Cerclage (the how, when, where, why, ect.)

johnnys june · January 2012

Warning: This pertains to a rainbow pregnancy. Ticker below. This post is meant to help answer some questions alot of you had regarding future pregnancies and potential preventative care.

Most of you know that I had a cerclage placed on my cervix on Friday to help prevent my cervix from shortening. Quick back story -- my cervix was measuring "normal" during my last pregnancy at my anatomy scan at 21 weeks. Three weeks later I went to L&D to discover I was in preterm labor and my cervix had shortened to .7 cm. A normal cervix is 3 - 4 cm.

Cerclage by definition is a stitch placed on the cervix. The stitch is about the thickness of shoe string and is placed as high up as possible. The hope is to give the cervix added strength (for weak cervix's) and if (god forbid) my cervix were to start to shorten, that it would stop at the point of the stitch. The stitch remains on the cervix until just before you give birth. It is usually removed a week before your due date but usually no earlier than 37 weeks. Mine will actually be removed at the time of my c-section since I will have planned one.

There are 2 types of cerclages (I'm not good with the exact names), but basically there is a preventative cerclage and a rescue cerclage. Rescue cerclages are done later once the cervix is found to have shortened (16 - 22 weeks). After 22 weeks they tend to not place them because of the possibility of stripping membranes and sending you into labor. Preventative cerclages are the best. Every thing I've read and talked to my doctor about states that a preventative cerclage is best placed at the end of 1st trimester (between 12 - 14 weeks). Mine was placed at 13 weeks 6 days.

As for the procedure. It's outpatient, but your care would also be based on what your cervix already looks like. My cervix was measuring at a whopping 5.5 cm so my doctor was excited to get the stitch placed early while it's still long. Prep was simple -- vitals, IV fluids, antibiotic, and mild pain meds to help prevent inflammation and headaches. I was not aloud to eat or drink 9 hours prior either. They took me to the operating room and that's where I was given a spinal. Not to be confused with an epidural. The spinal is less intense but just as good. The reason for the spinal and not being knocked out was because they spinal doesn't mix with your blood, therefore, it doesn't get to the baby at all. The baby probably had no idea I was even numb from the waist down. They used a tiny needle for lidocane to help numb the area of my back first. (it took 2 shots of that for me). Then the spinal was down which was just this intense pressure. I felt like someone was pushing in between my spinal column really hard. It wasn't painful just uncomfortable but only took a couple minutes. After that, they got me settled on the operating table and placed my legs in stirrups. They swabbed me down below real good and got to work. I was completely numb from my hips down. I could still focus and move my toes, but I couldn't feel pain, just pressure. The procedure itself was rather quick. My doctor explained the whole process before doing it. They insert a speculum (sp) as if you were getting a pap. Then she used these long tweezer type things to grab my cervix and pull it forward so she could see it. Once she could full see my cervix, she would take a needle and the "thick as shoe string" thread and sew back and forth all the way around my cervix (imagine your cervix is circular. The stitch goes in and out on the outside all the way around and then is pulled tight and knotted -- like a purse string stitch). When she pulled my cervix it literally felt like she was pulling my ovaries out. I've read that some women felt like the doctor was pulling their belly button down. It isn't painful, just alot of pressure. To me, it felt like an intense period cramp just before you pass a clot. It was an intense but dull cramp and I was able to breathe through it. It was just super uncomfortable. The actual procedure lasted literally 6-8 minutes though. ONce the stitch was placed, the doctor used an ultrasound machine to look at my cervix to make sure it was a good stitch. Then she showed me baby and baby was moving and had a strong heartbeat. It was a success! They cleaned me up and wheeled me back to recovery to wait for the numbness to wear off. All in all, I was in the hospital, prep, surgery, and recovery maybe 5 hours. I had period like cramps for about an hour after the surgery but the nurse gave me some tylenol which helped.

