May 4, 2009 at 7:42 pm
Dear Zuleyma,
Having constant tightening and hardness in the belly is not a great sign. Are your being monitored with a CTG? With continuous hardening, the baby can get into fetal distress, and the reactivity patterns on the CTG monitor can often be a good indication along with a biophysical profile. You should ask your OB about this.
Secondly, are you on any medications? With your current set of at least a trial of meds would be warranted.
Finally, if your doctor is not responsive to your concerns, I would think it is time to change to someone else. It is your right to look for a care provider who not only listens to your concerns but also does his/her best possible to address them and give you true informed consent for all that they try or do. If you do not change now, then when?? Most providers will accept patients at any stage of pregnancy. And, in my experience, mothers who are strong in expressing their opinions, are the ones who receive the best care. It is your body and your baby. If you feel that you are not receiving optimal care and attention, demand it!
Sorry to sound so opinionated, but I have very strong feelings about quality of care, antenatal counseling and true informed consent …
If there is anything more that I can help you with, please do write.. Good Luck!
Dr. Vijaya
May 4, 2009 at 6:07 pm
Hello Dr. Vijaya,
I just wanted to send you an update- your comments were very helpful to me when I went on bedrest at the beginning of January due to a shortening cervix and irritable uterus. I ended up in the hospital for the final two weeks of the pregnancy due to pre-eclampsia, but after 102 days of bed rest, delivered two healthy twins via c-section at 36 weeks 2 days on April 19th! My daughter Amani weighed in at 5 lbs 3 oz and my son Karim at 5 lbs 1 oz. Neither needed any time in the NICU and they are both at home with me now, gaining weight and doing great!
Thank you so much for providing this wonderful resource and taking the time to answer questions and give support. It is much appreciated!!
Warmly,
Paula
May 4, 2009 at 8:11 pm
CONGRATULATIONS … PAULA!!
How wonderful that both Amani and Karim are both doing great!
Having known your condition from almost 23 weeks, it feels great to have you back and post an update .. and such a wonderful, positive one at that! 102 days of bedrest .. wow .. and it all paid off in the end. I am sure many mothers on this forum will take heart from your experiences.
Good Luck, new mommy! Enjoy your babies
Dr. Vijaya
May 5, 2009 at 1:19 pm
Dear Dr Vijaya,
I’ll just go straight to the point to save on time.
I have come across the 17p-Alpha hydroxyprogesterone caproate which i gather is a form of the hormone progesterone.My question is,is it any different from regular progesterone medication?
The reason i ask is because i would like to know if i should be specific when asking my doctor on his opinion regarding putting me on it or will any kind of progesterone do?
I have my 20 week appointment this coming Wednesday and would as always want your input on this.
Many thanks.Nina
May 6, 2009 at 4:29 am
Dear Nina,
Any form of progesterone will do just fine. Progesterone just helps with sustaining your pregnancy and is used as a pregnancy insurance. Sometimes it helps, and at other times it is not so effective, but it gets prescribed just to ensure that we are doing everything we can to protect the pregnancy.
Good luck with your appointment.
Dr. Vijaya
May 6, 2009 at 12:54 pm
Dr. Vijaya,
Thank you for your reply. I have had an update and wanted your opinion on it. At my 22 week appt last week my cervix funneled more and it was measuring 2.2 cm, My dr. was alarmed and ordered a fetal fibronectin test (which was negative) and I am now on 17p shots for the next 10 weeks. He ordered strict bedrest that day and had me come in the very next day for a NST and another measurement. It measured 2.8! In one day! Does that make sense?
Anyway, I was on strict bedrest all week and I went in for another measurement yesterday and it was the same, 2.8 at 23 weeks 3 days. He will be ordering another fetal fibronectin test next week. My Dr. thinks I will be out of the woods with IC after next week and we only have to “worry about preterm labor.” Does that make sense to you??
Thank you so much for your thoughts – I greatly appreciate any advice you can give.
Annie
May 13, 2009 at 9:36 am
Annie,
At 2.8 cm, all you will need to do is take care not to overdo physical activity in terms of stairs, squats, sitting/standing up from low furniture. Rest, you need not even be on strict bed rest. We often find that mothers get extremely deconditioned, have backache and develop pelvic ring pain with strict bed rest. So, we avoid it unless the measurements are alarming.
As fro Ffn, I am not sure what prompted him to do this test. Again, except in cases of extreme shortening or symptoms of uterine irritability, Ffn is not really required. In any case, it is good that it is negative. You do not have to worry about PTL at this point at least.
