Re: Questions about cerclage

[Guest guest]

Hi Ami,

<<The peri, though, said it wasn't quite that simple. He isn't as

convinced about the cerclage being neccessary next time. He thinks

the septum sort of forced my cervix last time, and now that the

septum is (hopefully) gone, he thinks there is a good chance that my

cervix would hold up. He said it would be an option, and he would

prefer in this case, to monitor the cervix weekly or even 2x per

week to watch for changes, then put in a cerclage if necessary. >>

This is not bad advice, although it does seem unusually cautious.

<<I told him that I didn't like that idea because I'd heard that

cerclages put in after changes start happening don't work very well,

and what if the changes happened too suddenly and they weren't able

to stop anything, etc. >>

Very valid concerns.

I saw the doc on Monday and lost my baby on Friday. I had half an hour's

warning between onset of cramps and finding the membranes in the vagina.

It is unclear in my case whether the SU forced out the membranes or if I am

truly IC, but one thing I know for sure is that many women with complete SU

carry to term; there is nothing weak about their cervices, but there was

with mine.

<<He said that was a minimal risk, but it was rare, and that there was

actually more risk involved WITH the cerclage! He said that

sometimes a cerclage will actually irritate the uterus into

contractions and that it can actually cause PTL! I've never heard of

that????>>

This is true, although it is truer of cerclages done later in pregnancy, and

done with thicker suture material: infection, irritability, chance of PROM.

My peri advised me that the risks from my cerclage would be " minimal. " It

was done with thin sutures and done very early, when there was no stress on

the cervix.

<<Has anyone ever heard such a high number associated with cerclages

failing? Have you heard of these kind of complications? I thought

it would be a no-brainer nest time, but now I don't know WHAT to

think. >>

Keep in mind that these risks are probably from all types of cerclages

lumped together. And such risks can be minimized by doing a cerclage

early--like at 9 to 10 weeks, LMP.

<<How frustrating that the decision is not nearly as automatic and

easy as I thought it would be.

Anyone have any ideas?>>

This will be your call. I like what Hollie says, too (Way to go, Hollie--I

have been wondering how you were), although she did not really mention the

risks and problems with complete bed rest. Imagine ~20 weeks of bedpans and

taking your meals lying down. You lose physical conditioning anf strength,

memory acuity, and run the risk of blood clots on complete bed rest, so

recovery during the postpartum period is slower, too.

I spent from 11 to 37 weeks on mostly modified bed rest, which was not bad

at all. I spent from 18 to 21 or 22 weeks on complete bedrest when I began

having trouble with contractions, and that was difficult. The contractions

eased up after that, and I was able to go back to modified bed rest. I am

very glad to have had the cerclage and would not hesitate to do one again:

imho complete bed rest was horrid, my peri was 2½ hours away, and losing my

first son with no warning was no good, either.

You may live ten minutes from your peri, and you may have more people to

take care of you and yours while you are flat on your back (a rescue

cerclage entails complete bed rest, too) . . . you may turn out to have a

stronger cervix than you had suspected, too. Hope the information you're

getting from us helps flesh out your choices. Good luck.

Beth

SU, resected x 2

[Guest guest]

Thanks, Beth.

You always seem to be SOOO on top of all this stuff -- the latest

research, treatments, knowing what everything means ... you're just

great. I always look forward to seeing posts from you.

I have to admit, I was reallllllly hoping that you'd have some super-

concrete information that would remove all doubt and make this an

easy, obvious decision for me. So frustrating that there are not

any concrete answers in any of this -- that would sure make life

much easier. ;-)

Thanks again for all your help and information. I really have

appreciated it!

-Ami.

> Hi Ami,

>

> <<The peri, though, said it wasn't quite that simple. He isn't as

> convinced about the cerclage being neccessary next time. He thinks

> the septum sort of forced my cervix last time, and now that the

> septum is (hopefully) gone, he thinks there is a good chance that

my

> cervix would hold up. He said it would be an option, and he would

> prefer in this case, to monitor the cervix weekly or even 2x per

> week to watch for changes, then put in a cerclage if necessary. >>

>

> This is not bad advice, although it does seem unusually cautious.

