i need advice desperately, please!

Help!3 weeks ago I had my 20week u/s and found out we are having b/g twins - that's the best part. But when they did the cervical check, turns I'd funneled about 37% and my CL was 2.2. The peri recommended immediate hospitalization to monitor for cxs and bed rest. Of course the stress of being in the hospital increased my ever present BH and now they were coming fast and furious. I was started on indocine which I took for 48 hours and then my OB was ready to send me home and "wait and see." I refused to go home without meds so I asked for a cerclage, nifedipine and 17P shots. He agreed to the meds but said the cerclage and the meds I requested, have not been proven to be effective in preventing preterm labor in twin pregnancies but he'll give me the meds and a pessary instead.

So we went home and stayed on strict bed rest up until yesterday when I had my appt for CL check. Turns out at 22w4d, my cervix had funneled to 54% and the functional length is now 1.5cm. So now I'm back in L&D and the plan is to keep me here until I deliver. The peri suggested emergency cerclage and this morning again, my OB said no that it was too risky and in fact could be more dangerous and induce full blown labor.

I need some advice - I really would like to try the cerclage to keep my babies in as long as possible but with my OB against it, how do I go about talking him into doing this? Also, I know some of you have or had cerclages, did you get the same song and dance from your OB? Is it really that dangerous? What should we do? We have one more week before we hit the 24w mark when it'll really be too late. I just don't know what to do! Any advice would be really appreciated. Thanks so much!

 

First off, I'm sorry that you have to go through this. I'm happy to share my story with you though each and every woman is different as is every pregnancy and great research on the best treatment doesn't exist.
I was expecting G/G twins in May of 2004. I went in for my level two U/S like you and they thought that I was starting to funnel but it didn't look terrible yet. (I can't remember all the numbers) I came back in 2 weeks at around 21 weeks and was funneling enough that I was immediately admitted on hospital bedrest and by the end of the week my cervix had lengthen enough that the high-risk doctors were advising to do the cerclage. We went ahead and had the cerclage. The surgery wasn't too bad and the babies were ok during the whole procedure and my sacs didn't leak, we were both very nervous about the whole surgery and outcome. I stayed for the rest of the weekend and went home on strict bedrest and started the progesterone shots. I then started having PTL at around 26 weeks. We managed to stay at home but did the several L & D trips for frequent contractions. The girls were born at 29 weeks and 2 days because I was ripping through my stitch and contracting (which wasn't able to be stopped with the Mag.)
All that being said... I ended pregnant with twins again and had a cerclage placed at 13 weeks and now I'm 31+ weeks pregnant and haven't experienced the same issues whatsoever. So you just never know.
I wish you the best, hang in there. Whatever decision you make, be at peace with that choice.

 

Thanks for the feedback. I ended up getting a second and third opiion and they were both the same as my OB so we are fine now with just the meds and continued bed rest. Thanks again and good luck to you.

 

Good luck to you. Sorry I am a bit late seeing this, but I did have an emergency cerclage at 24w exactly. My cervix was a little over 1cm, from my previous visit 3 week prior. The next day the cerclage was put in. They told me I was still a good canidate for one so we went with it.

Good luck. They are keeping you on hospital bed rest until you deliver?

 

Hello- I was in your same shoes when I was 23 1/2 weeks. My cervix went from 3.0-1.4 and funneling in 1 week.
The Dr.'s discussed all the same things to me! At first they were watching me and discussing maybe a rescue cerclage,
but I'll tell ya a few Dr.'s were more affraid of it because when that late into the pregnancy I guess they could tear
the membranes from the surgery so they don't want to take the risk. Being here at the hospital I see different
Dr.'s and peri's all the time. I was more nervous about getting it that late into the pregnancy. If earlier, I don't
think I would be. That's the vibe I was getting from all the Dr.'s and peri's. Gosh, I feel like this was me when I
read your post!!! I was ao upset too!!!! It caused contractions and they gave me 2 shots to control them.

Ok, so long story short- I've been here at the hospital since 23 1/2 weeks. So far, I've been stable- now 31 weeks.
I take pracardia every 6 hrs. Twice I have taken Indocin to control the funneling- Twice I have done the
steriod shots to mature the babies lungs- by the way sometimes you have a reaction to the steriod shots with
contractions. It happened to me 1 night- but was controlled from the terb shot. I am now 1 cm dialated from the
funneling, but my cervix is around 3.0 (as of last Tuesday). They say that's good and I have a little room to play with.
IF I stay stable, I may go home at 32 weeks???? So we'll see. But everyones situation is different.