Just getting monitored once every other week would be the research recommended protocol, if your cervical length holds around the 2.6 or above mark.
Hope this helps ..
Dr. Vijaya
May 12, 2009 at 9:57 am
Dear Dr Vijaya,
I saw my OB for my 20 week appointment and he prescribed deanxit.I googled its uses and i’m confused as to why he prescribed this.
Would you have a reason as to why i was put on this? i’m yet to start taking the medication.
Many thanks.
Nina.
May 13, 2009 at 9:39 am
Dear Nina,
No idea!!
It is an anti-anxiety medication; and unless you are having severe symptoms of prenatal anxiety/depression, it does not make sense to subject you or the baby to it.
Did you not ask you OB as to why he prescribed it?
Dr. Vijaya
May 13, 2009 at 10:38 am
Dear Dr Vijaya,
I did ask what it was meant for and was tolt will help me relax.
However when i googled i had serious reservations about it.
The only thing i told my OB is that i’m very scared of these coming weeks, and rightly so! i’ve had 2 previous misfortunes.
Anyhow my insticts already told me i dont need that medication and i’m glad you have affirmed my sentiments.
I’ve noticed my doctor is really into medication,anytime i see him he must prescribe.
Will keep you posted.As always, many thanks.(wish me luck-i need to get to my next milestone which is 24 weeks!)
nina.
May 14, 2009 at 6:32 am
Dear Nina,
All my very best wishes to you … keep up your spirits, do some meditation and deep breathing exercises daily, and listen to calming music if you can. This will help you and baby to tune into each other – and help you relax as well!
GOOD LUCK!
Dr. Vijaya
May 13, 2009 at 7:21 pm
Dear Dr. Vijaya
First, I’d just like to say that your answers and comments provided a lot of very informative and interesting insight. My wife is in her 28th week of pregnancy. She was diagnosed with cervical incompetency in her 20th week of pregnancy. Her cervix was 20mm at her 20th week and shortened quite substantionaly (especially in her 26th week – measured 5mm). She is now in hospital on a really strict bed rest. I was wondering whether there is a correlation between the week of pregnancy and probability of preterm delivery? I mean, if for e.g. her cervix were 5mm at 20th week and at 28th week is there a difference in chances of preterm delivery? (of course, I’m aware that there is a huge difference in child’s chances of survival)
Thank you in advance
Jax
May 14, 2009 at 6:39 am
Hello Jax,
With remarkable shortening in the 20th week, was your wife not offered an option of cerclage? Even though cerclage carries a risk of uterine irritation, with remarkable shortening, it gives the expectant mom a better chance.
Now, with 5mm measurements, the only way to go forward would strict bed rest, as you are already doing. Although the chances of preterm labor do increase with greater and greater shortening of the cervix, it is known that may women do carry their babies to term or near term with bed rest, medications and medical supervision.
Hope this helps ..
Dr. Vijaya
May 14, 2009 at 2:21 pm
Dear Dr. Vijaya,
Thank you so much for helping me through this – I really appreciate it! I just wondered if you could tell me why my cervix showed 2.2 cm at 22weeks and then went back up to 2.8 cm in a week at 23 weeks? My doctor said that the funneling was worse when it was 2.2 and the funneling was better when it was 2.8 cm. Both times they were measured by the same, high risk ob, through transvaginal ultrasound.
Should I be feeling more confident about my situation that it was still about 2.75 cm when I went in for my 24 week appt? I am still on bedrest – I only get up to shower and use the bathroom. My doctor thinks I should do this to prevent further shortening like what happened at 22 weeks with the 2.2 cm. I want to be doing the right thing and I am terrified of walking around more and causing more shortening like what happened at 22 weeks. Right now the baby is laying transverse so she is up and off my cervix which is good – could things change if she ends up moving and pressing on my cervix? I am so worried.
Thank you for listening to my concerns and helping me through this – I tend to be a worrier so this situation is NOT good for me!
May 21, 2009 at 8:03 am
Dear Annie,
Sometimes, with strict bed rest, we do see remarkable increase in cervical length. However, we have also seen good increases in length without doing anything … go figure! Without sounding terribly unscientific, sometimes we are still trying everything in our bag to try and sustain the pregnancy without knowing what might help in the end. This is one area where lots more research is still needed.
So to answer your question, it is good news that your length is back to 2.75-2.8 range. If it remains in this region over the next 2-3 weeks, I would recommend that you can try limited activity and small bouts of walking around the house at that point of time.
