What Would You Do: Frustrated w/ OB, Short Cervix

kidcapri100

Hi all - would really appreciate some advice on how you would handle this situation.

To make a long story short, my cervix was measured at 15w 4d at 2.6cm after I begged for an earlier measurement as I wasn't supposed to be measured until 21 weeks. Average for this gestation should be 4cm and anything under 3cm is considered "short" with 2.5cm and under considered "incompetent".

Obviously I am very worried about preterm labor/birth as my measurement is not good especially for my gestation. Unfortunately I was seeing my doc's colleague as my doc was on vacation and he asked me to come back in a week to get measured again, and said if it is any shorter I will need to have a cerclage. Well after I went home and did some research I was very confused as to why we were playing the "wait and see" game as I was only .1cm off and all of the medical info out there says that the earlier a cerclage is placed in yor pregnancy the higher the success rate with the highest being between 12-14 weeks.

So I called my doctor (who is back from vacation) and asked why we were waiting a week if I was so close to "incompetence" and found out (from her nurse that called me back) that not only does she not handle cerclages but I will have to be referred to a perinatologist -however she won't refer me until I am 2.5cm or under.

I'm finding it hard to understand why she is so dead set on a difference of .1cm when we are talking about a very serious complication. Im finding it even harder to understand why she wouldn't call me back herself when this is a very serious issue and concern..I'm not just calling about a headache or a cramp I had.

My question is this - should I suck it up and wait it out until Monday to be seen by her? I'm assuming that by then I will at least have hit the 2.5cm mark. Or should I pick up the phone and call a perinatologist myself and ask to be seen? Also, would you continue with her as your OB moving forward? My sister (who unfortunately lives half way across the country) had a LEEP procedure like me and her OB had her see a perinatologist three times even though her cervix was measuring fine throughout her pregnancy.

Also, please tell me honestly if I'm just being hormonal and overthinking things. I'm a big girl and I can take it if that's the case!

Thanks in advance! I'm a FTM and all this stuff can be so scary!

preggoandglowing

Personally I would wait until Monday. But if it was any longer than a week, then I wouldn't wait.

I was told about 6 moths ago (before I got pregnant) that my uterus was small. Obgyn didn't seem too concerned and just said that I might deliver a couple weeks early or have a slightly smaller baby. I wonder if small uterus poses same problems as small cervix. This is my first so I don't have any experience and didn't even know they measure you but I'm going to start asking questions, so thank you and good luck! Please post the outcome

LC122

So, there could be a lot of things going on here.
1) it is not unusual for nurses to handle the call-backs. Annoying? Yes. Unusual? No.
2) insurance could be a factor - if your insurance won't cover the perinatalogist without the referral and clinical criteria is less than 2.5, then you don't yet meet clinical criteria.
3) I know you are freaking out based on what you've read, but you should also understand the risks associated with getting a cerclage. Ideally, you won't need one. Your OB may be trying to save you from a risky procedure (and it's less the risks of getting it so much as what happens after it's in)
4) some of it may be hormones and FTM worries, but the good news is that you are being proactive and trying to stay informed.
5) All doctors handle things differently and you can't assume your sister's experience was "normal". Her OB could have been overly cautious. Your insurances could be different and that could effect who orders what by whom and when.
6) if you called a perinatalogist directly, there is a good chance you wouldn't be seen soon or without a referral, so you are better off waiting a few days for a legit referral IF you need one.

Hope that covered all/most of your questions. Deep breath. You can do this.

kidcapri100

@preggoandglowing I'm not sure about small uterus, but from my experience these past few days I think it's wise to ask a lot of questions and let your OB know that you'd prefer a more cautious approach.

I'm not sure what shape I would have been in if I had waited to have my cervix measured at 21 weeks. Really the only reason I had it measured when I did was because I had heavy bleeding and they were already doing the ultrasound! Thank god for that..

As far as cervical measurement, they really only do it if you have had previous 2nd trimester loss, have had a LEEP or cone biopsy procedure or sometimes if you've had a D&C. I had an aggressive LEEP performed about 7 years ago due to cancer cells in my cervix.

kidcapri100

@lc122 Thanks for that - great and super logical points.

