Manual Checks with Incompetent Cervix?

1drmom

So I'm 27 weeks pregnant with baby #2.  I had a preventative cerclage placed at 13 weeks because DD was born at 30 weeks due to 0.3 cm cervix discovered at 23 weeks.  I see an MFM every two weeks.  For the past while, I've been having trans-vag ultrasounds bi-weekly to check cervical length.  The most recent one showed a 0.5 cm shortening in a two week time span.  It went from 3.6 to 3.1.  I know it's nothing to sneer at because 3.1 is still within normal range, according to the MFM.  Though I read that 27 weeks is a bit early for it to hit the 3 cm mark.  Anyway, time for my question.  My MFM wants to do a manual check of my cervix at my next appointment.  As in go up and use fingers to touch the outside of the cervix to check on the stitch and, I suppose, the length. My concern is that if it drops 0.5 cm in two weeks, what will the next two weeks bring, and what will actual touching of the cervix do? I don't want any unnecessary stimulation; however, I do want to be aware of the status of the cervix.  Currently there is 1.4 cm below the cerclage and 1.7 cm above the cerclage.  If there is another significant drop in length, I want to take the necessary further precautions.  And yet I wonder how accurate a manual check is going to be in the first place and if it will do more harm than good.  So yes, I'm really torn about the prospect of a manual cervical check at 28.5 weeks.  Any wisdom would be appreciated.  

peppercorn16

My experience is not quite the same as yours but it is somewhat similar so I will share my story in hopes that it will help you in your decision!

My cervix was checked at 18 weeks and it was a solid 4.1 cm, no problem. Then at my next preventative check at 22 weeks it was down to 2.2-- yikes. Docs did not want to do a cerclage but did want to make sure it was closed so they examined manually and confirmed that it was closed and not softening. I was placed on progesterone suppositories and bed rest and seen weekly from that point for transvaginals only. My cervical length stayed the same for a couple weeks, then shortened to 1.4 around the 25-26 week mark and showed some funneling. Doctor checked it manually again and confirmed it was closed. Cervix stayed at 1.4 for about a month and I was moved to biweekly checks. Then at 31 weeks it shortened to 0.5 cm and doc again did a manual check and confirmed it was closed. I received steroid shots and also was treated for preterm contractions that I had been having. 4 weeks later, baby is still cooking and doc will not be checking the cervix again until next week. He is going to check length and also check manually for dilation. So in my personal experience, manual cervix checks have never been followed by more shortening or new symptoms.

You always have the right to decline them (or ask more questions) if you are uneasy about it for any reason-- trust your gut! I personally just chose to go with whatever my doctor recommended, because I knew they had more experience than me and knew my history and I trusted that they would not do anything that would put me in my specific situation at risk. So far so good, and the treatment that they chose to do (and the things they chose to NOT do) as a result of what they found seems to have worked thus far! Good luck!!

1drmom

Thanks peppercorn16.  That is somewhat reassuring.  Congrats for making it so far!

PaniaO

Manual check would be helpful to know about softness, I guess. I don't see the harm. I only get transabdominals now though--not even transvag. My stitch is holding my length at 2.5ish (since 23 weeks, now at 31).

PlainJane8350

If you trust your doctor, then I would express your concerns, but probably allow it. If you don't, however, I would express your concerns and if he/she doesn't make feel better, then decline the manual exam. I know it's a tough decision and I wasn't much help, I'm sorry! Just trust your gut, that never lasts you astray.

1drmom

Well my other MFM decided a manual cervical check was not necessary at 28 weeks. And ultrasound checks are done. He said I should be celebrating that I've made it to 28 weeks. I am happy, but I had a 30 weeker last time and it was a very hard. MFMs don't see their patients after delivery. They don't know what we go through. I am happy to meet this milestone but I also know I'm far from out of the woods. And now I have no idea of the status of my cervix and whether I should limit my activity further. Guh. What do these specialists do for us with history of IC anyway? This has definitely made me realize that I've been clinging more to a measurement for hope than to God. Praying for a full term baby.

PlainJane8350

I would imagine they'd do an early, preventative cerclage next time. Hoping and praying you guys make it as far as possible!

1drmom

Well they did a manual check at 30 weeks just to rule out the need for the celestone injection for baby's lungs. Looks like I'm about 2.5 cm with the cerclage still holding strong. Praise the Lord.