I understand that it would be tempting to maintain “bathroom privileges only” routine – however, with bed rest come a lot of other issues including muscle weakness, pelvic ring pain, positional hypotension etc . So, if your cervix remains stable for the next few weeks , it would be a good point to re-evaluate your activity levels, and let you be a bit more active (and a little less worried ) at that point of time.
As far as babies’ presentation is concerned, nothing we can do about it. When baby turns head down, we can look into what that does to our cervix at that time. Hopefully you will be further along into your pregnancy at that time, where you would not have to worry about shortening.
Good Luck ..
Dr. Vijaya
May 21, 2009 at 12:57 pm
Thanks Dr. Vijaya,
Unfortunately, my cervix shortened considerably this week and I am now at 1.9 cm at 25 weeks. After being monitored for contractions my dr. felt that i didn’t need terbutaline b/c my uterine irritability was mild. He doesn’t think that this is causing the shortening. I am home on strict bedrest – bathrooms and showers only and taking it day by day. I am so worried now that after all that resting it still went down. Good news is the cervix is still closed…and there is hope that maybe the cervix will lengthen again. Good news also is the baby is growing really well and is already over 2 lbs at 25 weeks!
Thanks for continued guidance, I really appreciate it.
Annie
May 15, 2009 at 8:46 pm
Dr. Vijaya,
Thank you very much for your response. We definitely found it helpful. We are no under the care of a high-risk doctor and will be measured every week. Our measurement this week came back at 2.8cm. So the cervix actually lengthened from 2.5cm a week prior.
It was our understanding that cervix can not lengthen but only stay the same or shorten. Does bed rest help to lengthen it as well?
Finally, how reliable are the cervical measurements taken via the ultrasound? Is it possible for the tech to get it wrong and we actually are still at 2.5?
Our doctor is planning to give my wife the FFN test next week which will be 26 weeks. But he said not planning to give the corticosteriods shots as of yet. What is your thought on this?
Thank you again so much for your guidance.
Sincerely,
Sam
May 21, 2009 at 8:19 am
Hello Sam,
Yes, we have seen increases in cervical length with bed rest. Having said that, we really do not know the mechanism through with this happens, thought here are some theories out there.
As far as measurements by ultrasound, it depends on the skill of the technician, how full the mother’s bladder is at the time of evaluation and whether the US is done abdominally or trans-vaginal. It would be highly preferable to keep all these factors as constant as possible to get the most accurate picture on follow up visits.
In our own practice, despite keeping so many of these factors constant we still get widely varying results with ultrasound at times – baffling to say the least! We then try and correlate it to the clinical picture, so as to give the expectant mother the best possible line of care.
Why do you need the Ffn test? If there are no signs of preterm labor, and if your wife’s cervical length remains stable, there would be no clinical indication to do this test. You might want to check re: this with your OB. My rule of thumb – do only what is required – no more, no less. This avoids over medication and interventions – which can be only good for both mom and baby.
Steroids – again not required. If physical signs of preterm labor are present, cervical length is very short, and then an Ffn is done., and if this come positive – then only steroid would be advisable. Research shows that the efficacy of the steroids lasts only for 2-7 days; and that repeat steroids are not beneficial. So, makes sense to get this administered only if medical indication is there.
Hope this helps .
Dr. Vijaya
May 16, 2009 at 10:42 am
Dr. Vijaya,
I am currently 19 weeks pregnant with twins and during my 17th week of pregnancy I had a clerage. At 14 weeks I measure 3.4 cm and then at 17 weeks 2.6, but one of the babies heads was leaning on my cervix, my doctor suggested I get the cerlage done because it shortened so fast. My next ultrasound isn’t until May 21 and I am very worried.
After having had the surgery I read articles that suggest clerage should not be done on a twin pregnancy because it raised the chances of premature labor even more. I am very worried, my babis are ivf babies after ten years of trying to get pregnant and two ectopic pregnancies.
What are my chances of having these babies. Should I be on strick bedrest or is the couch rest and walking less then 500 m a day, what my doctor suggested, ok.
Thanks!
Aldora
May 21, 2009 at 8:33 am
Dear Aldora,
With twins, and with the shortening, it was probably the right thing to get the cerclage done. Despite this, you may have further shortening and go into premature labor – however, this would not be because of the cerclage but in spite of it. On the other hand, you may be able to carry the pregnancy as close to term as possible – we have definitely seen both ends of the spectrum! (Do read Az’s posts on this forum – it will probably give you some encouragement and hope!)
