XP - Q about manual cervix checks

Jenandtonica

I also posted this on the high risk board.

I'm seeing the MFM and my OB. The MFM is doing all the babies' checkups, & the OB is taking care of my health. The plan the two teams worked out for treating a possible incompetent cervix (trips + a slight uterine anomaly = not enough research to back up a solid plan) is for an OB to check me manually one week and to have an ultrasound to measure length the next week. The manual/ultrasound rotation started at 14w and will continue until 22w - at which point a new plan will be drawn up.

So far, my main OB did the first manual check. A second OB did the next, was worried about my cervix & sent me for a u/s. It was closed & measured 5cm. Today, the original OB checked me again, but it's been 4 weeks since she last checked, & she thought it felt thin. Again, I was sent for an u/s to check length. Still closed, measuring 3.9-4.2 (they monitored for 10 mins.). My next manual check is with a third and new-to-me OB.

My question: Is it normal to have something as subjective as how a cervix feels be checked by different OBs? It seems like something I should insist be done by only one doctor, but I don't want to ... I don't know - be unreasonable. I know OBs in general do a big square dance with patients & constantly rotate.

Any experience with something similar or advice? Thanks!

pea-kay

Does your MFM deliver? Is it possible just to have one doctor? I had two until 23 weeks, when it just got to be too many cooks in the kitchen, if you know what I mean. It was much better to just have the one doctor.

I never had my cervix checked manually, so I don't know. I'd want it checked by u/s only if it was me.

anna2006

Why exactly do they do the manual checks?  I never had any.  In fact, my MFM wanted to minimize any manipulation of my cervix.  Is this something the regular OB is doing just out of habit (with uncomplicated singleton pregnancies)?

U/S tells you the length of the cervix.  Manual checks tell you the effacement and dilation.  I'd ask them: which one are they worried about? 

srh08.05.06

My OB did manual checks every 2 weeks starting at 20 weeks because I had a shortened cervix.  In their practice, you took turns seeing each doctor in case a different doctor had to deliver you.  So I was having different doctors measure at each appointment.  I don't think they found it to be too big of an issue because they would get relatively the same measurement.  For example, I went into the hospital with PTL at 31 weeks.  The resident said I was 3 cm dilated.  Before I left, my OB manually checked to be sure I didn't dilate more (they wouldn't release me if I was dilated more).  My OB thought I was dilated more like 2.5 cm rather than 3.  But essentially it didn't matter because they wouldn't have treated me any different if I was 2.5 or 3 cm.  So maybe that is why they aren't too concerned - they might figure the measurements shouldn't be that far off enough to require different treatment?  Just a guess.

E&RMommy

A manual check is subjective.  A transvaginal u/s length is objective.  Plain and simple!  Our new policy on L&D for our service is to measure the cervical length and perform a fetal fibronectin.  Those in conjunction with the entire clinical picture are much more predictive than a manual check of the cervix.  They are also more reproducible.  FWIW, I do this for a living and I only had my cervix manually checked once during my pregnancy (at 35 weeks) as we preparing for my delivery.  I had cervical shortening and preterm contractions and was on bedrest from 23 weeks upward.  There was absolutely no need for a manual check at any time as long as a transvaginal u/s was performed in its place.  That is why I went to an MFM exclusively; I know my regular OB would have probably done manual checks (because that's how we are trained).  It's silly for your cervix to be man-handled that frequently when it tells you nothing more than an u/s (and may even stir up cytokines). 

So if it were me, I would just have the u/s done at the MFM office and skip the regular OB performing manual checks.  That's just me.

Good luck!!

Jenandtonica

When I asked my peri yesterday about stopping the manual checks, he said he and the OB wanted to continue with them because the u/s and manual checks look at different things. After spending the rest of the day yesterday with pain in what I can only assume was my cervix, I left a message to speak with the OB about stopping the manual checks. I just don't get why they want to do them if they make their conclusion based on an ultrasound AFTER the manual checks. I don't have another one scheduled for 2 weeks, so I have time to make my case and get them to stop.

I still don't know who will be delivering - I believe the MFM/OB practices work together on a lot, but I will ask next time. They've both told me the OB is for me, and the MFM is for the babies. I get the impression that they want lots of hands on deck to do the whole several-heads-are-better-than-one jig with me because of my uterine anomaly/lotsa babies combo.

MrsLee, is there info for the sale online? I certainly won't rule out going!