Thankfully my insurance is great and I do not need referrals, however my doctor is always overly-cautious about the insurance factor. So that could be very well why she's waiting. I have made it a point to tell her on several occasions that insurance and money is no object to us when it comes to the wellbeing of our baby. But she has a lot of patients and I'm sure can't remember every insurance preference of each one!

Also just to clarify, I am scared to death of a cerclage! I totally agree that there are many risks and it's very scary. But I'd at least like the opportunity to discuss other options like progesterone) with a Specialist. Especially when I'm still at 2.6 and not down past that danger-some marker where it's too late to try alternative methods.

You guys are really helping to talk me off a cliff here.. Thank you so much!

kepoole

kidcapri100 said:

@preggoandglowing I'm not sure about small uterus, but from my experience these past few days I think it's wise to ask a lot of questions and let your OB know that you'd prefer a more cautious approach.

I'm not sure what shape I would have been in if I had waited to have my cervix measured at 21 weeks. Really the only reason I had it measured when I did was because I had heavy bleeding and they were already doing the ultrasound! Thank god for that..

As far as cervical measurement, they really only do it if you have had previous 2nd trimester loss, have had a LEEP or cone biopsy procedure or sometimes if you've had a D&C. I had an aggressive LEEP performed about 7 years ago due to cancer cells in my cervix.

@kidcapri100 I had a LEEP done a year and a half ago by the same OB I still see. She hasn't mentioned anything about having to do anything extra because of it, in fact the subject hasn't even come up. Should I "remind" her about it?

kidcapri100

@kepoole I definitely would!! It doesn't hurt for them to check!

Beckah31

I think you know what my response is going to be...
But I'd be finding an MFM. At least call one and ask the nurse what the dr thinks. My MFM doesn't play around when it comes to cervical issues.
While a cerclage is not without risk, an untreated cervical issue is even riskier.
Call and ask and then go from there.

bkeller34

The perionatologist that I saw required a referrel from my OB before they would even schedule an appointment...so you may have no choice. Secondly I have had a cerclage and it isn't fun and comes with a whole list of potential problems. From what I was told an incompetent cervix usually won't cause a lot of problems until further down the road and more pressure is on it. I had mine done at 19 weeks and made it full term. Good luck and hang in there.

JennaAmiDe

I am going to be monitored because of a LEEP and was just told not to go away because of being monitored, you absolutely need to get checked, remind your dr you had it.

kidcapri100

Hi all! Thanks again for your replies.

My husband was not very satisfied with the nurse's answer to our questions so he called (unbeknown to me) to speak with the doctor. They told him my doc would call him back the next day.. Needless to say he wasn't too happy about that either.

This morning he received a call from a different doctor at the practice and was told that my doctor was out for the remainder of the week, but he looked at my records and thought it was appropriate to refer to me to specialist this week.

I already have an appointment at 10:30 this morning and am feeling so much relief! I hate to say it, but I think after witnessing how my OB handled the situation I think I am going to switch.. I honestly felt like she couldn't be bothered to call us. When we called to make our perinatologist appointment they said they take all cases of cervical issues very seriously, especially anything under 3cm so early in gestation.

Moral of the story = trust your gut ladies!! Mother's intuition is a real thing!

Beckah31

Yay! And good on hubby for getting things done!

rmortinsen

I have also had several leep procedures done. I have ultrasounds every other week to measure cervical length and so far it's been ok. If you truly feel something doesn't feel right I would always trust your gut. Did they put you on any restriction until you can get in for cerclage? Maybe you are being overly cautious but you should feel more confident and comfortable with your obgyn. If it is an insurance issue they should tell you that not leave you hanging and wondering. Maybe time for a new dr.. Good luck to you and I hope everything goes well!! Keep us updated

kidcapri100

Thanks ladies!

Had our first MFM appointment today and althought it wasn't the greatest news we both feel so much better now that we know all of the facts and I will now be monitored weekly.

Cervix was already measuring shorter at 2.3. If it goes below 2cm then doctor would like to heavily consider cerclage. For now I am on progesterone to see if it helps keep my cervix from shortening anymore. No funneling which was a great sign!

However, he was very concerned about my hematoma as it is just above my cervix and he feels it was from an infection or clotting disorder since it just appeared recently. Apparently my risk for early membrane rupture is now much higher and there is no predicting when and if it will happen. I was only given a statistic of "possibly 3x's more likely for preterm labor".