I do understand your anxieties and concerns with your previous history – but, hopefully you will be able to continue with your pregnancy safely this time around.
As regards activity, if you are monitored only a biweekly basis, and if your cervical length remains relatively stable, you should have no issues with limited walking and sitting up. I do not like couches though. Getting up from low couches increases pressure in the abdomen which you should try and avoid. Also, sitting reclined in the couch gets the baby (ies) into less than optimal position, making it harder for natural childbirth. You can use regular chairs instead. Being reclined on bed/couch for short periods of time during the day is okay.
Take care,
Dr. Vijaya
May 18, 2009 at 6:47 pm
hi dr i went to my ultrasound today im currently 29 weeks and they told me that i was 1.7mm and funneling dont understand the funneling part my question or concern is is this normal or should i be worried because he only sees me once a month and doesnt say anything just the ultrasound tech is the one that informs me whats going on and also he didnt tell me to rest or anything please let me know what you think and what should i do. thanks hoping to hear from you asap thanks
May 21, 2009 at 8:48 am
Zuleyma,
I am really unsure as to why your OB is not seeing you more frequently – especially with your previous history. At the cost of repeating myself – see if you can change your care provider. It may make all the difference in the world.
It is baffling to me that the technician is communicating results to you, and there is no further counseling or medications/plan of care being discussed with you. Since I cannot really know how you are physically, I cannot recommend anything other than bed rest to you. However, you are right in worrying about your plan of care – and you need to take matters into your hands and change to a provider who can work with you to ensure that you carry this pregnancy forward in a healthy manner.
Good Luck
Dr. Vijaya
May 19, 2009 at 3:25 pm
Thanks for this great post Im pretty sure that many people are searching informative post like yours .
May 22, 2009 at 2:56 pm
Thank you so much for your reply Dr. Vijaya.
I am just here to tell everyone that I had an ultrasound today and my cervix length is back to 3.4 after my cervical cerlage. I still have to be extra careful and rest most of the day because I am having twins and my cervix can shorten permaturely again but at least now I know that the rest is doing it’s job.
I wish everyone the best!
May 28, 2009 at 8:52 am
Dear Aldora,
Good to know that you are doing well. Thanks for the update
Take Care,
Dr. Vijaya
June 6, 2009 at 8:17 pm
Hi Dr. Vijaya! I just wanted to touch base and let you know that I ended up delivering a healthy baby girl at 37 weeks 1 day! I made it!!!!! What an amazing and healing experience to hear her cry after such a long, scary road. I wanted to thank you for the information and support you offered throughout my journey. I hope that others can receive encouragement from my success. With warmest regards,
Heather
June 8, 2009 at 6:56 am
Dear Heather,
CONGRATULATIONS!!
It is truly wonderful to hear wonderful, patient and courageous moms like you come back and share your experiences and successes. Having known you on this forum from around 23 weeks, I feel glad that I have been a small part of this journey.
All the best you, your family and the little one!
Take care,
Dr. Vijaya
June 9, 2009 at 10:10 am
Hi Dr Vijaya,
Hope all is well with you.The last time i wrote to you i was in panic as i was entering the danger zone.I’m glad to be 25 weeks! Tell me:
1. I’ve heard peole say that after 25 weeks the baby somehow lifts/gets off the cervix there by reducing pressure on the cervix.How true is this?
2.Now that i’m 25 weeks, can i consider myself out of the woods with my condition?
3.I’m considering taking the ffn test just for my own peace of mind.Do you think this is necessary(i’ve had no contractions at all so far)
As always your input is highly appreciated.
Nina
June 15, 2009 at 1:31 pm
Dear Nina,
Sorry for the delayed response. To answer your questions -
1. No, baby does not lift of the cervix – in fact in many cases, as the baby’s weight increases and pressure is applied on the shortened cervix, it actually leads to further shortening, dilation, contractions or all of above. Having said that, in great many instances no further shortening or dilation happen until closer to 37-39th week. Perhaps what you are hearing about is about low-lying placenta. This corrects itself in 70% of the cases, around 25-28 weeks, and pulls itself up.
2. 25 weeks is great from your point of view – however, you would still need to be monitored every 2 weeks or so, until you reach 37 weeks. 28 weeks would be your next milestone, as that would be the baby would have very good chances of survival even outside the womb, in case you start having pre-term labor.
