Incompetent cervix 21 weeks. What do I do?

perchancetodream

Hello,
Im 21 weeks and at 20 weeks my cervix measured at 2.4cm. Previous to this measurment my cervix was 3.3cm at 12 weeks...
My OBGYN is not even monitoring me. He didnt tell me to restrict any activities or anything. He didnt even mention my cervix during our last appointment but instead I had to ask and he said "what is it?" then actually had to go through all the 'hassle' to LOOK at my file.
I went to my family doctor today and was told that yes, 2.4cm at 20 weeks is short, but if I make it to 23 weeks "chances are the baby will live." .....WHAT?!...
Should I be demanding treatment or is the doctor right to just see me every 4 weeks? I dont see him again until Im 24 weeks.

kidcapri100

First of all, I completely know what you're going through.

Second, yes a 2.4 cm cervix at 21 weeks is short but not quite in the danger zone. I was measuring 2.5 cm at 15 weeks and was sent to a high risk MFM. You may want to ask your OB for a referral...different OB's have different opinions on this but IMO it's better to be safe than sorry. Just FYI, sometimes MFM's won't see you unless you are 2 cm or under at 20 weeks.
Most of the time your cervix will be fine and will hold steady if there is no funneling (it's important to know if you are funneling or not, which I'm assuming you aren't given the reaction from your OB). There is a higher likelihood for preterm birth, but many women go to term.
The 23 week statement, although shocking, is true: at 24 weeks there is a chance for viability for the baby if you were to go into labor, and of course that increases with each week the baby stays cooking! But at 2.4 cm at 21 weeks there is a very high chance you will be ok although I would still recommend asking for a referral if it will help put you at ease.

I am 21 weeks and went from 2.5 cm at 15 weeks to 1.9 cm at 21 weeks. My doctor prefers not to perform a cerclage unless it's an absolute emergency given the associated risks - I should also add that I have a 12cm subchorionic hematoma that appeared at 15 wks. I'm currently on progesterone suppositories as they are proven to help stabilize the cervix. I'm monitored weekly until 24 weeks (in case they need to place a cerclage) but then after 24 weeks I am released back to my OB. If I start to go into labor then they will put me on hospital bed rest until I have to deliver.
As far as restrictions, I'm on modified bed rest but I also have a large SCH. I'm on pelvic rest as well and can't lift anything over 5 lbs.
As far as how early I will deliver we won't know! And I may make it 40+ weeks with no issues whatsoever.

I know it sounds incredibly scary but so far your numbers look decent and you're super close to 24 weeks! Try not to worry too much!

perchancetodream

Thank you for such a detailed answer. Its hard to read about women who have been told to go on mbr at 2.5cm and yet Im here with no information whatsoever. What is MFM?
Good luck to you and your baby!

perchancetodream

Nvm I got it! Haha

happywifemomofone

Do you have insurance that will allow you to make an appointment and consult with MFM? I agree that 2.4cm is right on the border of needing intervention. Was it measured tranvaginal? That is the only way to get an accurate reading. My cervix was 7mm and 1cm dilated at 20w u/s. I had an emergency cerclage place, put on progesterone suppositories, pelvic rest and lifting restrictions. Do you have a history of PTL or LEEP procedure that increase your risk of delivering early? Do you trust your OB?, if not, you might want to consider a second opinion from a different practice. My MFM stopped checking cervical length at 24w, after cerclage and viability it seems there is little else they can do. I am 35w today

perchancetodream

I had a LEEP right before conceiving. LEEP was done in Jan and I conceived in March.
I do have insurance but the real question is will my OB refer me to a MFM? He will probably decline my request. I tried to go to another OB for a second opinion but there is a 5 month waitlist.
My measurement was NOT taken transvaginaly at 20 weeks.

kidcapri100

@perchancetodream Most of the time an OB won't ignore a request for a referral! It's in their best interest, especially if (God forbid) something serious happens - they could have a major lawsuit. I was given a referral and saw an MFM the next day.

I also had a LEEP about 8 years ago. My MFM claims that many times short cervixes due to LEEPs can still be very strong. And yes, did they measure abdominally or transvaginally? There is a huuge difference in accuracy.