It's crazy because ya know this whole cervix and funneling thing is so silent!!! It's frustrating!! As far as the cerclage,
I would just listen to you Dr.'s. PM me anytime.... we're going through the same thing. I know I'm further along,
but I remember like it was yesterday when I checked in. Please keep us posted!!! This is tuff I know!!! At times,
I would get so upset, but sronger every day.... Hang in there! Be strong for your little ones!

 

Can the peri do the cerclage and get your OB out of it? I had an emergency cerclage with a cervix length of 0.2cm, funneling, and contractions. And it worked. I made it to 31 weeks and delivered not due to cerclage failure, but due to baby A PROM'ing and threatening to kick her cord out with her foot.

The earlier the cerclage the better, but I think some doctors will do them up to 24 weeks.

Sending P&PT's.

 

Just to let you know my story… I was bedridden with DS @ 26w (hadn’t even heard of the word Cerclage much less had one) and was able to hold him in until the day I turned 36w…. with the twins my cervix shortened to 2.2 and I started to funnel, so at 19 w I had a Cerclage (last time it was measured the funneling was gone and I was 4.4)… my OB actually sent me to a Cerclage specialist to help with my decision (my OB didn’t do the Cerclage)… and my Peri was the one who was trying to stop PTL with all these medications and hinted he wasn’t a Cerclage fan… but never came right out and said anything… I am now a day shy of 33w and I’m not even on bed rest… I think it’s my Cerclage that has made this a less eventful pregnancy… also... I was only on self imposed bed rest the weekend I had the Cerclage… I really felt fine the next day…like nothing had happened

GL w/ everything

Elizabeth

 

I am a cerclage Momma and I echo a lot of the positive remarks in this thread. If you are going to get a cerclage it needs to be done ASAP. They won't do them after 24 weeks. The good news is that after Week 29 -- the head of the baby begins to rest on the pelvis vice the cervix and the funneling decreases, at least it did in my case. Keep us posted! Prayers for your cervix to stay as it is... stay down -- you can do it.

 

I just wanted to add that I was being monitored for a short cervix when it went down in length A LOT over a two week period. At first my peri was against doing the cerclage (when I was first being monitored) then when it shortened so much, he said that it might be my only option.
I was admitted to the hospital to get the cerclage and for hospital bed rest until delivery at exactly 22wks. I was discharged at 35wks. Had the cerclage removed at 36wks. Had the babies 36wk4d.

I know that I would not have made it that far without the cerclage and bed rest. (I still lost most of my cervix, even with the cerclage, but it basically kept me closed enough to stay pregnant.)

 

I had an emergency cerclage put in at 21 weeks when my cervix was found to be dilated 1-2 cm and funneling. . . only measuring .9 cm. No kidding. The OB was even able to get 2 stitches in. After the procedure, my cervix has measured back up to 3.3 cm after that and being on strict bedrest.

I was NOT having preterm labor though. I was contracting no more than once every few hours. So I don't know. . .

 

Thanks to everyone that responded!!! I've been in the hospital since I sent the post and lost access to my laptop and blackberry. I just came back home after 4 weeks in the hospital to continue my bed rest at home. They were going to keep me until i delivered but because i remained stable and my fFN tests kept coming back negative, they let me go home. Still getting cxs but not as many as before.

The past 4 weeks have been interesting. as I said, the peri and OB decided against the cerclage because they were very concerned about rupturing the membranes so we just stayed with the pessary that was inserted at 20 weeks. I'm still on nifedipine 10mg q6 and doing well, thank God! We've made it this far and will continue to pray that we make it another 8-9 weeks! Thanks so much for all your responses and your thoughts and well wishes. This has and continues to be a life altering experience and i'm grateful for all the lessons i've learned thus far. Thank you for your support and for sharing your stories with me. I've just been able to read them today!!!

 

Glad to hear that you are still hanging in there... 26 weeks is a good milestone! You are doing a great job of caring for those little babies already and I wish you many more weeks to come!
Beth

 

Thanks for the update! Glad to hear that things are stable and that you are home.