Let's talk about your cervix

Hi ladies,

So here's some background on me:

* First pregnancy with singleton was textbook, delivered exactly at 40 weeks after spontaneous labor
* Second pregnancy is twins (hooray!) and I'm 29 weeks today
* Around 23 weeks, doc felt cervix was shortening more than it should be (maybe 2.5 cm-ish?)
* Started procardia, instructed to take it easy, increased monitoring
* At 25 weeks, had very small amount of bleeding, admitted to hospital to check it out (no cause 100% pinpointed, bleeding stopped quickly and everything seems to be okay)
* Spent a week in the hospital on bedrest, biggest concern was cervix (bouncing between 1.9 cm and 2.5 cm)
* Monitor would pick up a couple of contractions during the day, I would never feel them, they were minor
* Sent home on complete bedrest, upped dose of procardia, added prometrium and ibuprofen
* In the past couple of weeks, my cervix has been hanging out at 2.4-2.5 cm with ever so slight funneling at the top, but it's closed and high from an external view.

So now I have been on complete bedrest for four solid weeks. I am happy to be doing something good for my boys, I want them to cook as long as possible. However, it's interesting to go online and read about different doctor's philosophies and treatment methods for a shortening cervix. It's not that I would ever want to put my babies in jeopardy, but I'm wondering if *complete* bedrest is a bit of an overkill at this point? I only get up to pee or go to the doc or take a 10-minute shower every-other-day. I know that there are risks of bedrest as well (e.g. blood clots) and I think that just minor activity (modified bedrest) might be good for me. My mom is living with me and hubby and our son for the next three months to help out, so it's not like I'd be lifting my toddler or cooking meals or anything. Something I will bring up to the doc to discuss, I guess.

So I've blabbed on and on about my cervix, but really I want to hear about yours! What were your lengths, and treatment plans if your cervix was on the short side?

And did your doc to fFNs? Were they accurate? Mine doesn't because she says they are not very reliable in twins, and she'd hate for a false positive to cause needless concern. I would consider requesting them anyway (she would probably go along with that) but I'm doing the prometrium suppositories and I am afraid that they would cause a false positive.

Thanks ladies!

 

First, you can read a ton of stuff of the internet to back up any argument. I think you should follow your Dr's advice and remain on strict bedrest. The benefits of bedrest definitely outweigh the risks. It is the basic laws of gravity. The less weight and pressure constantly on your cervix, the less likely it is going to be to dilate. Bedrest does not guarantee that you are going to make it to full term (I didn't), but at this point every single day is a victory.

Every day you can keep those little one's in, is 2 days they won't have to be in the NICU. Despite the fact that my girls were born at 28 weeks, knowing I did everything I could do to keep them inside for as long as I could, really helped ease a lot of the guilt that I experienced. To this day, I still carry some guilt and blame for my girls having to go through everything they did even though I did everything as I was told, and followed all the Dr's orders.

I have never heard of an fFN test in a twin pregnancy producing a false positive. fFN tests for a protein that is present in labor, so either you are excreting the protein (and are in labor) or you aren't. The amount of babies a woman is carrying should not matter. That being said, a positive result on an fFN is very inconclusive. It doesn't mean that you are definitely going to go into labor, my Dr actually said it didn't really mean anything. Whereas a Negative fFN test is a lot more accurate, and there is a 99% chance that you will NOT go into labor in the next 2 weeks.

I don't remember my exact cervical lengths, but at 24 weeks I was admitted on hospital bedrest with PTL, cervical dilation, out of control contractions, funneling, and a positive fFN. They put me on a mag drip, procardia, and terb PRN, and I remained in the hospital on strict bedrest until my girls were born.

Bedrest is hard, there is no doubt about it, but I can promise you that it is worth it!! :hug: I am glad that you have help, that must take a lot of the stress away. Best of Luck to you and your babies!! Keep up the good work, you are doing a great job! :hug:

 

Kyrstyn - Thanks for the response! I'm sorry you feel lingering guilt about your girls' beginning. It sounds like you did everything right, but I know that's not enough to make everything okay. I feel a lot of guilt for this, too, for many reasons... using infertility treatments to produce multiples in the first place, and the toll that this is taking on my twins as well as our toddler. But I am thrilled to be blessed with two, and with God's help, we'll all get through this.