@happywifemomofone Congrats on 35 weeks! So happy to hear the cerclage was successful for you!

perchancetodream

The measurement was done abdominally. Should I ask for a second ultrasound? This time transvaginally? My doctor is REALLY difficult to get along with and talk to. I know he'll give me hell for having concerns. He embarrassed me infront of the entire waitingroom when I went in for bleeding at 17 weeks.

kidcapri100

He sounds terrible! Are there any other OB's you can see? Perhaps an emergency appt with the OB that is on a 5 mo wait list?

You'd really want to have a transvaginal as that will be the most accurate measurement. In fact they recommend anyone with a LEEP to have a transvaginal btw 18-22 weeks to take the measurement.

Your other option is to call your insurance company and see if you would need a referral in order to see an MFM. If not then just find one in your network and go. If yes then first ask your OB for the referral - if the answer is no or he is difficult then perhaps call an MFM office and explain your situation.

Your right on the cusp - again, some MFM's feel 2.5cm or less is the standard for monitoring, others won't see you unless you are 2 cm or less. But you should really be measured transvaginally to have an accurate measurement and then go from there.

happywifemomofone

I would insist on a tranvaginal measurement!! You might also try calling the nurse line at your insurance company, see if you can get a advocate from their end to help you deal with difficult OB office?

PlainJane8350

Switch to a perinatologist pronto. I didn't need a referral.

bashley3

happywifemomofone said:

Do you have insurance that will allow you to make an appointment and consult with MFM? I agree that 2.4cm is right on the border of needing intervention. Was it measured tranvaginal? That is the only way to get an accurate reading. My cervix was 7mm and 1cm dilated at 20w u/s. I had an emergency cerclage place, put on progesterone suppositories, pelvic rest and lifting restrictions. Do you have a history of PTL or LEEP procedure that increase your risk of delivering early? Do you trust your OB?, if not, you might want to consider a second opinion from a different practice. My MFM stopped checking cervical length at 24w, after cerclage and viability it seems there is little else they can do. I am 35w today

It's crazy how doctors do things so differently. I have been 7mm since a 22 week check and was immediately put on hospital bed rest and the suppositories. But was told a cerclage was too risky, as it could puncture the sac. I'm now moving into week 6 of being in the hospital and going home has never been an option.

perchancetodream

Update: went to hospital with cramping and they checked my cervix manually (ouch) and its closed. This has caused some bleeding and pain today.
Had a transvaginal ultrasound and cervix came in at 2-2.8cm. They didnt suggest any intervention.
I guess I'll just take it easy and not lift anything...hoping my cervix keeps hold until 24 weeks.

SouthernYankee87

@perchancetodream - if your cervix gets any shorter you could ask your doctor about inserting a pessary ring.  

My cervix was 2.5 cm at 21 weeks and then decreased to 1.3cm at 22 weeks.  Instead of doing a cerclage, my doctor gave me the option of having a pessary ring, which is a relatively new concept.  It's basically non-invasive.  It's just a plastic/rubber ring that pushes up against your cervix to take the pressure off.  It has worked like a charm for me.  I had trans-vaginal cervical length checks weekly until 34 weeks.  The ring lengthened my cervix until very recently but it isn't a concern anymore since I am now 36 weeks and will have the ring removed next week.    

Just a suggestion to bring up with your doctor in case your cervix gets worse.  It takes 30 seconds to insert without pain, I figured it wouldn't hurt to mention to you.  

Best of luck!

PlainJane8350

I had a LEEP, too and have been on "couch potato rest" and progesterone suppositories for a while now. Did your OB refuse to refer you to a perinatologist? Do you need a referral? Is there no other OB that you could see now, not even through a clinic or something just to get a referral?

christina4436

I would definitely demand more attention and do your research and ask questions. If you are not getting what you need then go elsewhere ASAP. While it's great that 24 weeks is viability it is by no mean 'chances are your baby will live'. That is really when they can start being able to live outside of you and with lots of extra care an attention from a higher level NICU (not every hospital will even take mothers less than 28/30 weeks). I would make sure you're also at the right place and definitely take it easy until you get more answers.

BP1979

Based on what you've said about your doctor -- not listening to your concerns, not explaining information clearly, embarrassing you in front of waiting room... this all sounds very unprofessional. If it was me, I'd be looking at switching OB practices to somewhere that I felt more comfortable.

purty4u

I'd say look up hospitals that's take you in the maternity ward as of how far along you are. Head there and explain your concerns and the info your doctor provided. They will take care of you well! Good luck