Incompetent Cervix/Pre-term Labor...

ShannonAndWill

Hi everyone!  I wanted to see if anyone else was in a similar boat to me and how their pregnancies progressed.

My first pregnancy was blighted ovum that ended with a D&C.  My second pregnancy produced my wonderful son who was born at 36 weeks after a bout with pre-term labor at 33 weeks and three weeks of bed rest to follow.  During my second pregnancy, I had my cervical length monitored (past history of a LEEP), but it didn't ever drop below 3 cm prior to 24 weeks.  When my pre-term labor was caught at 33 weeks, it measured 0.5 cm, was 2 cm dilated, and 90% effaced.  I had the dexamethasone shot at 33 weeks to develop DS1's lungs.  Despite being a little early, he didn't have any NICU time.  We were very lucky.  

Fast-forward to my current pregnancy.  I am 32 weeks 4 days and have been on modified bed rest for 9 weeks after having a rescue cerclage placed at 23 weeks 5 days with a cervical length of 1.7 cm and significant funneling (prior measure 2 weeks earlier was 2.6 cm).  I began receiving 17-p progesterone shots at 23 weeks 6 days.  My cervical length has been pretty dynamic since the procedure and has varied from around 1.7-2.9 cm depending on the week.  The last measurement (at 31 weeks 3 days) was 2.0 cm.  The MFM isn't measuring my cervical length anymore because it's supposed to shorten gradually for the rest of my pregnancy.  I will have my cerclage removed and the 17-p injections stopped sometime during my 36th week.  

I have been Googling around to try to estimate how quickly I might go into labor after I have these interventions ceased.  I have found a large range of responses, obviously, but I have two further variables to my condition that I can't seem to find any information on how they will affect my going into labor: my son is measuring large (~3-4 weeks ahead--just like his brother, which is not surprising since their father/my hubby is 6'5" and comes from a family of giants) and I have polyhydramnios (excessive amniotic fluid).  Both my son's growth and my fluid levels are expected to deviate further and further from the mean, which will create additional pressure on my already stressed cervix.  

Has anyone ever dealt with similar circumstances (IC/PTL with/17-p and rescue cerclage + potentially LGA + excessive fluid)?  I know this is a lot of variables, but I'm just wondering how other mamas have been affected, specifically regarding the onset of their labor.  Thank you for reading and for your help!!! 

kneenah1231

I didn't have a rescue cerclage but I did have most of the stuff you stated with a preventive cerclage and made it to 39.2 days. Had an elective csection. My baby was measuring 10lbs but ended up being 9lbs 3oz.

Cervix measuring 2.0cm at 33wks is good. I wouldn't worry. I was 1.8cm from 27wk-32wks then they stop cking my cervix. I was off Bedrest at 34wks and did alot and never showed signs of labor. I stopped my 17p @ 36wk and also had my cerclage removed and dilated 1cm. 17p really helped prevent preterm.. I think I would have made it to my EDD if I didn't ask to have baby out..

Roses87

You can ignore my question in the other post, I just saw this. Sorry its been rough for you, but it sounds like they have been proactive and good thing you got your cerclage! I had a uti at 23+ weeks and I was having a lot of braxton hicks. At my follow up appt at 24 weeks my dr did a ffn and it came back + and I recieved steroids at that time. I then had a cervical US the following day and they found my cervix to have funneling. It was only closed by 1.2-2.6 so I was place on bedrest and put on procardia and progesterone suppositories. My last cervical length was at 27 weeks and the funneling was a little thinner but it was longer than before and my cervix was only closed by 8 mm. The mfm at that time said the US were not necessary because we already know its short and she just recommended having me be spec on occasion and making sure I am not dilating. I was last spec at 29 weeks and my cervix appear closed and long per spec but obviously the funneling is there. I will be 31 weeks on Sunday and I am just happy for everyday LO is cooking!! This is my first pregnancy so I have no other history of preterm labor I also have no risk factor like a leap or anything so we are unsure of why this happened. My baby is measuring right on so I am no help there, I fluid levels are also normal. 

Do you have gestational diabetes at all for him to be measuring big?

If you scroll down you will see a post by kneenah and her birth story. She has a 21 week loss due to IC. She just delivered her baby girl last week at 39 weeks after recieving a preventative cerclage and being on bedrest. So its very possible to make it to term! Best of luck!!

JackieP1023

Somewhat similar story, although I'm only 29w now. I had a preventative cerclage, though, at 13w after a previous IC diagnosis (20w stillbirth). I've been on procardia since 15w, p17 since 20w. I also have GD, and baby is measuring about a week ahead (as of last week--belly is measuring 4 weeks ahead as of yesterday). I have read lots of stories about people that deliver right after the interventions quit (36w)... And lots that end up being induced. I asked my MFM what her experience was, and it sounded as though she's experienced more that have required induction. I suppose only time will tell!

ShannonAndWill

@kneenah1231, Thank you so much for sharing your story.  I read through your other thread regarding your birth experience with your new little one as well.  Congratulations!  I would be ecstatic to make it that far, but thrilled to make it to 37 weeks.