I will definitely do whatever my doc tells me to, I would rather be overly cautious than reckless. I would feel horrible if I started moving around and then suddenly went into labor.

The accuracy of fFN tests, though, is definitely debated by specialists. Basically there just aren't the studies to back it up for multiple gestation. My perinatologist doesn't feel like there's enough evidence to use them, but I'm sure if I asked, they would do one. (I did have one at 24-25 weeks that was negative.) The positive result is next to useless, like you said, so I guess she doesn't want me to worry about it? My main concern is really the prometrium suppository I take every night, if that would automatically make it positive, then I don't want to bother with the fFN.

 

Sunny, not sure about the suppository effecting the results. I know if you have sex than that can effect them. It might definitely be worth talking to your Dr about. Are you seeing a Peri as well, due to all the issues you are having?

I don't think you are being wreckless at all. I remember how all over the place my emotions were when I was going through it all. It is beyond hard, and the pregnancy hormones don't help it one bit. You are doing an excellent job, and those two wonderful little babies are so lucky to have a mom that has dropped everything to ensure that they make a safe arrival into this world. :hug:

 

I can only offer a counterpoint, that clearly your body is handling the twin pregnancy differently. I also had a normal 40 week pregnancy with a singleton first, and then a twin pregnancy. My cervix was like 5cm up until 35 weeks! Then I was dilated to 2cm, and thinning, but I still held them in until 37weeks 5 days when I had my c/s. You just can't assume that your body will respond the same way to your twin pregnancy, unfortunately. It sounds like you are using caution, and it's better to err on that side than to live with regrets.

 

Hi there,
I had PTL, funneling and a 6 mm cervix at 24 weeks. I was on strict bed rest, too. I actually rested with my hips slightly elevated above my abdomen. I showered for 5 mins every other day and could use the restroom. I followed very STRICT bedrest from 24 weeks until about 32 weeks. Somewhere around 32 weeks, I started to sit up for meals and stretch a bit more often. I would go into the kitchen and make a sandwich while sitting down. It was extremely hard physically and mentally. I have no regrets and I would do it again in a heartbeat. As Kristin said, I didn't want to have any regrets about what I did for my children. Amazingly, we made it to 36 weeks. I feel so fortunate, and I know others who had similar situations with much more unsettling outcomes. Every day is worth the effort. We were hanging by a thread, and I have no doubt the bed rest helped.

You are doing a great job, so hang in there a while longer. It will be worth it!

My OB/Peri didn't give me the ffn test either. They didn't feel like it would give helpful info for my situation.

 

I was on bedrest for a shortening cervix from week 17 to almost 32 when I delivered. I was never put on medication, only the bedrest. I probably got up a little more towards the end than I should have, because it had been so long (almost 4 months!). My cervix was less than 1 cm by 26 weeks and it held out and actually when I ended up delivering it was due to preeclampsia.

For the fFN test, I had one at 25 weeks and it was negative and another at 27 that was positive. It was obviously a false positive because 5 weeks later I still had not gone into labor or even had contractions or any dilation.

Good luck keeping them in as long as possible!

 

I agree.

I also had a completely normal singleton pregnancy. In fact, she was a week late with no PTL. However, my twin pregnancy didn't go that way at all. At 24w, my cervix suddenly was very short and I started to dilate and my twins came a bit later. Like Kyrstyn, I still have guilt at how early my twins came. My head knows I could have done nothing differently, but my heart says something different. Luckily for us, everything turned out fine.

I personally don't think complete bedrest is ever overkill. I know it's hard, good luck. :hug:

 

I agree - bedrest is never overkill. Our DS was born at 34 weeks, so going into the girls' pregnancy I was high risk - moreso because of twins. My cervix was measuring 3.5 at 29 weeks, but went into spontaneous labor at 29.5 weeks that couldn't be stopped. I was 4cm dilated when we got to the hossy and mostly effaced. So cervical measurements don't mean much because they can change SO fast. I was on modfied bedrest at 28 weeks with the girls, but really took the modified part to heart and was up a LOT more than I should have been.

