Should I go for a cerclage?

Dears

Some of you may remember my story. I lost my beautiful firstborn son in nicu in Nov, 2010. He was born at 30 weeks due to pprom. My water broke for no reason.

Am now pregnant again with the help of fertility techniques and am carrying twins. Presently am 13w 4 days. My high risk OB measured my cervix through abdominal ultrasound and concluded that its 3.5 cm long, hence I don't need a cerclage. She plans to measure it again at 16 weeks.

My fertility specialist however suggested I get a cerclage because I have twins.

i would like to get your opinion. What should I do?

I don't have any other children and since losing my son I have been a wreck. My poor husband is shattered too. This pregnancy is a do or die thing. Please suggest something. I need these babies very very badly.

Thank you for listening.

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Absolutely. The "wait and see" approach your OB is suggesting is very risky. Your cervix is measuring long now, but your only 13.5 weeks and it's too early for it to shorten. If your cervix is incompetent, it will likely change very quickly and it may be too late to do anything at that point. Better to be safe, than sorry, IMO. Good luck

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Get a second opinion with another high risk OB. The fertility specialist is simply that. While he/she may know a lot, the specialty is in getting you prego, not in carrying it all to term. That's what the perinatologist does.

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A cerclage is not without it's own risks primarily prom and infections. I would second the second opinion but my understanding of the evidence is cervical surveillance not routine cerclage. Good luck

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I had pprom w/ my twin pregnancy & have now met w/ 2 peris. Neither believe a cerclage would have anything to do w/ pprom & a cerclage has its own risks. One of the peris said she would definitely put me on P17 shots. Good luck!

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Sorry I didn't mean to hit done, wanted to say I am sorry about your loss & cannot imagine the stress you are feeling now.

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Thanks. My high risk OB said they don't give 17 p shots. I plan to see another high risk OB in a few days but am all confused.

Some people think a cerclage will definitely help, especially with twins. That's what I findout when I google.

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I would definitely think about the cerclage. There are many risks, but it might help. I regret not insisting on one with my daughter. However, it is a personal choice. Whatever you do, take this pregnancy very easy. Don't do any heavy lifting and try to stay off your feet as much as you can. Congratulations on your exciting news!

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I would go see a different Dr. A friend of mine made to term after several miscarriages thanks to a cerclage. Don't listen to just one Dr. I would try to get a high risk Dr if possible. Don't give up, fight , fight ... I wish i had.

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I had to make this choice after a loss and I would say YES get the cerclage. Find the right doctor to do it (one who has done many and supports you doing it). For me it turned out none of my 3 children would be here if i had not gotten the cerclage. I went into early labor (my cervix started to open) with my twins and with my sone after the twins. I was told i DID NOT have an incompetent cervix but yet it opened each time .... I lost twins at 4 months and then because of the cerclage I have three children. All were born early but are doing very well. Every experience is different and you have to do what is right for you but for me it was critical. Good luck.

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I just had an emergency cerclage at 21 weeks. My first son was born at 26.6 weeks due to unexplained preterm labor. I have been checked very carefully with this pregnancy and they found out at 21 weeks my cervix was funneling and shortening. I was told that you cannot have a cerclage past 24 weeks so if you are going to get one I would recommend sooner rather than later, although I have heard that PROM may not necessarily be an IC issue, especially since you made it to 30 weeks. Usually IC shows up much sooner than that. Also, 17p shots are not thought to work on twin pregnancies so many high risk doctors do not prescribe. I would recommend being as proactive as possible and if you feel something is necessary ask about it and get a second opinion. I had asked about a cerclage early on but neither my ob or high risk doctor thought my son was early bc of IC. Unfortunately, I think they were wrong.

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I had incompetence cervix and delivered twins at 23 weeks, twins have higher risk in delivering early than singleton pregnancy. my peri said studies show clerclage is not effective in twins pregnancy. For my future pregnancy, My ob suggest me to reduce tO one baby, place a cerclage and use progesterone shots.

