High-Risk Pregnancy
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Dynamic cervix and back on bed rest
So, apparently I have a dynamic cervix that is on the short side (u/s techs have seen it shorten and lengthen before their eyes). Anyone else? Here's a quick break down of the last few weeks: at 21 weeks my cervix was measuring 2.7cm, at 21w6days it was 2.4, at 22w3days it was 3.1 and at 23w it was 3.2. Today at my OB's office it was measuring 2.6 with beaking (it actually opened and then closed twice during the ultrasound) so my OB put a cervical pessary in and sent me right over to the Peri. The peri took a look at my cervix (an hour later) and it was measuring 2.8-2.9 with no signs of beaking. He took out the pessary, saying it was not necessary for me at this point. I am now on strict bed rest and go back to my OB on Monday for another FFN test. I had one at 24 weeks and it came back negative. Anyone go through anything similar? I'm very nervous about the beaking.
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Re: Dynamic cervix and back on bed rest
I don't quite understand why they removed the Pessary...was it hurting anything by sitting there?
In any case, while of course the beaking/funneling isn't ideal, having 2.5cm+ towards the end of the 2nd trimester isn't that bad either. You definitely have some risk of pre-term labor/PPROM/etc., unfortunately, but overall I don't think you're in crisis mode yet.
Also, you're getting pretty close to the point in the pregnancy where your pelvis will start taking more of the weight, so that may help reduce stress on the cervix somewhat.
Sounds like your doctors are taking a good approach with keeping you on SBR and doing FFN tests. I don't know what else they can really do. I would ask your Peri why they wouldn't just leave the Pessary in there? Are there any negative side effects to putting one in and just leaving it there until you deliver?
There are definitely a few schools of thought on the steroids.
What has been pretty much proven is that 1 dose of steroids seems to show very positive improvements in fetal outcomes with no significant fetal side effects or long-term issues. It has also been shown than 3+ doses of steroids do not seem to have significantly better outcomes than 1 dose of steroids and DO seem to have some potential long-term effects (lower fetal birth weights and head circumference). There is limited research on 2 doses, but there does seem to be some indication that it is no worse and possibly better than 1 dose, and does not seem to show the same long-term effects of 3+ doses.
The data also shows that the greatest beneficial effect conveyed by the steroids is in the ~1 week following the injection, but there may be some residual value even if the injection was more than 1 week ago. So that's why the doctors like to try and wait until delivery is imminent to give the steroids.
Currently, the standard approach currently seems to generally be waiting until it seems like labor is likely within the next week before giving steroids and then giving a single course, typically betamethasone, 2 shots 24 hours apart. If your cervix changed significantly, or you had a positive FFN test, it might be a trigger to do the steroids due to increased risk of pre-term labor. And this would be the only steroids you get, so if it ends up that you don't go into labor within a week but you end up going into pre-term labor later, you don't get a second dose.
There's another school of thought with the steroids that 1 dose should be given around viability or at initial post-viability diagnosis for anyone who is at higher risk for pre-term labor. And then if the woman remains pregnant and presents again with what seems to be a risk of imminent pre-term labor, a second "rescue course" of the steroids can be given--again, 2 shots, 24 hours apart. Since the research around the rescue coursing approach is limited so far, most doctors don't seem to follow this approach yet--though our doctors do, so that's what we're doing.
My guess is that unless your doctor thinks you are at major risk because your condition gets worse than it is now (more cervical change or positive FFN would be the 2 most likely indicators), they will recommend you wait on getting the steroids until it seems like you are at greater risk for labor. For you, you do have some risk factors but overall you're pretty stable, and while the steroids are helpful it is a medical intervention that may be unnecessary if your cervix keeps cooperating until you are close to term.
I'm guessing beaking is the same as funneling? I have never heard the term beaking.
I also have a dynamic cervix that likes to shorten. It isn't incompetant as I have carried a baby to term without a cerclage but it isn't "fort knox" either.
Similar to you, I measured in the high 2 cm range at 21 weeks with my first pregnancy. It would lengthen and shorten but ended up shortening to the 1.5cm range with funneling by 32 weeks when they stopped measuring. With my first pregnancy, I ended up delivering at 35w4d due to pPROM. The pPROM was likely caused by my short, funneled cervix but that is something we don't know 100%.
Pregnancy #2 they gave me 17-P shots and I was on Procardia to stop any BH contractions (they were having an effect on my cervix). I ended up having a longer cervix and delivering my son at 39w4d by induction (for other reasons). He was 9 pounds 11 ounces so my cervix definitely held up.
I was never on bed rest. I actually worked (a desk job) both pregnancies and was just given orders to take it easy. No sex, no exercise, no long shopping trips. When I was home I tried really hard to put my feet up. I am honestly surprised that they would put you on strict bed rest in your situation - but if that is what makes your doctors and you comfortable I can understand the precaution.
Best wishes!
Married 6/28/03
Kate ~ 7/3/09 *** Connor ~ 11/11/10
4 miscarriages: 2007, 2009, 2013, 2014
*~*~*~*~*
No more TTC for us. We are done, and at peace, as a family of 4.
"Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but – I hope – into a better shape.” — Charles Dickens
Steroids...
Yes, I recieved a course of steroids (two doses given 24 hours apart) at about 30 weeks with both pregnancies. I credit them for my daugher (born at 35w4d) not needing any breathing assistance or NICU time. She was 100% perfect and healthy - just tiny. If you are high risk for pPROM or PTL due to your cervix (according to your peri) I would lobby for some steroids at some point.
Married 6/28/03
Kate ~ 7/3/09 *** Connor ~ 11/11/10
4 miscarriages: 2007, 2009, 2013, 2014
*~*~*~*~*
No more TTC for us. We are done, and at peace, as a family of 4.
"Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but – I hope – into a better shape.” — Charles Dickens
Here's a really good overview on prenatal steroids that I found when I was researching this extensively a few weeks ago...sums up all the approaches with some good data if you like graphs and charts, and some fairly plain text explanations if you prefer that.
https://www.perinataliowa.com/for_med_prof/documents/Dr.NeilMandsager.pdf
With my first pregnancy I think the funneling started at about 27 weeks or so. With pregnancy #2 we didn't see it until much later ... 32 or 33 weeks?
As for steroids, I forget why they did them at 30 weeks. But the timing matters so I would chat with your peri.
Married 6/28/03
Kate ~ 7/3/09 *** Connor ~ 11/11/10
4 miscarriages: 2007, 2009, 2013, 2014
*~*~*~*~*
No more TTC for us. We are done, and at peace, as a family of 4.
"Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but – I hope – into a better shape.” — Charles Dickens