3. I do not think Ffn test is required at this point. However, with your previous history of painless dilation and protrusion of membranes, it may be worthwhile simply for your peace of mind- as you so aptly put it. Can’t do any harm. However, I would not recommend repetitive Ffn, as sometimes this can trigger uterine irritability.
Good Luck – keep up the good work
Dr. Vijaya
June 9, 2009 at 5:37 pm
Dear Dr. Vijaya,
Thank you so much for providing this oasis in the desert, I feel so relieved to be reading such informative answers to all these questions which have been at the forefront of my mind.
If I can seek your opinion in my case I’d be most grateful. I’m currently 21 weeks and 1 day pregnant with my second child. The first went full term and after a traumatic labour which ended in C section, my 8lb 13oz baby is now a healthy 21 month old boy. My 20 week scan last week showed that ‘internal Os appear open with marked funnelling and a closed cervical length of 1.3cm’
The consultant seemed fatalistic about my chances of a successful pregnancy and commented that she’d had to induce women with similar scan reports. She advised to slow down, but there was no mention of bedrest. She also stated that studies were inconclusive as to whether cerclage would be of benefit in my case. She thought that as I’d carried successfully once I shouldn’t have a problem?
Since reading the information on your very helpful website, I’ve gone on bedrest and called home my husband who was working away home. The consultant requested I have a further scan in 4 weeks, is there anything I can do other than keep on bedrest, I’m using the bathroom and making snacks and drinks? I’m taking each day as it comes and hoping all will be well.
Many thanks again,
Kate
June 15, 2009 at 1:53 pm
Dear Kate,
Sorry for the delayed response. Things have been a bit hectic at our Birthing Center.
I have a couple of questions:
1. Was your scan an internal scan or was it done abdominally?
2. In your previous pregnancy was there any cervical shortening noticed?
I agree with your OB that cerclage at this stage, would not be the best option. It might even land up triggering premature uterine irritability.
I would definitely suggest that you continue bedrest. Granted that studies are equivocal as to whether bedrest has any true benefits, but for many, many moms in our practice, this does seem to help at least to some extent. Getting up for bathroom and minimum food prep is perfectly ok – it actually helps keep your blood pressure and muscle tone in better shape than if you were on complete bedrest. I almost never recommend total bedrest.
Also, I am wondering why such a large time lapse to your next appointment/scan? All research protocol suggest that with your length of cervix getting monitored every other week would be ideal.
Hope all goes well for you – Good Luck
Dr. Vijaya
June 12, 2009 at 3:03 pm
Dear Doctor,
I just wanted to get your opinion on my situation anything would help at this point. You have been very informative with other posters.
With my first pregnancy, I had bleeding around the 9th week and was put on bedrest until end 1st trimester. After that the pregnancy was pretty much uneventful until the end where they induced me at 39 weeks because the doctors though she was not growing in the womb.
With this pregnancy, I started feeling Braxton hicks contractions around week 16. At my 23 week check up, I told my doctor that I was still having these contractions and that I had a dull ache about two weeks ago for 2 days and it went away and came back a week later for a day. I was not concerned about the number of contractions, just that I felt them so early. She did a cervix check and said it was closed and also did a ffn test. Later that day, she told me to drop everything and head directly to the hospital because ffn test came back positive. I was admitted after a few contractions showed up on the monitor. I was given steroid shots and give Procardia. At one point during my hospital stay, my heart had raced to 150, doctors don’t know what caused it. I was released two days later. I talked to the doctor and stopped taking procardia as I thought it was giving me insomnia and making my heart race sometimes, and my blood pressure is on the low side, plus I was only having about 3 or 4 contractions a day. (2 days of hospital stay, I lost 3lbs and could not sleep for over a week)
I took the last procardia on May 7 and had about 3 or 4 contractions a day until May 16 at which point they increased to 15, then the next week it would increase to 20, then the next to 25 and now I’m averaging about 30+ sometimes 40+ a day. I was concerned because of the increasing numbers of contractions so I went in to see the doctor, though I had a ultrasound a week ago and cervix showed long and closed. They picked up about 4 contractions in 45 min. She did a cervix check and said it was closed (maybe very slight opened) and thick. I was a bit comforted when I read Heather’s story on your board, except the doctor did a ffn test and it came back positive again. I’m more worried now because though the previous ffn test came back positive, I was not having this many contractions at the time. The doctor told me to go to the hospital and get terbutaline shots, but since I have gestational diabetes (and the bad effects I read it had on mother and baby), I would rather try procardia. I tried10mg procardia and it does seems to be working.