>

> <<I told him that I didn't like that idea because I'd heard that

> cerclages put in after changes start happening don't work very

well,

> and what if the changes happened too suddenly and they weren't able

> to stop anything, etc. >>

>

> Very valid concerns.

>

> I saw the doc on Monday and lost my baby on Friday. I had half an

hour's

> warning between onset of cramps and finding the membranes in the

vagina.

>

> It is unclear in my case whether the SU forced out the membranes

or if I am

> truly IC, but one thing I know for sure is that many women with

complete SU

> carry to term; there is nothing weak about their cervices, but

there was

> with mine.

>

> <<He said that was a minimal risk, but it was rare, and that there

was

> actually more risk involved WITH the cerclage! He said that

> sometimes a cerclage will actually irritate the uterus into

> contractions and that it can actually cause PTL! I've never heard

of

> that????>>

>

> This is true, although it is truer of cerclages done later in

pregnancy, and

> done with thicker suture material: infection, irritability, chance

of PROM.

>

> My peri advised me that the risks from my cerclage would

be " minimal. " It

> was done with thin sutures and done very early, when there was no

stress on

> the cervix.

>

>

> <<Has anyone ever heard such a high number associated with

cerclages

> failing? Have you heard of these kind of complications? I thought

> it would be a no-brainer nest time, but now I don't know WHAT to

> think. >>

>

> Keep in mind that these risks are probably from all types of

cerclages

> lumped together. And such risks can be minimized by doing a

cerclage

> early--like at 9 to 10 weeks, LMP.

>

>

> <<How frustrating that the decision is not nearly as automatic and

> easy as I thought it would be.

> Anyone have any ideas?>>

>

> This will be your call. I like what Hollie says, too (Way to go,

Hollie--I

> have been wondering how you were), although she did not really

mention the

> risks and problems with complete bed rest. Imagine ~20 weeks of

bedpans and

> taking your meals lying down. You lose physical conditioning anf

strength,

> memory acuity, and run the risk of blood clots on complete bed

rest, so

> recovery during the postpartum period is slower, too.

>

> I spent from 11 to 37 weeks on mostly modified bed rest, which was

not bad

> at all. I spent from 18 to 21 or 22 weeks on complete bedrest

when I began

> having trouble with contractions, and that was difficult. The

contractions

> eased up after that, and I was able to go back to modified bed

rest. I am

> very glad to have had the cerclage and would not hesitate to do

one again:

> imho complete bed rest was horrid, my peri was 2½ hours away, and

losing my

> first son with no warning was no good, either.

>

> You may live ten minutes from your peri, and you may have more

people to

> take care of you and yours while you are flat on your back (a

rescue

> cerclage entails complete bed rest, too) . . . you may turn out to

have a

> stronger cervix than you had suspected, too. Hope the information

you're

> getting from us helps flesh out your choices. Good luck.

>

> Beth

> SU, resected x 2

[Guest guest]

Thanks, Beth.

You always seem to be SOOO on top of all this stuff -- the latest

research, treatments, knowing what everything means ... you're just

great. I always look forward to seeing posts from you.

I have to admit, I was reallllllly hoping that you'd have some super-

concrete information that would remove all doubt and make this an

easy, obvious decision for me. So frustrating that there are not

any concrete answers in any of this -- that would sure make life

much easier. ;-)

Thanks again for all your help and information. I really have

appreciated it!

-Ami.

> Hi Ami,

>

> <<The peri, though, said it wasn't quite that simple. He isn't as

> convinced about the cerclage being neccessary next time. He thinks

> the septum sort of forced my cervix last time, and now that the

> septum is (hopefully) gone, he thinks there is a good chance that

my

> cervix would hold up. He said it would be an option, and he would

> prefer in this case, to monitor the cervix weekly or even 2x per

> week to watch for changes, then put in a cerclage if necessary. >>

>

> This is not bad advice, although it does seem unusually cautious.

>

> <<I told him that I didn't like that idea because I'd heard that

> cerclages put in after changes start happening don't work very

well,

> and what if the changes happened too suddenly and they weren't able

> to stop anything, etc. >>

>

> Very valid concerns.

>

> I saw the doc on Monday and lost my baby on Friday. I had half an

hour's

> warning between onset of cramps and finding the membranes in the

vagina.