Recovery. Recovery is pretty mild. I was told I might have cramping and spotting for a day or two. It actually only lasted the night of the surgery. I have some mild discoloration in my discharge but nothing major. Actually, the main soreness I've experienced has been my back where they did the spinal. Feels like I pulled a muscle right in the middle of my back, but some tylenol has helped. My doctor instructed me to take it easy for a day or two. I'm on strict pelvic rest, but not to be confused with bed rest. Since my cervix is long and in good shape, I am able to resume "normal" activities pretty much whenever I'm up to it. And I have. I've done the dishes and some laundry, but if I'm up for 30 minutes then I sit for 30 minutes minimum to ensure I don't over do it. I think every doctor is different, but my MFM believes that the cerclage is preventative. If there is no current sign of weakness she does not believe in strict bed rest. Mild exercising is ok too. No sex though. No intercourse I should say. For the rest of the pregnancy. She said the reason for this is that something hard hitting the cervix would cause the stitch to tear from underneath. So this is a no no. However, as long as there is no pre term labor (which I will be on the p17 shot to prevent that), orgasms are ok and so is external stimulation. "High school sex" as she called it, lol.

Restrictions. As mentioned, no sex (intercourse) (and nothing for atleast 1 week until follow up), no heavy lifting (nothing over 10lbs). Mild exercises are ok until further notice (walking, light prenatal pilates, ect.). I will have cervical length checks every 2 weeks. Each week we will re-evaluate my physical restrictions based on my length/shortening. My doctor is one who advocates for exercise during pregnancy because it's healthy for baby and mom and because there is NO PROOF that exercise causes cervical shortening and/or preterm labor. Yes, you will need to be put on bed rest if your cervix starts to shorten, but that is because the cervix is already weak, not because your exercise caused it. She told me to do whatever gives me peace of mind though. If walking for 30 minutes is all I can do, than great. She also said to pay attention to my body. If I experience any form of cramping then I need to put myself on modified bed rest for a day or two. The key is to listen to my body.

She did mentioned that everyone's care is different. If you already have true IC with a short cervix at the time of the cerclage, you will most likely already be put on modified bed rest with no exercising included. If your cerclage is mostly preventative, then I suggest you find a doctor who will advocate and be behind you having as normal of a pregnancy as possible.

I hope this has answered some questions and concerns and given you more insight to what your future might hold. I will tell you this, after meeting with my MFM, she has given me hope and 10x more confidence in this pregnancy than I had before.

Depending on your story and your body, your care maybe be different, but somewhat similar. Since I had short cervix and preterm labor I had the cerclage but will also be on p17 shots form week 16 - 36. I will have a planned c-section at 37 weeks tops due to my previous classical c-section with Logan. My doctor will be monitoring my scar tissue on my uterus as well to ensure it doesn't weaken later in the pregnancy. I feel much more confident having the cerclage placed. I was really nervous up to the procedure. But the procedure was alot less invasive than I thought it would be.

Please feel free to message me anytime if you need any advice or just need to talk. Knowing that there are others out there with similar care plans and knowing they've had success in their pregnancies has helped me alot.

weddedwife · January 2012

Hi, thanks so much for sharing this. I will likely have a cerclage in any future pregnancies. I went into preterm labor w/ Nathaniel @ 22w4d having had no prior issues w/ my cervix (as well as having had my DD full-term).

One question I have- did they tell you not to lift anything over 10 lbs. just for the week's recovery, or for the rest of your pregnancy?

nuttycoconut · January 2012

Thank you so much. Your post just gave me the first glimmer of hope and excitement I've had since my loss for a successful future pregnancy. I really appreciate the time you took to post this update. It sounds like you have an amazing Dr. and I hope you continue to have peace of mind throughout your entire rainbow pregnancy.

foxxy1 · January 2012

Thank you for posting this! I was really nervous about getting a cerclage since I need to have one for all future pregnancies but your post makes me feel so much better and gives me a lot of hope.

johnnys june · January 2012

weddedwife:
Hi, thanks so much for sharing this. I will likely have a cerclage in any future pregnancies. I went into preterm labor w/ Nathaniel @ 22w4d having had no prior issues w/ my cervix (as well as having had my DD full-term).
One question I have- did they tell you not to lift anything over 10 lbs. just for the week's recovery, or for the rest of your pregnancy?