I am really hoping I am one of these people that has tons of contractions, but does not do much, but at the same time I do not want my baby to be born early, I’m currently 29+ weeks. What would you suggest? The whole time after I was discharged I have been on modified bedrest. Thank you.
June 15, 2009 at 2:18 pm
Dear Traci,
You are absolutely doing all you can.
I do think Procardia is probably the better option for you. Terbutaline does have many more effects on mom and baby, and I would avoid it if possible. Having said that, if the contractions increase overly, and your cervix starts to show shortening, then you may want to get admitted for a day or two and try alternating Procardia and Terbutaline. Again – only, only ,only – if becomes absolutely necessary. Otherwise, titrating the dosage of Procardia should hopefully be enough.
Ffn test being positive is the only slight issue. However, Positive Ffn does not always mean pre-term labor. There is a high degree of correlation between a negative Ffn and not going into PTL, but there are enough instances of false positive with positve Ffn. So, hopefully you may be one of those moms with a positive Ffn but not go into PTL.
With your number of contractions, modified bedrest is a good rule to follow. Along with this, some meditation, deep breathing and relaxation techniques would be of great help, as all of these have a calming effect on musculature. Uterus being a muscle, also reacts well to these techniques. Along with this, having someone pour warm water over your belly for 10 minutes everyday, while you do deep breathing might also help. Granted that the contractions will not completely go away, but it will minimise them for a few hours, which can only be good for both you and the baby.
Hope this helps – if you have any further questions, please feel free to write in.
Good Luck -
Dr. Vijaya
June 15, 2009 at 5:38 am
Hi Dr. Vijaya,
I am 12 weeks pregnant and my cervix measures 2.9cm is it dangerous i have had 2 miscarriages and one ectopic pregnancy before this baby is very important for me my age is 27 years I am scared if everything goes all right till the end can you please let me know if I need to take some precautions ill do everything to get a healthy child
Thanks/Poonam
June 15, 2009 at 2:35 pm
Dear Poonam,
Before I can answer your queries, I would like to know a couple of things:
1. At what weeks were your previous 2 miscarriages? Depending upon this, I would be able to give you better guidance.
2. Are you on any progesterone shots or medications?
Dr. Vijaya
June 19, 2009 at 8:32 am
Yes mam i am taking duphastone 2 each a day folinext & ecosprin & Susten (orally) i had my miscarriages 1 month & a week ahead it were before 1.5 months always also it was same incase of ectopic now I have conceived naturally have done my sonography last week and the baby is normal I am just worried if my cervix which measures 2.9cm would that be a problem?
June 15, 2009 at 6:04 pm
Dear Dr. Vijaya,
Thank you so much for your response, I’m truly grateful you find the time to answer these queries on top of all your work commitments.
The scan I had was a internal trans vaginal scan and in my previous pregnancy the last scan I had, at 20 weeks, did not show up any cervical shortening, although I am unsure whether in the UK checking cervical length is normal protocol? I feel perhaps my cervix may well have sustained trauma whilst trying to deliver my little boy, maybe causing this problem?
Do you feel it would be advisable for me to request my next scan appointment be brought forward? Having been on bedrest for a week I feel a huge reduction in pelvic pressure and I no longer have a sensation that I can only crudely describe as having a very uncomfortable tampon in place ( sorry for the description!).
I’ve now reached 22weeks today, but that magic 25 weeks still feels along way off!
Many thanks again,
Kate.
June 16, 2009 at 1:34 am
Hi Dr. Vijaya:
Your website is really informative and I have a question for you as well. Last week, I was 21 weeks and 3 days when I had a transvaginal and abdominal ultrasound done. During the transvaginal, they noted that my cervix was 2.7 cm with no funneling. I went back again today, which made me 22 weeks and 2 days today and they found no change in my cervix length. I have another child who is 8 years old but I carried her to full term with no problems. I am scheduled to be seen again next week to do another transvaginal ultrasound. Should there be any specific questions I should be asking my doctor? I also live upstairs in an apartment complex and do quite a bit of walking at work. Please advise as I want to give my baby the best chances possible. Is there any specific milestone that I have trying to reach as well?
Thanks,
Kendall
August 7, 2008 at 2:21 am
Am 21 weeks pregnant and my ultrasound revealed cervix size as 3.2 cm today. Last month it was 5cm in scan. Does it indicate shortening of cervix and am I at risk?