At this point I am on modified bed rest, no travel, weekly appointments (I go in again this Tuesday) and lots of prayers that we make it to our first marker of 24 weeks (just 8 more weeks..). The doctor feels that the chance of survival given the hospital's NICU abilities would be better at 24 + weeks.

Everyone keep your fingers crossed that everything stays intact and my little boy keeps cooking!

Again, can't stress it enough - trust your gut and intuition!! My OB told me my hematoma was nothing to worry about and it would just bleed out and I would be fine.

LeahMGA

I wouldn't be overly zealous to have a cerclage put in. I know that the length you have sounds scary to you, but it can fluctuate and even grow! Mine was measured at 12.5 weeks at 3.2 cm and is now just OVER 4 cm at almost 16 weeks. The thing about a cerclage is, they don't always take, they can cause an infection, and they carry about a 10% risk of fetal death. That's a real risk. On the other hand, the more conservative "wait and see" approach can work out very well. With my last pregnancy, for example, my cervix was under 2 cm for 20 plus weeks and I ended up with a full-term baby. I'm just glad that I wasn't overly eager to put a cerclage in, but of course, it still is your decision. I hope things work out for you.

kidcapri100

@LeahMGA Definitely not zealous about having a cerclage! My original post was just about being proactive vs reactive with my care. I'm scared to death of a cerclage!
I posted an update just above your comment - my cervix has shortened again but because of my hematoma my MFM is hesitant to do a cerclage until it's absolutely necessary. Right now trying progesterone which I'm really happy about and praying that it works!

Beckah31

That 10% statistic is way off.

LeahMGA

@ Backah31, what are your sources? According to the encyclopedia of surgery, UC hospitals, about.com, healthline.com, and americanpregnancycenter.com, and 3 different obstetricians and perinatologists I asked, 10% to 15% is the failure rate of a cerclage. Maybe you should back up your claim...

@ kidcapri00, I'm sorry your cervix has shortened. I know how stressful it is (I had a 24 week preemie before my full-term baby with an incompetent cervix). Zealous was the wrong word. It's hard to know whether to be proactive or reactive. My last OB thought a cerclage was too reactive, so I dropped her. I wanted to feel like she was fully supportive of taking care of the baby, and I didn't get that sense. The OB I have now hasn't done one either, but she seems more proactive than my last. I think the progesterone is great (even though the shots are painful as heck). I read from the manufacturer that the 17P reduces the rate of pre-term labor by 33%, which is awesome. Hopefully you'll get a good result with it too. I'm hoping for another success story here too!

gamblel

I had a keep done and my doc isn't going to measure until 18 weeks. Your experiences have me a little concerned that this is too conservative.

I'm the positive, I've had 2 ultrasounds (6 week and 11+6) and though they only looked at baby, no one seemed concerned...

kidcapri100

@gamblel My MFM said that generally they do the cervical measurement around 18-20 week mark because that gives them the most accurate read and enough time to perform a cerclage or determine the correct course of action. I just happened to be one of the unlucky ones who was measuring short early on (about 16 wks), but my MFM is still being cautious by monitoring and trying progesterone.
Also, just because a cervix measures short because of a LEEP you may never need a cerclage! It all depends. But I think it's always a good idea to make sure you are in good hands and with a doctor whom you trust and feel like they 100% have you and your baby's best interest in mind!
In my case my doctor is super reluctant to do a cerclage because my hematoma already possesses a risk for rupture, so they probably won't do one unless it's clearly necessary.
It never hurts to "remind" your doctor Oh and they do the cervical measurement via vaginal ultrasound as abdominal is not very accurate

Beckah31

I wasn't attempting to question you, however the cerclage failures cited by those sites does not equate to fetal death rates. The same sites note that non-emergent cerclages have an 80-90% success rate. It is not a procedure to be taken lightly, but is an important tool. The survival rates of neonates born at 24 weeks is about 50% with girls having a slightly higher rate of survival. At 28 weeks, this rises to 80%, and by 32 weeks it's over 90%.
A cerclage will not prevent preterm birth in every case, but it can increase the chances of survival for the baby if they can reach these important milestones before birth.