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Perhaps ask if you can get your cervix measured every 3 weeks instead of every 4? I had my first bb at 31wk3d due to pPROM also and did the monitoring every 2 wks. The first US showed a "twisty cervix" that measured 3.5. It actually 'lengthened' after that haha...My 'twisty cervix' btw comes from a unicornuate uterus (half size). Our perinatologist said the same things as others, p17shots not proven effective for pprom moms or twins. You could always try progesterone anyway if it makes you feel better. Our doc suggested the vag suppositories if I realllly wanted to try them so we could avoid the shots and how they break down in the body like cator oil.

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Get a cerclage! If it's a possibility u'll need one than better safe than sorry! When i told
My obgyn i wanted to have ultra sounds every 3 weeks she said " it's not necessary " .. Yeah right!! Well i insisted! Alot!! And i even went and got another dr.. So now i have both of them monitoring me very closely! Do what u need to do to protect those babies :) good luck mama

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I had not heard before that doctors feel that a cerclage is not effective with twins. I can only say I lost twins at 4 months w/o a cerclage and had twins at 30 weeks with a cerclage. I went into early labor and had to be On heavy medication to keep the labor at bay including a medicine pump into my leg and home monitoring. This is only my experience. I just wanted to let you I ow it worked for me

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Thanks for valuable advices from everyone. Am inclined to go for a cerclage inspite of risks. I will be seeing a different high risk OB Gyn on Thursday. Will seek her opinion.

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The risks of infection with a preventative cerclage is very low. PROM with the cerclage is usually related to the IC, and not the cerclage. If you have an incompetent cervix, chances are, your cervix is going to open to the level of the cerclage and you will be left with a short cervix. This increases your chances to PROM. However, without the cerclage, there is no protection. If you choose to watch and wait, I would insist of cervical checks every week. That's how fast things change. Good luck!

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I agree with several posters that this is a good time to do the cerclage as a preventative. Of course there are risks with any procedure, but doing it early on minimizes the odds of PPROM. What you don't want to have is cervical changes that then require an emergency cerclage. That is much more dangerous. Take it from someone who had a 0.8 cm long cervix dilated to 1cm at 20 weeks. The emergency cerclage at 21 weeks helped me hold off delivery of my twin boys, but my membranes bulged through the stitch because it was so dicey. Eventually I got an infection, delivered at 24 weeks, and lost one of my sons. Don't get yourself into an emergency situation. Do it now while your cervix is nice and happy, with a doctor who is experienced with the procedure.

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My IVF doctor mentioned getting a cerclage when we "graduated" but I almost forgot about it. Luckily, right around the 19 week point, I did see a high-risk OB and he noticed that my cervix was shortening. He was going to monitor it but wasn't sure about cerclage. For insurance reasons, I switched to another high-risk OB about 2 weeks later. By then my cervix had shortened greatly and I had to get a cerclage ASAP, luckily still within a safe time period. My new high-risk OB had done thousands of cerclages and I was able to carry my twins to 36 weeks (also with strict bedrest). I have read that some doctors don't think cerclages work but I think that it made a difference for me and I'm so glad that I had it done.

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I saw high risk OB # 2 today, she was more proactive than my first OB and am planning to stick with her. She checked my cervix through internal scan and said it's a bit tinted. It's at good length though, over 3 cm.

Anyway, she strongly recommended a preventive cerclage due to twins and my pprom history. Since I work for another two weeks before fully quitting, she scheduled the cerclage placing surgery after that. I will be 16 weeks then.

She also prescribed taking crinone suppositories( progesterone) until delivery. She also took my urine and vaginal swab samples to test for any lingering infection. Am glad I found a OB who could think of all these things.

I just need to hang on. Hopefully, this time I will be given a chance to take my babies home and keep them with us forever.

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I'm happy you found a solution! I wish u an uneventful pregnancy!

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