Cervical Incompetence

happymommy0902 · January 2014

Hello ladies! I'm new here, I've just been lurking around this board the past week or so. Lol. DH and I just found out that we are expecting baby #2, last week!! Although we're so excited, we're also very scared. We suffered the loss of our son in September due to Cervical Invompetence. I went into labor at 22 weeks, and had no idea until I was just about 7 cm dilated. So I have a few questions for you wonderful ladies about what to do this time around.

we're 4 weeks 4 days along. I'm already seeing an OB that I was referred to from the ER. They've been doing HCG quants, and yesterday I was at 814. They said everything was progressing, so scheduled me for an ultrasound next Monday! Hubby will be in the field, but I can't wait to see our baby. Even if it's just a "blob"

so here are my questions.
1. I have an in home daycare- should I or will I need to just let it go?
2. 17P shots? Any success?
3. Will I be bed rested?
4. Will I get a cerclage?
5. DH will be deployed the last 5 months of my pregnancy. Will I need to be hospitalized for bed rest or just fly home?
Any advice, or opinions are appreciated! And stories from others in the same boat.

TIA!

MissChanandlerBong · January 2014

Hi there! I'm very sorry about your loss last fall. Congratulations on this pregnancy! I had cervical incompetence with my first pregnancy, and gave birth at 23 weeks after I had a rescue cerclage placed at 21w. I am also pregnant again with #2. I had a preventative cerclage placed at 14 weeks and I'm getting the weekly p17 shots. I would think that it's likely you will have the same treatment (cerclage & p17) given your prior loss. I am on pelvic rest and modified bed rest. I am not supposed to lift anything heavy and I'm to stay off my feet, etc. I have a desk job so I'm able to work, but my doctor would not have wanted me to if I had a more physically demanding job. Therefore, you may be advised against continuing with your daycare, but definitely discuss it with your doctor before making any decisions. In terms of bed rest, thankfully my cervix has stayed long so far this pregnancy. If it did start to shorten, then I would likely be on strict bed rest and/or hospital bed rest. I go for weekly cervical length checks to monitor this. I can't say what your doctor would want in terms of hospitalization or not if it was necessary for you though. Good luck with everything!

PerkyErky · January 2014

We lost our daughter at 20w4d due to IC and this pregnancy I was being monitored and had a rescue cerclage done at 18w6d. I am now 31w3d. If we have anymore children I will definitely be getting a preventative cerclage around 14w. Their success rate is better. I don't take the 17P shots but many women do.

My cervix is holding strong at 2.1cm below the cerclage placement. I am not on bedrest, but modified activity. I have a desk job so there are no issues with me going to work. Whether or not you are placed on bedrest will definitely depend on your cervix and your dr.

I am on complete pelvic rest and have been since about week 16. I am not supposed to do any heavy lifting (this could make running a daycare difficult if you have the same restriction). I was told no exercise, but at last week's appt my dr said I could start walking again.

I was worried about bedrest but at this point it looks like I will have avoided it completely. My cerclage is holding and doing its job. I think if you get a preventative cerclage you will have an even better chance of avoiding bedrest and making it to term. Overall my daily routine hasn't changed much besides limiting the time on my feet and in the evenings making sure I elevate my feet to relieve some of the pressure and weight on my cervix.

I highly recommend getting a preventative cerclage. Like I said, if we have anymore children I will definitely be getting one. For me the scariest part about a cerclage was the idea of getting one. Once it was placed I felt so much better anxiety wise and wondered why I hadn't gotten one sooner.

Congratulations! And good luck!

happymommy0902 · January 2014

Thank you all for the great advice and opinions! I'm hoping and praying I get the option to do all I can to go full term. Cerclage, 17p shots, bed rest, etc. I'll do it all! I'll do anything to bring my baby home.

should I begin pelvic rest now just to be safe?

