Met w/ peri for the first time, have cerclage questions

easjer05 · October 2011

Long story short, there are two possible reasons I went into labor at 21 weeks with my son. One OB said one thing, another said a different thing. My OB said, with all my files and an shg in front of her, that she believes it was non-standard incompetent cervix caused by a previous cervical ectopic, which damaged the internal os. I had a ton of bleeding issues, diagnosed as placenta previa at the time (there was previa, no question) - she thinks it was covering the damaged area, and causing the clotting, then bleeding. When the previa cleared, my water bulged, membranes ruptured, triggered labor. We can't be certain my water broke - we think so, but the nitrazine swab was negative. The other possibility was a placental abruption.

So, the OB said we'd leave it to the peri. On review he said I definitely need a stitch, no question, and 17-p from 16w onward (precisely my OB's recommendation). He said my OB would do the cerclage in 3-4 weeks, and I should have first tri screening done before then if we would consider termination.

My next appt is 10/17 with my OB. What questions should I be thinking about in relation to the cerclage for her? I've researched it generally and know roughly what to expect, but will of course be asking for details of the procedure, what to expect going in, recovery time, etc.

What else should I be asking? Was there anything that took you by surprise with a cerclage? Is there anything unusual that you wish you'd known before-hand? Any experiences/stories with preventative cerclage would be great.

Tapioca · October 2011

I'm so sorry you're going through this but I know how you feel. I had a stitch placed with my last pregnancy at 13 weeks and ended up going into labor a week later. I guess my recommendation to you is to ensure there aren't any other possible scenarios that could have caused your loss. I trusted that my doctor fully understood what had happened in my previous 3 pregnancies that I didn't think to ask about other possible causes or treatments. Their recommendation of a cerclage for me, "It can't hurt", now seems like it exacerbated an underlying autoimmune issue that causes inflammation and triggers an early onset of labor.

Good luck to you! Just remember that there are no "experts" in this area, as every person and every pregnancy is so unique. Follow your gut!

Lina1030 · October 2011

I'm so sorry for your loss.....I wish you a healthy long 40 week pregnancy this time. My 1st pregnancy ended at 21 weeks due to an incompetent cervix and premature rupture of membranes. The week prior all looked great...with the IC it can happen overnight. So I had preventative cerclages with each of my babies. My cervix was always nice and long but the cerclage was there just in case (1st time may have been a fluke). Both cerclages were removed at 36 weeks or just under and my DD was born on her due date (no dialation at all until the day I went into labor) and DS was born 5 days past due date I refused internals until 40 weeks and at that point I was 4 cm. My first suture was the flat ribbon (different perinatologist) the removal was fine, a little uncomfortable but not bad. It was placed around 13 weeks and that was fine also...normal cramping but nothing bad. I was on restricted activity, lifting, no exercise, no sex in the beginning (I forgot how many weeks). My 2nd was a different suture....much more conservative perinatologist (excellent in his field)...he used a wire stitch and TWO of them (one for back up....he said I was locked up like Fort Knox! he wasn't kidding). The procedure was fine (done around 15 weeks this time), cramping, minor bleeding, nothing abnormal, I needed some pain meds I remember. Also don't worry if you see some mucus type discharge...it is normal to have some...peri said since the suture is a foreign object in your body the tissues do this....but if you see a lot or have cramping/contractions call your OB to make sure you did not lose your mucus plug if it is early...your mucus plug regenerates throughout the pregnancy. Ok so the removal of this was WAY different. I thought I was going to die...because it is thin/wire the tissue over the course of all those weeks builds around it making it hard to pull it away, cut and pull out. I almost passed out, we had to stop, take a break and had a choice to go surgically to remove or try again in his office. I was not offered any meds/numbing (which I read somewhere here that a girl was given something, can't remember what...I did not need any meds w/DD's removal of the flat ribbon). So I decided to avoid surgery and try again...I survived BOTH of them being removed but it was the worse pain ever! The girls here seem to all have the ribbon suture which I think is more common. That being said this time my OB called peri and requested the flat ribbon (btw both are just as effective) and peri was on board so YAY!!

What I wish I knew was the pain of the removal with the wire or give myself an option of which suture I prefer/explain the differences. That's pretty much it.

Good luck to you and your little one.

easjer05 · October 2011

Thanks so much! Very helpful.

I had complete repeat loss panels and every other test the OB could think of done after I lost Gabriel (was not seeing her for prenatal care during that pregnancy, or I think he might be alive). No auto-immune issues, no thrombophilia issues save for a heterozygous MTHFR mutation, for which I take extra folic acid/b6/b12. So far, everything has been perfect with this one, and placement is definitely better than with Gabriel.

The only other cause for all of the bleeding and other issues, and ultimately pre-term labor, was a placental abruption that went undiagnosed. It's hard to say because I had several ultrasounds by multiple qualified people that never found other signs of abruption or issues with the placenta. Given that the MTHFR mutation was unknown at the time, and that I wasn't supplementing high amounts of folic acid as I am now (and that my folic acid base had been stripped by the methotrexate of the cervical pregnancy just before we conceived), it is possible there were placental issues or clotting issues with the placenta.

But the other diagnosis seems to fit the facts better. The previa covered the spot where the internal damage was, and I didn't have a lot of bleeding until the placenta had crept over it. Then clot after clot after clot. . . and once the previa was cleared, no more bleeding. But delivery shortly thereafter, with potential PPROM (the hospital report may say, but I've never seen it and my OB has not received it yet either).

The other issue is that I went through a full labor - dilated to 7 when my son delivered, with hours of increasingly strong and close contractions. The hospital was negligent in my care, so we don't know if things could have been stopped or reversed if they had treated me appropriately, which makes it a bit harder to gauge precisely what happened.

I'm relieved the peri is on board for the cerclage, because I honestly feel it's the best thing. I know there are risks, of course, but I feel like the risk of waiting, given what we think happened with Gabe was likelier to lead to another second tri loss.

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Met w/ peri for the first time, have cerclage questions

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