For now, I know the heavy lifting is STRICT for the 1st week. I also think it comes down to the severity/length of your cervix at any point. Obviously there are sometimes that you just have to lift more than 10lbs. But I would avoid it as often as possible. I'll confirm with my doctor at my follow up if this is for the rest of the pregnancy or just for this 1 week. I see her on Friday. I'll let you know

johnnys june · January 2012

Foxxy & Nutty, you're most welcome. I was incredibly nervous during the whole TTCAL process and again once I got pregnant. Honestly, it wasn't until Thursday when I met the new MFM that I finally gained some confidence and security in this pregnancy. If I can give you any advice moving forward, once you do get pg again, please please please make sure you 100% secure in your doctor's (MFM's) hands. That made all the difference. Her positive attitude about this pregnancy is contagious. And feel free ask any questions whenever you have them. It's helped me TONS!

*hugs* I hope you all get your rainbow pregnancies sooner than you think! And I will be there cheering you on

mdluv21 · January 2012

There is also TAC (transabdimonal cerclage) where you cervix is sewn shut from the inside. If anyone would like info on this please let me know.

leneae10 · January 2012

mdluv21:
There is also TAC (transabdimonal cerclage) where you cervix is sewn shut from the inside. If anyone would like info on this please let me know.

I was about to post about this. I had a TAC placed at 11w with my rainbow baby!!!! IT was by far the best decision I've ever made, and hands down the only reason he is with us today.

I lost my twins at 17w and 18w to IC. My OB had recommended a preventative transvaginal cerclage in my next pregnancy. However, I did some research and found the TAC. When my betas came back and I knew I was pg, I had a phone consultation with Dr. Arthur Haney at the University of Chicago. I knew this surgery was for me. I had it done at 11w with my rainbow baby. The surgery went great!

I had weekly cervical length checks with my OB's sonographer. I was the first TAC patient in my uber-busy OB's office so they were all super interested in my progress. Around 20 weeks, when the sonographer started applying pressure to my uterus, my cervix would funnel down to the TAC. If I had had a traditional transvaginal cerclage, the pressure would have ripped right through my very weak cervical tissue. No doubt. I would have had a 25 week preemie (best case scenario).

I made it to 35w, delivery was not related to the TAC or the surgery; I had a 1:5,000 complication where he hemorrhaged blood inside of me. After a strong fight, we brought him home for good at 7.5 weeks old.

If anyone wants my WHOLE story, with all the gory details, my old blog is full of information: https://tacbaby.blogspot.com/

Please feel free to page me here or on PAL for more info if you are interested.

Love to all of you.

Cercamom2011 · January 2012

Thanks for posting this. My experience was very similar to yours. The only big difference was that my Dr made me stay in the hospital overnight. He was just extra cautious (probably because it was the week of Thanksgiving and he wanted me off my feet).

I hope that any ladies that are worried about this procedure, feel free to ask any of us that have gone through it any questions. We all want our rainbow babies, and will go through great lengths to make that happen. GL.

Jackie2200 · January 2012

I had a TVC placed for this pregnancy at 12w exactly. My surgery and recovery were very different than yours though. I was in so much pain that I begged for them to give me an abortion! I said that I was done with this child-bearing $hit!

I had an epidural and some meds that made me loopy. I went into surgery at 12:30 and was done at 2:10. I was at a teaching hospital and I know the students took over at one point because I remember my MFM leaving and saying she'd be back in a little while so I don't know if that had anything to do with my experience.

All in all, the surgery was fine because of the meds but I was in so much pain afterwards that I needed narcotic pain relievers. I finally had the strength to leave the hospital at 9pm! It was crazy! I could barely walk for a week and took narcotics for about 5 days. Would I do it again though? Absolutely! The peace of mind is worth it and it seems to be working--I'm lmost 22 weeks now and have no residual effects from the cerclage. I am (so far) having a completely normal pregnancy.

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Cerclage (the how, when, where, why, ect.)

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