My last CL measurement was actually at 31 weeks and I'll be 33 weeks on Monday.  So I have no idea if it's shortened (or lengthened lol) since then!  31 weeks is when they quit measuring me.  It's been quite "dynamic" since I had my cerclage placed (it was gradually decreasing prior to placement).  It was 2 cm last time, but 1.7 cm the time before.  The MFM doc said that it should continue to gradually shorten, so that's why they stopped measuring me.  The only thing they're going to measure now is fetal growth and fluid (since I'm polyhydramniotic).  By the way, considering your history, it is really awesome that you made it as far as you did even with being active at 34 weeks and beyond!  Clearly, these were awesome interventions for you.  I am demanding a preventative cerclage next time.  I tried for weeks to get one and even after I hit 2.6 cm (1 mm above the "cut-off"), they wouldn't do it.  When I hit 1.7 cm (I knew it would get worse), my MFM group started panicking.  They think I would have made it to 26 weeks max if I hadn't had the cerclage (and started the 17-p).  We are really lucky.  

@Roses87, my BH contractions have been out of control as well.  I asked my MFM doc about it and she said that if they were, indeed, causing cervical changes, then I'd see at least a little blood/spotting.  Reading through other people's postings, though, I have not found this to be the case.  Anyway, so far, they haven't been terribly problematic.  Just annoying.  I didn't have a UTI with this pregnancy, but I had recurrent ones with DS1 and was on prophylactic antibiotics until around 6 weeks postpartum.  At my 6 week appointment, they cultured my urine specimen and found out I still had the original UTI bacteria (an enterococci) and E. coli as well (which I didn't have at all during my pregnancy).  So I essentially had two UTIs.  Going on all of those antibiotics really messed up my vaginal flora and I ended up going back and forth between yeast infections and BV.  I want to say I was around 8 months postpartum before I finally got things back to "normal."  No one warns you about that stuff...

Your story sounds similar to my previous pregnancy, except that they did monitor me until 24 weeks when everything appeared normal.  Also, I never had a + FFN.  At 33 weeks my cervical length was 5 mm and I was in pre-term labor.  Keep resting and cooking your LO.  At 36 weeks, I was told I could go off of bed rest and start to move around, so hubby and I went on a date and I went into early labor that night.  If you have that little cervix left and you are further, it might not take much to start your labor.  Just FYI.  HOWEVER, I was not on progesterone, so I don't know how that would have factored in.  My Ob was totally incompetent and I've since switched to a much better practice.  

I do not have GDM!!!  I swear I thought I must have it this time since I have excessive fluid as well, but my blood glucose levels are normal (and I've been periodically checking at home--I'm pretty anal retentive lol).  My DS1 measured large too.  They both started out perfectly on target (at 6 weeks) according to my ovulation date (I used FAM and OPKs), but around 8 weeks and beyond, they start making their own growth curves.  My husband is 6'5", his brother is 6'4", and his father is 6'7" (DH's other brother is the "short one" at 6'1").  They are just an enormous (tall and skinny) family.  DS1 was 7 lbs 4.5 oz and was 19.5" long at 36 weeks (they think he would have been 9.5-11 lbs at term; average for that gestational age is 18.66" and 5 lbs 12.5 oz).  He's 20 months now and is in the 99th percentile for length (and around the 50th for weight).  DS2 is following a really similar growth curve to DS1.  He is just going to be another giant.  I joke with DH's stepmom (who is 5'2" like I am) that we're just gestational vessels for their giant offspring lol!

@JackieP1023, it sounds like you have a big one cooking too!  I have read the same stories too.  I have a feeling that if they snipped my cerclage that I'd go fast, but I'm not sure how the progesterone will factor in.  Also, since I have the extra weight (from the heavy baby and excess fluid) pushing against my cervix, I have no idea whether it would offset the progesterone or not.  I'm hoping to have a VBAC this time, but I'm a little worried about how big the baby is getting and if it would even be possible.  Ultrasounds tend to be very accurate in predicting size for me (in fact, during DS1's pregnancy, they under-predicted his size).  There are so many moving parts that it is hard for me too figure out what is going to happen.  I'm hoping to make it to at least 37 weeks, but everyday cooking beyond that would be a blessing (even if I end up with a repeat cesarean).

ShannonAndWill

I wanted to leave an update in case someone searches for a similar cluster of pregnancy complications in the future.

At the end of my 33rd week, I started having frequent and regular contractions. After a trip to L&D, I was sent home and told I had no dilation and my cervix was plenty long (3 cm--sonographer didn't measure correctly. It hadn't been that long since my 16th week).

Three days later, I was sent back to L&D. Same symptoms. Now, I was two cm dilated. They sent me home on bed rest again. I missed the cut-off for the betamethasone.

Two days later (34 weeks and 4 days). Back again. Three cm. They keep me overnight for observation. The next morning, I'm 5.5 cm (at my external os) WITH the cerclage in place and 7 cm BEHIND the cerclage. My contractions were 90-120 seconds apart. They removed my cerclage and I went into labor. I delivered that evening. VBAC! A huge 6 lb 10 oz 34 weeker (dates were 100% accurate). He spent 10 days in the NICU and came home around a week before Christmas.

In the end, it wasn't what I wanted, but I have a beautiful boy who is alive and healthy. I also had a fantastic labor and delivery. :-)

Dollymarie

Wow I'm 35 weeks n 3 days . On the 23 rd I'm having the cerclage removed n kinda scared about it. I've never made it to 37 weeks b4 my longest was the day I turned 36 weeks

JackieP1023

Great news! I'm 36 weeks today, and the cerclage comes out on Monday. I am a bit nervous, but all we can do is deal with what comes!