>

> It is unclear in my case whether the SU forced out the membranes

or if I am

> truly IC, but one thing I know for sure is that many women with

complete SU

> carry to term; there is nothing weak about their cervices, but

there was

> with mine.

>

> <<He said that was a minimal risk, but it was rare, and that there

was

> actually more risk involved WITH the cerclage! He said that

> sometimes a cerclage will actually irritate the uterus into

> contractions and that it can actually cause PTL! I've never heard

of

> that????>>

>

> This is true, although it is truer of cerclages done later in

pregnancy, and

> done with thicker suture material: infection, irritability, chance

of PROM.

>

> My peri advised me that the risks from my cerclage would

be " minimal. " It

> was done with thin sutures and done very early, when there was no

stress on

> the cervix.

>

>

> <<Has anyone ever heard such a high number associated with

cerclages

> failing? Have you heard of these kind of complications? I thought

> it would be a no-brainer nest time, but now I don't know WHAT to

> think. >>

>

> Keep in mind that these risks are probably from all types of

cerclages

> lumped together. And such risks can be minimized by doing a

cerclage

> early--like at 9 to 10 weeks, LMP.

>

>

> <<How frustrating that the decision is not nearly as automatic and

> easy as I thought it would be.

> Anyone have any ideas?>>

>

> This will be your call. I like what Hollie says, too (Way to go,

Hollie--I

> have been wondering how you were), although she did not really

mention the

> risks and problems with complete bed rest. Imagine ~20 weeks of

bedpans and

> taking your meals lying down. You lose physical conditioning anf

strength,

> memory acuity, and run the risk of blood clots on complete bed

rest, so

> recovery during the postpartum period is slower, too.

>

> I spent from 11 to 37 weeks on mostly modified bed rest, which was

not bad

> at all. I spent from 18 to 21 or 22 weeks on complete bedrest

when I began

> having trouble with contractions, and that was difficult. The

contractions

> eased up after that, and I was able to go back to modified bed

rest. I am

> very glad to have had the cerclage and would not hesitate to do

one again:

> imho complete bed rest was horrid, my peri was 2½ hours away, and

losing my

> first son with no warning was no good, either.

>

> You may live ten minutes from your peri, and you may have more

people to

> take care of you and yours while you are flat on your back (a

rescue

> cerclage entails complete bed rest, too) . . . you may turn out to

have a

> stronger cervix than you had suspected, too. Hope the information

you're

> getting from us helps flesh out your choices. Good luck.

>

> Beth

> SU, resected x 2

[Guest guest]

<<I have to admit, I was reallllllly hoping that you'd have some super-

concrete information that would remove all doubt and make this an

easy, obvious decision for me. So frustrating that there are not

any concrete answers in any of this -- that would sure make life

much easier. ;-)>>

Hi Ami,

Well, I can pinch myself and verify that I, myself, am concrete, but other

than that, there is nothing concrete that I can tell you. ;-) However, I

can always tell you what I would do in your shoes. I would do what I did in

real life: have an early, preventive cerclage. The risk is much, much

better than what your doc cited, and it allows you to hopefully escape

months of total bedrest. As my peri put it, the idea behind cerclage is not

just keeping the baby in there, which bed rest also accomplishes, it is also

allowing the mother a reasonably normal life during the pregnancy. And a

normal life for the mother may contribute to a healthier baby, given the bad

effects of months of immobility--it's not just a luxury. IMO, complete bed

rest is a poor second to an early preventive cerclage. And with your

history of IC or IC-like loss, there is enough cause to place one rather

that watch and wait.

The caveat is that you have a--what?--5% chance of cerclage failure? That

is only a little higher than the m/c rate after 12 weeks.

Things are not so sweet if the cerclage is done after 17 weeks, if my

memory serves, or if a rescue cerclage has to be done. Hence the scary

stats from your peri.

BTW, my DH and I are now debating whther to TTC again before I go into

menopause or something :-) If I am so fortunate as to have another, I would

without a moment's hesitation go for the early cerclage again, just as soon

as we could verify good fetal growth and features.

Good luck in your decision.

Beth

SU, resected x 2