Not sure if this is a dumb question, but can we talk about cervixes (cervices?)

pblge · October 2014

I don't think I'm alone in that being past the time of highest miscarriage risk now means that I'm worried about the new set of things that can go wrong. One of the most common, I think is cervical incompetence or shortening (anyone want to provide other things for me to worry about? ;-) ). My OB hasn't looked at my cervix since my 8 week appt, and I have no idea how "competent" mine is. I have so many questions! Some of them are:

When do doctors normally look at cervix length?

Can you request an earlier examination, just out of paranoia?

Are there any indicators to the laywoman her cervix might need extra attention? Like feelings of pressure or similar?

Do you ladies...ahem, "monitor" your cervices in any way at home?

...And probably more questions that aren't occurring to me right now. From what I've read, the biggest indicator of cervical problems are past cervical problems, but I don't think any of the women in our situation want to lose, or even come close to losing, a pregnancy because of cervix issues. It also sounds like the cerclage is disputed, but I don't have a good sense of this.

Any thoughts?

Regan1976 · October 2014

I hadn't even thought to ask about mine. I figured they would have told me at the OB appointment. I've learned that there is so much more for me to learn. :-B I hope someone has some insight for you.

ladyteach0505 · October 2014

I am concerned about this too. My nurse was able to look At my 12week NT scan and see where the placenta was as well as the length of my cervix.

dp21 · October 2014

Mine was just measured at my anatomy scan at 19 weeks. Said everything looked good. I know we have an OB on here, I can't remember which poster it is, I bet she could give us some credible information!

FishyMom · October 2014

I had mine checked at my anatomy scan @ 19 weeks (which is also the last time I have seen my LO). I have always been worried about my cervix, but my doctor continue to tell me I'm just a normal pregnant lady not to worry. Hopefully your OB is a little bit more understanding than mine is. I asked a lot of questions about that and they seem to always get shrugged off. My suggestion is trying not to worry about it and to move on if your OB doesn't want to help you.

You're always going to find something to worry about. The worry doesn't really go away just make sure you ask all the questions you need to do your OB that's the only thing want that will help.

hopeby2015 · October 2014

I think the OB is @Ecarabeo217‌ .. i had my cervix checked at the 12 w scan and the anatomy scan. Tech and docs weren't worried, figured I won't be either.

Grateful&Thankful · October 2014

I had a LEEP procedure ( where they go into the cervix & remove abnormal cells )10 yrs ago. I also have had two hysteroscopies to remove a tiny fibroid each time. Because of these procedures my doctor wanted my cervix to be checked every 3-4 weeks. This week was my last cervix check with the high risk doctor & thankfully everything looked fine.

hopeby2015 · October 2014

Shouldn't that be part of the scan?

Pintobean39 · October 2014

IFinTN said:

hopeby2015 said:
Shouldn't that be part of the scan?
I'm really not sure? :-/

My Dr's always checked as part of the scan. I just assumed if it was ok at those points there is nothing to worry about. Although I don't know much about an incompetent cervix.

blueberries8 · October 2014

I apologize if my response is redundant because I haven't read through the other responses. The most reliable way to evaluate cervical length is by serial transvaginal ultrasound. The ideal is if they have a baseline for you, usually taken between 12-16 weeks, and then you are monitored at regular intervals (usually biweekly or even weekly). This is usually only done if there are risk factors for IC/PTL or a history. Many doctors will include a cervical length check (by ultrasound) as part of the anatomy scan, though this isn't super helpful unless the cervix is objectively very short. With serial monitoring, they are most interested in change over time, even if the absolute measurement isn't super short.

They will often apply or have you apply fundal pressure during the ultrasound (by pressing on the abdomen) and they will look for funneling by ultrasound. Funneling is when the cervix begins to open at the top (as opposed to at the bottom as is the case with traditional dilation). Also, it is possible to have a normal cervical length measurement one moment, and then a shorter measurement with fundal pressure or even at rest the next moment. This is usually referred to as a dynamic cervix, meaning it is not all the time short, but rather alternates between normal and short.

A short cervix that develops very early is often due to a mechanical problem with the cervix (i.e true incompetent cervix) whereas a short or dynamic cervix later in the 2nd trimester/early 3rd trimester can be due to productive premature contractions rather than a true mechanical problem. At my MFM practice, they stop monitoring cervical length at 28 weeks because they say that while <3rd trimester it is a good predictor of IC and preterm labor, by the third tri it loses its predicative value (apparently there are many women who will start to shorten by the start of 3rd tri but won't experience true PTL and won't deliver until full-term).

In terms of cerclage, it is quite effective when performed preventatively in singleton pregnancies in women with true IC, but how effective it is in other circumstances and when placed later in pregnancy is very controversial. Sometimes people will get an emergent cerclage at 16-20 weeks, but those are much riskier and on the whole less effective, and beyond 20 weeks, most MFMs won't even attempt cerclage. If productive contractions are shortening the cervix (rather than a mechanical problem) it is often a losing war with the cerclage.

I feel like I've written a novel. but the good news in all of this, is that the likelihood of having true IC (i.e. a mechanical problem) with no risk factors is very low...those who will have shortening or funneling due to premature contractions that are productive is probably harder to predict. I think everyone should get at least one cervical length check by transvaginal u/s mid-pregnancy with the anatomy scan. As far as symptoms -- that's tough -- shortening due to true IC is usually pretty painless. Some people report an increase in discharge and feelings of pressure but in truth, those can be completely normal 2nd tri symptoms. If a woman thinks she is contracting, I would of course get it checked out. Unfortunately, PTL can have pretty oddball presentations (like stomach flu-like symptoms or backache, for example) when compared to normal full-term labor symptoms.Hope this helps.

ksgsmu · October 2014

blueberries8 gave you an excellent response....

Also DO NOT CHECK YOUR OWN CERVIX AT HOME! This can cause an infection that could harm you and your baby.

Canuck13 · October 2014

Like a previous poster I have also had a LEEP procedure, so my Re has asked for me to have an extra ultrasound at 16 weeks to check cervix length. Hopefully everything looks okay.

southernyankeegirl · November 2014

If you are at a higher risk (previous cervical surgeries like a LEEP, etc. or Muellarian defect like a unicornate uterus, a personal or family history of late term loss, etc.) then ask your doctor about how frequently you should be checked. For everyone else, it's really, really rare to have it be a serious issue with no symptoms of pre-term labor.

I had a crap ton of Braxton Hicks so ended up getting it checked by our old friend the Dildo Cam around 24w. Everything looked good. There are manual checks your practitioner can do starting late in your 2nd trimester to see if you are dilating (not if it's shortening).

If you are higher risk or having lots of contractions, mention it to your doctor quickly. Otherwise, chalk this up to something you don't really have to worry about.

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Not sure if this is a dumb question, but can we talk about cervixes (cervices?)

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