WEEK 13 : Week by Week Incompetent Cervix Pregnancy Guide - RISKS OF CERCLAGE

NOTE : For the regular advice on Week 13, I suppose there are hundreds of other websites to tell you how it goes. This blog serves to supplement those sites, my personal favourites being What To Expect, Baby Centre UK and Parents. Do take note, however that I am not a professional physician, I practise law for a living and the only thing I know about incompetent cervix is through my own experience as a mother of 2 and a 17 week old baking in the oven! :)  The purpose of this blog then is just to simply share the joys and heartaches, the blessings and curses, the sadness and happiness and the disappointments and the pleasant surprises of our journey as a mom with an incompetent cervix.

If you have a scheduled transvaginal cerclage, your anxiety may start to set in.  This is the final week leading to THE day.  You have heard of the risks, but you also know that the advantages outweighs the risks, and preventive cerclages have been known to be as high as 80 to 90 percent successful.  Successful as in these IC mommies manage  to carry baby to term, or 37 weeks.  Most IC moms do not even dream of full term, most of us look for the V-day, or the date of viability.  Babies start to have a small chance of survival after 24 weeks, before such date most doctors do not even want to consider any measures to save the baby if it was born prematurely.

So what are the known risks of the transvaginal cerclage?

• As with most invasive surgeries, there is always the risk of infection
  
• The procedure may also trigger contractions which may further damage the cervix, the cerclage, or may cause preterm labor.
  
• Spontaneous delivery may occur during the procedure or soon thereafter.
  
• Premature rupture of membranes
  
• Tearing or rupture of the cervix if labor begins before the stitch is removed, or on the other hand, what is known as cervix dystocia, where the cervix is unable to dilate even after the stitch is removed.
  
• Injury to bladder/uterine rupture
  
• Risks of anesthesia
  

 At this point, you may, or may not want to know what is to come.  Some women find it comforting to know exactly what and how the procedure is carried out, whilst some others would rather not know - in fact some may favour elective general anaesthetic instead of the spinal block so they do not have to go through the ordeal in the operation room!  So, to those of us who want to know, what does a transvaginal cerclage entail?

First of all, of course you would have been told by your doctor to fast the day before, at least 10 hours before surgery.  If you are prone to gastric or heartburn, do let your doctor know so he may prescribe some medicines to be taken the day before.  If you have been using vaginal suppositories, you may want to check with your doctor whether you should continue to do so the day before.  And common sensically, do not have sexual intercourse (besides, at this stage of your incompetent cervix pregnancy you shouldn't even be having anymore pelvic activities!)


The Day of the Procedure

• Just before the procedure begins, an intravenous (IV) line is placed in your hand or arm. It delivers fluids and medication into the body.
  
• You will be given anesthesia. This is medication to keep you free of pain during the procedure. Depending on what type you are given, you may be relaxed, drowsy, or fully asleep during the procedure.
  
• During the procedure:
  
  • A speculum will be put into your vagina to hold it open.
    
  • Local anesthesia may be injected into the cervix to numb it.
    
  • The doctor uses instruments through the vagina to stitch the cervix closed. Surgical thread is used. Knots are made to hold the thread tight until it is cut later in your pregnancy. In many cases, the thread is wrapped around the cervix and pulled tight.
    

After the Procedure

• You will be taken to a room where you’ll recover from the anesthesia. Nurses will check on you as you rest.
  
• You will be watched for signs of premature labor. You will also be given medication that helps prevent premature labor.
  
• Your baby’s heart rate will be monitored.
  
• You will have some light bleeding and cramping. This is normal. You will likely be given pain medication. If you are still in pain, tell the nurse.
  
• You may be able to go home later that day. Or you may stay overnight in a hospital room to be sure you do not go into premature labor. When you leave the hospital, have an adult friend or family member drive you home. (Source  : University of Minnesota Medical Center)
  
  Of course mental preparation is essential as well.  This is the time when you may want to announce the news of your pregnancy to friends and family, perhaps even church members, and at the same time request for prayers for your procedure.  You may find yourself having to explain to them what is incompetent cervix all about, and what procedure this is, including its risks.  And I hope by this time you have informed your employer about your impending bedrest, and that whether or not it will be until birth or just a few days/weeks will very much depend on the development of various factors.
  