Blessedchild4 · January 2014

Good afternoon. I'm so sorry for your loss. We lost our son at 17w5d due it IC and my mom had three losses due to IC after giving birth to me. I would like to go on this journey with you bc I'm 5w1d today. I have an excellent OB who says I don't need a high risk OB. Here's his plan for me... 1. Do a formal 8week check up 2. Then a 10 week first ultrasound to confirm intrauterine pregnancy 3. At 12-13 weeks I'll be getting a preventative cerclage with a purse string suture (sorry for being so technical but I'm in the medical field too and it's a super strong stitch) 4. Ultrasounds every 2 weeks after that with no current plans for progesterone (17P ) shots -- we'll do progesterone vs steroid shots as needed basis 5. Complete pelvic rest including minimal straining of pelvic muscles and absolutely no sex until the cerclage comes out around 32 weeks. 6. No high impact exercise and no high heels. 7. Bed rest will be only if needed. And I'm constantly on my feet at work so I'll probably be on it eventually my doc says. But we'll see.... My OB said he's really waiting for me to make it to 26-28 weeks when the baby will be more supported by my pelvis rather than my cervix so much. I'm extremely nervous but I know God is in our corner. I'll be praying for all of you everyday. We'll get through this. DH and I have lost a total of 3. But this will be our golden child. I'm sure of it.

Blessedchild4 · January 2014

Oh we're doing GENTLE baby dancing until full pelvic rest.

happymommy0902 · January 2014

Hi! I'd love to have someone to go through this with! Your doctor sounds wonderful. I'm hoping mine is as proactive. I'm also sorry for your losses, but you're right. God is in out corner, and I know He makes all things beautiful.

when is your due date?

JackieP1023 · January 2014

Here's my experience: i had a 20 week loss in 2011 due to IC.

This pregnancy, I had a cerclage placed in week 13. I started preventative doses of procardia (to prevent contractions) at 15 weeks. I started p17 shots weekly at 20 weeks. I have been on pelvic rest since the cerclage placement, and have been working from home since 15 weeks (I have super flexible understanding employers!). I have put myself on a sort of 'modified' rest throughout the pregnancy-not lifting/pushing anything heavy, avoiding a lot of activity, minimal exercise. Lots of recliner/couch time. I am currently 36 weeks, and will have my cerclage taken out in 6 days.

jennybean80 · January 2014

Sorry to hear about your previous loss, but congratulations on your pregnancy! I'm currently pregnant for the 2nd time. My first DS was born at 27 weeks due to suspected IC or abruption or chorioamnionitis.

This time around I'm carrying twins and because we didn't have a definite diagnosis, and research isn't very supportive of cerclage in multiples, I basically was put in the 'wait and see' category. By the time my cervix started significantly shortening I was too far along for a cerclage because the risk of rupturing the waters was too high. Instead I had a pessary placed at 25+ weeks and am now 30+1. My cervix is still thin, <1cm, but the pessary seems to be helping.

If I were to get pregnant again, I would opt for a preventative cerclage around 13 weeks.

happymommy0902 · January 2014

I definitely want to be able to do the preventative rather than emergency and risk anything.

angelsnight · January 2014

I also lost my baby last pregnancy due to IC (or at least they suspect it was IC) at 22 weeks. I'm very sorry for your loss, and a new pregnancy is very scary. If your OB a high risk doctor (MFM?)

1. I have an in home daycare- should I or will I need to just let it go? This is a wait and see. Everything may be fine with the right care this time, so I wouldn't give it up just yet. But you may want to keep the parents informed of your progress (especially as you get closer to second tri) so they can be prepared to make other arrangements if necessary.

2. 17P shots? Any success? I did not get these

3. Will I be bed rested? It depends if you have any cervical shortening or funnelling. Even then, some doctors do not believe it helps. However be your own advocate....I wouldn't put yourself on bed rest if you're doing fine, but I was prepared to do so if I had any shortening, even if my doctor didn't think I needed it. I had to do what I thought was best because I couldn't stand the thought of losing this baby too.

4. Will I get a cerclage? This depends on your doctor. I have 4 doctors in my practice, 2 are for them and 2 are against. I wanted it so I went with the doctors suggestion for one who is pro-cerclage. The two who are against don't believe in IC, they think my loss was due to an infection and "probably" wouldn't happen again. Probably isn't good enough when it comes to the life of my child, so I erred on the side of caution. You can get a preventative one around 14 weeks, or you can wait and see if you have any shortening and get a rescue one between 18 and 24 weeks I think. However if they are certain you have IC, I see no reason not to do the preventative one. The risk of complications is much lower, the procedure is less complicated and there is greater chance of success. In my case they were not even certain I have IC, but both MH and I, and my doctor were comfortable with doing the preventative one just in case. If your doctor is not pro-cerclage and you think you need one, find a new doctor who is willing and supportive of doing one.

