Advice on how to live with a short cervix (26mm) during pregnancy

[Rex2021]

Hello everyone. I am 19 weeks pregnant and my cervix is 26 mm long. I underwent a lletz procedure in 2018 which removed 14 mm. The sonographer insists that I don't need further monitoring or progesterone. I have been fighting a lot to get at least one or two measurements, but no luck. Thus, I guess I will have to live with my short cervix and carry on as best as I can. To those women who had similar experiences, would you give any specific advice? E.g. things I should avoid doing which could make the situation worse.

[Chess5]

Hi Rex

I think it depends on hospital policy as I had a similar situation to you (also due to LLETZ) but was put through for extra scans etc. and I would agree that it’s good to push for these even though it can feel like hard work - I would ensure that they know that this is causing anxiety for you.

The advice in my case (they did give me the progesterone) was to really limit activity to short walks and nothing much else really which scuppered my plans for keeping active and certainly swimming as the pregnancy progressed bit we obviously went with that advice to try to help things. (I think mostly avoiding lifting and jumping seems the mains things which go for mostly pregnancies to some degree anyway - but he swimming was vetoed by my consultant). They said we were aiming for 28 weeks, then 32 and then 34 for birth (at which point they were saying they would not really be concerned at all) and in fact all these happened and we got to 39 weeks.

If very worried there are some websites abs specialist centres (Leeds is one) who you can contact and they can book you on for more scans sometimes there. I did this and they were very helpful as I was concerned that if I needed a stitch it would not be done quickly enough.

As you say the measurements can vary (I found significantly) from consultant to consultant so that’s worth also bearing in mind and asking them how the LLETZ has been done as if this is on an angle is can cause measurements to be less. They can also comment on the perceived strength of your remaining cervix which I think had an impact for me as this was quite strong.

Hope this helps!

[Rex2021 in reply to Chess5]

Many thanks for sharing your story and advices. After a persistent, long and labyrinthine sequence of phone calls, I managed to get a second cervical screening. The consultant agreed with me. It will take place in my 22 week. I hope it is not too late to receive progesterone if needed...!

[Bigblueskies]

Hi

It’s very stressful worrying about a short cervix. In my first pregnancy my cervix measured about the same as yours and it was considered marginal but normal. So it was not diagnosed as a short cervix because it wasn’t below the 25mm that is the threshold.

I had LLETZ and a very large scar of 25mm so I was pretty worried about it. Your scar sounds more like medium size so definitely not high risk.

I was given progesterone as a prophylactic anyway because I was so anxious and had a second measurement later on but before 24 weeks.

I must say I worried for no reason. Despite my very large scar and shortish measurement I delivered normally at 39w3d a healthy baby and in a straight forward vaginal birth.

I read a lot about this. The cervix is a muscle and it stretches and contracts all the time. They would have to keep the probe inside and take measurements over 20min to have a real average of its length. I presume they didn’t do this, so it is reasonable for you to say that you are extremely anxious about it and would like follow up tests. If necessary speak to the PALS team in your hospital, they are extremely helpful.

The progesterone and the stitch are unfortunately not very effective. From memory the evidence is not conclusive that they do anything. Bed rest is not helpful either. But if it makes you feel more reassured, do ask for progesterone. It’s not a pleasant thing to take but it might make a bit of difference in how your cervix responds and most importantly how you feel.

They don’t measure the cervix after 24 weeks because the chances of survival of a baby born after that point tip over to more than 50%. I find that an extremely cold way to think about it but considering the limited tools they have to prevent a preterm birth I think I understand it.

But please don’t worry too much about this as there is little you can do. It is just one of these things in pregnancy that we have no control over and we just have to accept. Your scar is not too large and your measurement is above the threshold. So that’s not a bad place to be!

[Rex2021 in reply to Bigblueskies]

Many thanks for sharing your story and other details regarding cervix features. At first, to be honest, I was not too worried. However, since borderline measures tend to be monitored I felt that I would be failing my baby if I did not try all available options. It was very difficult to get a second screening but I finally got it. May I ask you how did your second screening go? Did you still have the same measures as the first measurement scanning or was it shorter the second time?

[Bigblueskies in reply to Rex2021]

Oh that’s really great! I find that with maternity services, being assertive and asking for what you need is the way to be.

My measurements fluctuated and actually my cervix was longer in the second measurement. The consultant did explain that it is a muscle and contracts and expands all the time. So taking one measurement is literally a snapshot in time and often means nothing.

When you have your second measurement ask them to measure across a few minutes and give you an average.

[Rex2021 in reply to Bigblueskies]

Sorry, just another question. After the second measurement, you mentioned that you request progesterone in a prophylactic way. Did you actually take it? If so, do you think it made a difference?

[Bigblueskies]

No problem! I did take it…for two weeks! It made me really sore and itchy and, after reading how little it actually helps, I stopped. I think reading research about it and having a couple of measurements above the threshold of 25mm just helped me mentally to let it go a bit. Going past 24 weeks helped too, as I knew that there was good chances of the baby surviving if born early.

So I would say from a clinical perspective, it wasn’t the progesterone that helped me get to over 39 weeks before I delivered. It was just what my body was going to do anyway. Although my scar is huge, they told me that sometimes it matters where it is and how well one’s body has healed. So it is impossible to tell!

Also some of these worries in pregnancy get better as it goes on and you can feel the baby getting stronger. To be honest, there is always something else new to worry about instead too!

Do insist on proper measurements and monitoring and do take the progesterone if it helps you. If you need another measurement after the second one then ask for it! But then it’s helpful to just let go as you can’t really control the rest and your scar is not actually that large anyway.

Fingers crossed it will all be fine and you will not have to worry about this soon! Xx

[Bigblueskies]

Sorry I should also add that in this pregnancy I had my cervix measured again but just once this time. It was done by a specialist on short cervix complications and he was the one who told me the rule about the 20min-long measurement to get the average length. He also told me that it is not only the length but the shape of the cervix too that matters. They like to see the cervix being the same length all around and sometimes that is more important than the length. So you could have a short cervix but pretty symmetrical and that is generally a very healthy sign. So when you get your measurement, ask the sonographer to describe the shape as well as the length to you perhaps!

[Rex2021]

This is all very helpful. Thank you very much!