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cerclage ?

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  1. #1
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    cerclage ?

    Hi Ladies,
    I was hoping to get advice from people with more knowledge on the subject of IC & PTL. I am currently 7 weeks pg with my 2nd child. When I became pg with my DD I suspected I may have some issues due to a LEEP & cone biopsy I had 10 years prior, I remember that Dr saying it could cause cervical problems in PG. I went to a practice with a peri just in case & mentioned my concerns & he told me we could wait & see or do a cerclage if I am that worried. I opted not to do a cerclage because I thought I was being paranoid. at 14wks my cervical lenghth was 4, at 16 weeks I asked for another measurement & it was 3.5 which they said was still ver normal. Not long after did I start feeling my belly tighten, more & more often until it brought me back to the Dr at 18 weeks, sure enough I he felt my belly & said he felt a contraction... he asked about my fluid intake which was not really good & told me how important it was to stay hydratd, told me to go home & stay off my feet for a day, hydrate & if I felt anything to call. I was back 2 days later- cervical lenghth down to 2.4 with contractions - about 4 an hour. I was told that a cerclage at that point was too risky & put on full bedrest, no more work, only getting out of bed to use the loo & shower every other day.... VERY LONG story made short, tried all kinds of meds, nothing helped the cx, many L&D trips/stays, finally put on terbutaline pump whuch I guess helped although I still contacted constantly with it, I was also monitored by Matria 2x a day, I would wear a cx belt & send the strip in via modem & a nurse would call me telling me how many cx I had that hour. At 32wks my cx picked up & Matria sent me to the hospital because I was having 5 min cx, by the time I got to the hospital they were 3 mins apart, I was given a Mag drip, and all stopped the next day. I was 1cm dialted, and after 4 days I was sent home on bedrest. At 36wks I was taken off rest, 3cm dialted & never went into full labor! I was induced at 39+ weeks & delivered my almost 8lb beautiful healthy daughter!!
    Here I am again pregnant again and don't know what to do! Should I get a cerclage? If I have an irritable uterus and contract anyway, would that tear the stitch? Would it prevent the contractions? How does this work?
    Thanks for reading my long post!

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  3. #2
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    My situation is a lot like yours: I too have a hyper-irritable uterus, contract like mad, need meds to stop contractions in every pg, and my cervix does change with the contractions. However, with bedrest and meds, I have carried to term 2 times (39 wks and 37 wks). I have a very experienced peri and her view in this pg (my third one) was that she would not give me a cerclage (though she seriously considered it and we discussed it at length at around 12 weeks). Her reasons were: given that I have carried to term twice, the prognosis for this time too is good; my cervix at around 12-13 weeks was still around 3.5 cm (which is the short end of normal); my problem are contractions, not really IC per se, and cerclage does not work very well for that (you can even tear through it if you have strong contractions). Given all these factors, she said the risks of the cerclage (mainly infection, tearing) outweighed in a case like mine the potential benefits. Having said all that, you really need to discuss the risk-benefit ratio in your personal case with your care provider. GL!!

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    I might see another physician for a second opinion. I had a cerclage placed at 20wks and know that they can be safely placed until ~25wks (though definitely more risky the further along you are).

    It sounds like you had some undiagnosed preterm labor going on. Were you ever cultured for a vag. infection as those can often cause uterine irritability and are usually not detected during the routine urine tests done in the OBs office?

    A cerclage will NOT prevent contractions so it's best to investigate what is causing the contractions. In my case, uterine infections were the underlying cause, though I did need to have an emergency cerclage placed at 20wks.

    Congrats on your pg!

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