5. DH will be deployed the last 5 months of my pregnancy. Will I need to be hospitalized for bed rest or just fly home? Again it all depends. I have a friend who lost her son due to IC, had a cerclage in for the next pregnancy, still had shortening, was on bed rest, then HBR and delivered at 27 weeks. However I am 30 weeks today and I have had no shortening at all, and therefore no bed rest. It's hard to say if I really do not have IC, or if the cerclage is just doing its job, but there are plenty of women with success stories of having no shortening with a cerclage and making it to term with no bed rest.

Good luck!

angelsnight · January 2014

Laura8388 said:

Hi happymommy! Welcome, and congrats. I am sorry to hear of your previous loss but we will all be rooting for this baby to be your bring home rainbow babe!! The answers to many of your questions, honestly, will depend on your doctor. I do not have a cerclage as my shortened cervix was discovered too late, and once it was discovered, I was not immediately put on bed rest, which many people on this boat couldn't believe. Since it has gotten down to below 1cm, I have been put on bed rest. Doc told me, many people would be put in hosp at this stage, but he wants me in my own environment for my sanity. I too have been on pelvic rest- which won't be a problem for you if your husband is away! There is many many stories of great outcomes with preventative cerclages placed. Some woman are able to carry on as normal if the cervix stays long, others are advised against heavy lifting/activity so couldn't say for sure about the day care. I hope you could keep it going, but be prepared for the worst case scenario. If given the option of cerclage, from what I have read, go for it. Sorry we can't give more definite answers!!! All the best and keep us updated on your appts. Good luck at the ultrasound

@laura8388, I know you know this, but I just wanted to add in case anyone reading this wasn't aware....pelvic rest is no sex, no orgasm, nothing. So even though OPs DH will be away, pelvic rest also means she cannot partake in any one on one time either

OP, as long as your doctor is fine with it, I wouldn't put yourself on pelvic rest until your doctor says you should. It may not seem like it right now, but that 26 weeks of it can get rather long at times so I wouldn't start before you need to

happymommy0902 · January 2014

Thanks so much for all the info! We did actually decide to let go of the daycare, and starting Monday I will only have one child left which I'll probably keep a few more weeks.

ThereBeDragons · January 2014

I'll just echo what most of the other replies have said. Preventative cerclage = awesome.

If a cerclage is given as an option- I don't personally see any reason not to get it with your loss history. My MFM feels very strongly that my loss last year was due to PTL instead of IC, but since I presented at 17w with a cervix length of 1.2cm with active funneling, I was given the option to have a cerclage placed even if the MFM felt my cervix wasn't my biggest issue. Since this is our last attempt to have a baby I went with both the cerclage and 17p shots.

My doc considered my cerclage preventative, so my restrictions are lighter but they will stay with me until my cerclage comes out at 36w. I get to actively walk 1hr a day (which includes bathroom trips so its not much time), stand still up to 6hr a day, and sit for as long as it feels comfortable. When I am tired in any way- I am to rest lying down. No lifting anything over 15lbs, no running, jogging, or exercise of any kind other than a sedate walk. No bending awkwardly, no doing household chores. I'm not even supposed to throw up- and since my morning sickness never fully went away that's an ongoing challenge lol. And yeah- full pelvic rest.

My restrictions will continue to get higher (all the way up to possible hospital bed rest) depending on how my body is handling the pregnancy. But that's all an unknown right now. I am preparing my hospital bag and nursery early with the understanding that its entirely possible that I will go in for a routine check one week and wind up in the hospital for the rest of the pregnancy. I like to be prepared.

I'm on 17p. I qualified to have it covered by my insurance because of my short cervix, so it should be an option for you if your cervix starts to shorten. Because my last loss was before 20weeks, I cannot get insurance coverage for PTL (which doesn't officially exist until 20w, although my MFM says my last loss was classic PTL) but I got my first shot at 20weeks and will continue until 36. I think its a good option if you can get coverage- just another tool in the toolbox to keep the baby cooking right up until s/he is full term.

I'll keep my fingers crossed for you!

Maryng10 · January 2014

I am so sorry for your loss. I am ftm. I was diagnosed for ic at 21 weeks; I was scare cried so much. My Ob had me seen a high risk md. I was put on vaginal progesterone nightly; weekly ultrasound to measure the cervical length; modified bed rest ect. At 24 weeks they gave me steroid shot to help nature baby lung; I pray a lot and also have a lot of people pray for us. I am at 35 weeks now. Just hang jn there, ask a lot of questions; do research. Good luck to you. Will keep you jn my prayer.

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