This time we're being very proactive and careful - including bedrest starting at 20 weeks. No, it's not fun (especially with 3 kids running around) but I feel like it's really important to my own well being to know I did all that I could to keep the boys in for as long as possible. Right now my cervix is holding steady at 4cm (longer than it ever was with the girls) but like I said, it can change so fast that I don't really put much stock into that. I do also have a preventative cerclage, so hopefully that will help keep that darn cervix closed too.

So I would keep doing what you're doing. At the very least you'll be able to look back and know you did everything in your power to keep them in. Nothing is harder than leaving your babies in the hospital and thinking that you could have done more to keep them in (and really, any mom who has delivered preterm has mommy guilt - but you don't want to make it worse than it has to be!)

 

Thanks for all the replies, ladies, I appreciate the perspective. I do want to do everything I can so these boys spend as little time in the NICU as possible! I don't know how I'm going to keep going, but I will. I think part of it is just the psychological stress of not knowing WHEN it will end. I am an eyes-on-the-prize kinda girl. Obviously the prize is healthy boys, but it helps to specifically have that numerical goal, like 37 weeks or whatever. I do make small goals (currently working towards 30 weeks) but I guess it's just not cutting it for me. I am hoping to schedule my C-section when I see my OB on Wednesday, and even though I most likely will not make it that long anyway, perhaps having the countdown to that date will give me some mental relief.

Oh, and piling GD on top of the bedrest has just really made it all the more difficult. Whoever invented whole grains should be shot. Mama wants a muffin -- A REAL STINKIN' MUFFIN!

 

I understand that completly! It starts to mess with your head too - thinking every time there's a twinge that it could be it. Most people only really have to worry about labor for a couple of weeks before their due dates, but when you're on bedrest for a long time it's a different ballgame. I know I won't go past 36 weeks, so that's my long term goal. But 34 weeks would be good with me too. Sorry about the GD - but I have to say the cat on your blog really cracked me up!! I go in for my GD test next week and I'm already dreading it. I never had a problem with GD before, but that drink is not the most fun to take.

 

At what point do they start measuring your cervix? I'm at 19 weeks and no one has told me anything about it...

 

From what I gather, this varies quite a bit.

My OB used the measurement at 16 weeks to compare to subsequent biweekly measurements. Like the PPs mentioned, things can sometimes change quickly.

 

I think its great your dr is being proactive. Mine wasn't as proactive. My cervix was never bigger than 3 the whole time. No one ever mentioned it being an issue. I was told modified bed rest but I told them I had two kids at home at the time and a dh that traveled all the time so they knew I couldn't do too much bed rest. I have terrible guilt for not taking it more seriously. I had ptl with my other two kids (singletons) but was able to hold off till 36 weeks on both so I figured my body would do the same. It didn't. I ended up going to the hospital a little over 28 weeks and was already 5cm dialated. I know its soo hard now!!! Maybe once you get a date you will really feel better!!

 

leaudemeil - I think my doc started bi-weekly measurements around 20 weeks. I am so grateful she did, because without those cervical ultrasounds we would have no idea there is a problem. I suggest talking to your doc about it.

4js - I am so sorry you had to go through all that, I'm sure it was a horrible surprise. But you did the best you knew how to do at the time, hindsight is 20/20 and maybe nothing would have changed the outcome anyway. Your kids are lucky to have you!

 

I went on bedrest for a shortened cervix at 28 weeks (at that point I also tested positive for the fFn test). I lasted until 35 weeks, 2 days at which time I had an emergency c-section (that day the girls' fetal movements had decreased and when I went into L&D for monitoring - their heart rates plummeted at the end of the monitoring session so they thought they might be in distress). Twin A was 5lbs, 5oz and Twin B was 4lbs, 13oz. Both stayed in the NICU for two nights only and then stayed in my hospital room until I left a few days later. The point of all that being bedrest seemed to work for me - my cervix stopped shortening and my babies were born healthy and strong. I know how much bedrest sucks but it will be worth it! And clearly the fFn test was not accurate in my case. Best of luck through the rest of your pregnancy and beyond!