IC - preventative vs rescue cerclage

SweetieD21

Hello,

 I had a loss at 18 wks due to IC and my dr's plan this time around is to do an u/s and p17 shots weekly, starting at 16 weeks, then place a cerclage if necessary.  I've read that rescue cerclages don't have as high of a success rate as preventative ones.  Should I push for a preventative one?  Any advice or experiences would be great!

TIA!

dnewby

I also had a loss (5 years ago) due to IC. We did do a rescue cerclage (I had dialated 3cm) but a few weeks later my water broke. My ob at the time said any future pregnancies would require a preventative cerclage. At the time I lived in a different city. When I moved back to my hometown, I changed gynecologist. He was not convinced that I had IC. When I did get pregnant, I knew for sure that I was going to fight for a preventative cerclage. I went in to speak with him and after discussing my history and letting him know that if he did not support my decision on doing a preventative cerclage, I would find an OB that would, he decided to support me on it and sent me to a perinatologist.

My peri did a preventative cerclage at 14w3d. It has been very successful. I also am on progesterone suppositories nightly and an antibiotic to fight off infection that I use the first week of the month (also a vaginal suppository). My cervix has measured anywhere from a 4.0 to a 3.1 since my cerclage placement. My most recent cervix check was 3.5 in length but it is funneling. I questioned my peri about the funneling. He said that the cerclage will help that. He also said that the funneling tells him that without the cerclage I would have lost this baby.

I am not on bed rest. However, I have been taken off work since my cerclage placement and can not return until after the baby is born. I do work in a factory with heavy lifting and long periods of standing, which is why they took me off. I am also on pelvic rest and have been instructed to only do light chores at home. He said no grocery shopping, grass cutting, etc...

With all that said, due to my experience, I would absolutely push for a preventative cerclage if I were you. The benefits outweigh the risk. A preventative does have a higher success rate than a rescue. If you have any additional questions or concerns please feel free to PM me and I will give you my yahoo email. HTH

luvndazys

I too had a previous loss at 16weeks. During my current pregnancy, my OB also recommended bi-weekly U/Ss beginning at 16w along and weekly 17p injections from 16-36weeks. At 16 weeks I started the shots & had my first t/v u/s at which time my cervix measured 4cm.  At my 18 week u/s my cervix had changed to 2cm. Given that the cervix is a muscle & can be dynamic I had a f/u U/S one week later at which time the CL remained at 2cm. At that time I chose to have a cerclage. Since then my CL has measured between 2 & 3cm, the last two measurements showed funneling as well. I am convinced that without the cerclage, and the injections I would have lost the baby.

I will be 30 weeks tomorrow (YEAH)! and have been on full bedrest for 5 weeks.

Your OBs plan sounds similar to mine. I sometimes wonder if i'd be in a different situation (longer CL, no funneling & not on Bedrest) if i'd known to request the cerclage at 16 weeks after my cervix measured 4cm....rather than waiting until it measured 2....I guess i'll never know. You have to do what you feel comfortable with and hopefully your doc will support that. I wish you luck!

Denesdia

The success rate for the preventative cerclage is exponentially higher and if I had had the opportunity to have one with either of my children, I would have.  My first DD arrived at 25 weeks and we were not even aware of the IC.  For DS, we caught problems just before 22 weeks, got the rescue cerclage, and I had 14 weeks of bedrest plus the P17 shots.  If you can avoid all the drama, I say do it!    Best wishes to you.

PalmettoTreeMom

I had a preventative cerclage just today.  It was actually too soon to see what was going on in an ultrasound, but given the nature of my previous labor with DS and the fact that my cervix looked irritated at my 12 week visit, they went ahead and did it anyway.  When they went in today, my cervix was very soft and it started bleeding quite a bit, so much that they actually had to do some cauterizing.  So, everyone is glad that we went ahead with the cerclage.  My instincts had been telling me that this was the way to go because I had been having heavy pelvic pressure that I had not felt before.  If your instincts are telling you, go ahead and ask the doctor about it.