  All the best for next week!
  

WEEK 8 : Week by Week Incompetent Cervix Pregnancy Guide - THE PREPARATION NOW THAT IT'S REAL

NOTE : For the regular advice on Week 8, I suppose there are hundreds of other websites to tell you how it goes. This blog serves to supplement those sites, my personal favourites being What To Expect, Baby Centre UK and Parents. Do take note, however that I am not a professional physician, I practise law for a living and the only thing I know about incompetent cervix is through my own experience as a mother of 2 and a 16 week old baking in the oven! :)  The purpose of this blog then is just to simply share the joys and heartaches, the blessings and curses, the sadness and happiness and the disappointments and the pleasant surprises of our journey as a mom with an incompetent cervix.

If you are seeing your baby for the first time on the ultrasound, I can feel your excitement! You may even be able to hear his/her heartbeat, and you might be so tempted to announce to the world now that it is sooooo real!!!

But if already know you have the condition of an incompetent cervix and this is another 'IC baby' (as we IC moms fondly refer to our little babies), you may start having mixed feelings.  Along with other 1st trimester pregnancy worries, you know that while others look forward to Week 14 as it marks the end of the 1st trimester, that will be the time when we will have to undergo the cerclage procedure.  Some of us may already have some changes to our cervix, or if you are like me, you have a short cervix to begin with.  You may not know of your condition yet, but some countries are already making it compulsory for cervical length to be checked at 16 weeks (do refer to Week 7 on England NHS's petition).  I have also shared some of the worries (financially, psychologically and physically) in Week 7. 

Some of us do get some bleeding/spotting at this point.  I was diagnosed with subchrionic hematoma
which is supposedly common, but how many pregnant women like the idea of bleeding during her pregnancy? Blood is never a good sign, and seeing a dark patch around the sac on the ultrasound isn't exactly reassuring.  The happy ending says the blood clot will dissolve on its own, the unhappy ending says you end up in a miscarriage.  Either ways, it is especially not a welcomed diagnosis for an IC mom, simply because this should be the last few weeks of normal activity, perhaps even a few more gym sessions before the dreaded bedrest (modified, strict or otherwise), but with a subchrionic hematoma, again bedrest is prescribed. So now what... instead of 6 months of restricted activity, it has become 8???

But well... if it is for the good of having that little bundle of joy in your arms in the end... WHY NOT? If I have to do this over and over again, I would.  But at this point, perhaps the question of whether you would stop having babies may pop up with hubby (ignore the rest, remember?). For me, this is my 3rd IC baby. and my OBGYN noted during my cerclage procedure 2 weeks ago that there were scar tissues from my previous cerclages, and he had to stitch around and away from those scar tissues. It will not get easier or less risky if I do decide to have more babies. He did mention I may have issues with dilation when labour comes (cervical dystocia). And of course, other factors like, will your career be once again stagnanted, how about finances? If you already have 2 or 3 children, you will need to plan for their future as well.  Bedrest may affect them too, as most of them may still be a toddler, or a preschooler, and they  need lots of cuddles and attention and outings. Which, of course, is not possible with bedrest.

Since your pregnancy is now very real (there are statistics that show if you hear and see the heartbeat at 8 weeks, the chances of a continuing pregnancy increases to 98% as compared to just a couple of weeks ago when it was slightly above 60%), this is a good week to start making some solid plans for what is to come.  Start with the short term ones, like who will help out with household chores during the weeks (or months) of bedrest after the cerclage placement, who will chauffeur the older kids around to babysitters, playschools and piano lessons, who will prepare your meals, and what will you do to occupy yourself.  Do you have to inform your employer now? Should you?  It is best to be honest and open, tell your boss the possibilities, from the best to worst case scenario, and what to expect.  As for yourself, Be prepared for the best... or worst. You may be asked to leave, or you may be granted paid leave.  But always remember at the end of all this... what can be worth more than that Little Rainbow you will hold against your breasts?