Wednesday, August 13, 2008

Courses of Action for a shortened cervix

So I saw the Peri today for a cervical length check. It has been three and a half weeks since my last check. In that time I have been in triage for a half day with contractions as close as 5 minutes. No treatment other than fluids was provided. I have contractions daily, some days worse than others.

So today my cervix was 2.3, down from 3.6. There was no funneling and it measured 1.9 when I would bear down. I am reading just within the "normal" window. My doctor described my situation as having just "walked into a swamp," that the lead up to preterm labor was a place where obstetrics has not made many advancements. He reiterated what nearly all the doctors have stated, which is, that with out a history of preterm labor they do not get super aggressive with treatment yet. He thought it was too late and too risky for a cerclage. I am 23 and a half weeks.

I was offered a pessary, but declined because I wanted to do a little research and decide on a worse case scenerio game plan of my own. I see the peri for another check in exactly one week.

DH is not sure if he is supposed to wig out yet or not. I told him too hold off. I think we'll know next week if we should freak. For now, no lifting, no sex, no work, no getting too far from the couch. And no hysteria.

Advise is very welcome. I am in uncharted territory.


G said...

Oh Mer, I dont have any assvice. Just that I am always here, thinking positive thoughts for you. Trying not to visualize your cervix, because that's a little creepy.

big, big, big awkward hugs from me.

sara said...

Crap girl...I emailed you before I saw this and I'm emailing you again now, okay? Hang tight, we'll get through this...I promise. I know how scared you must be, but we're going to do this the meantime, I am duck taping you to the couch because that is a huge first step towards the finish line.

jenn said...

I have no advice to offer- just some hugs & support. Good luck getting through the week. I hope your next visit brings some good news or at least a more concrete plan of action. I wish I had some knowledge or comfoting words of wisdom & experience for you!

Kim said...

Boy have I ever been there. My cervix went from 3.0 to 2.0 in a week at 19 weeks though. Usually the cervix does get shorter as you go through the second trimester, so "normal" is a moving target, but anything over 2 ain't too shabby, really (especially without the history of preterm labor and without funneling).
I skipped the cerclage too - it has a lot of risks, but I came close after a reading of 1.6 at one point (and 2.3 the next day).
Once you are 24 weeks you can do fetal fibronectin tests which will give you an idea of your risk for preterm labor and really inform your other decisions.
I did several months of bedrest and got to 36 weeks.
Unfortunately, there isn't much to be done except to not do very much. And even that isn't proven to work. Personally i think it does and I was looking for anything to do (or not do, as it were) that might help.
Good luck! I would have sold my husband to be on rest during the Olympics. I was laid up during the writer's strike. Cruel world.

Meg said...

Oh hun, I do not have any advice for you. I wish this were easier for you. Trust your docs and your instincts. I am thinking of you.

IVF 4 Dummies said...

I saw this on Lost & Found...
Just wanted to share my cervix went from 3.7 at 14 weeks to 2.8 at 18 weeks and I was put on modified strict bed rest at that time. Of course right about then I started having contractions and PTL problems. I highly recommend bed rest! I was able to get up and make lunch and move around some, as long as I stayed down 90-95% of the time. I followed orders, went for weekly cervix checks (v. important if you have a shortening cervix), and here I am almost 38 weeks and holding! I was released from bed rest at 37 weeks, would have been sooner if my uterus wasn't so irritable and contracting ;)
At 30 weeks my cervix measured 2.4 and I credit bed rest for that. There are varying opinions in the medical community on its effectiveness, but I think I would have had a very different outcome had I not done it. Good luck!

Amy said...

Not sure I really have advice to offer, as my cervix gave out at 24 weeks with twins (I was two centimeters dilated and had an emergency cerclage, strict bed rest and made it to almost 35 weeks). I also contracted like crazy and was on two different anti-contraction meds.

I do remember that my peri thought anything over 2 centimeters was decent. In your place, I would stick with the bed rest - believe me I know how much it sucks - and make sure you have frequent ultrasounds to measure your cervix. If you decide on a cerclage, I'm happy to share my experience. I'm not sure about effectiveness of a preventative cerclage after 23 weeks, but I know preventative beats an emergency one like mine.

Hang in there!

Amy (amy bds @ yahoo)

Kristin said...

The one bit o advice I have is talk to your doctor about progesterone shots. This is diff than the progesterone shots that you take at the beginning of pregnancy. There are a few studies and some very strong empirical evidence that they cane stop/delay preterm labor. Lots of prayers coming your way.

May said...

Here from Lost and Found... I went through the shortening cervix (24.5 weeks for me, with spectacular funneling) and landed smack in preterm labor. Three months in the hospital and every drug on the planet later, my daughter was born safely.

I concur with the fetal fibrinectin comment above, and i'd add that you make sure they do repeat cervical length measurements to monitor what's going on. Minimizing contractions is also going to be your best friend, so know what your docs consider to be the threshold number per hour for concern, and remember to stay well hydrated yet keep your bladder empty (let me know how we're supposed tomanage that!!). I, too, would have sold my husband to be on bedrest during the olympics. I got the US Open and the hurricane Katrina coverage. And lots and lots of Law and Order reruns.

JGirl2005 said...

I'm sorry your cervix is shortening, but it sounds like you are being seen.
I'm thinking positive thoughts for you.
An online friend of yours pointed me to your site.
I've been through a incompetent cervix problem, so she told me to talk to you. I have a cerclage now because of a previous loss.
Here is a website I frequent that has others who have IC or a shortening cervix. They should be able to give you advice.

Neenie/PawsNY said...

Hey :) My cervix was 1.6 at 24 weeks and I was in the hospital on magnesium sulfate to halt contractions (which I didnt even FEEL anyway) then later set up with a subcutaneous terbutaline pump. This administers medicine (terbutaline) into your system every few hours and can be increased or decreased as needed. I was on strict bedrest from 23 weeks until we were discharged at 34 weeks. I had 3 rounds of steroid shots for the baby just in case delivery wasn't able to be stopped. I had 4 fetal fibronectin tests to indicate if pre term labor was imminent or not. My first positive came December 26th. I must have defied the odds because I got 2 more positives yet didn't dleiver until February 19th at 35 weeks! In other words- there is hope! I am a classic case of wtf do we do and I had my baby at 35 weeks and he is fine & healthy :) And you will be fine too- ask your doctor if terbutaline is an option for you. Magnesium sulfate- whatever they can do to prevent labor from starting. You and baby will do just fine so hang in there!!!!!
(btw I was too late for a cerclage also so this was all done and SOMETHING worked!)