WEEK 12 : Week by Week Incompetent Cervix Pregnancy Guide - SYMPTOMS OF THE CONDITION?

NOTE : For the regular advice on Week 12, 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.
 
What prompted me to start this series of blogs in the first place is because I am so sick of tired of scouring hundreds of "Week by Week Pregnancy Guide" sites that tell you the 2nd trimester marks the beginning of your "honeymoon period".  Supposedly, this is the trimester when you are not too large to be feeling clumsy yet, yet the morning sickness is over and the risk of miscarriage is significantly lower and it's time for that short babymoon and back to EXERCISE!!! You know what, whilst it may be true for most women, the start of the 2nd trimester for us moms with incompetent cervix is the start of a long tiring road to holding our little Rainbows in our arms!

No, the end of 1st trimester may be well and good when it comes to morning sickness, but the risk of miscarriage has just worsened, for us with this condition.  Unfortunately, many of us may not even know yet that we have this condition.  More often than not, there are no symptoms until it is already too late, and we don't even know the exact cause of the condition.  Sad to say, in some countries, women continue to lose their babies during late pregnancies without ever knowing why.  From observation, most women lose their babies between 20 to 24 weeks, and at that point of time our little ones are just simply too little to survive.  They are considered not to be of viability yet, and even if they survived after agonising months in the NICU, they may have a long road to recovery, or may even suffer permanent defects. 

At this stage, we have to start being careful about our activities, particularly those involving pelvic movements - sexual intercourse may not be wise as we may not know the condition of our cervix.  The ultrasound at this stage may still be unable to pick up abnormalities of the cervix yet, but within weeks, or even days, the changes may start. Here's an excerpt from Women's Health UK website on possible ways to detect IC : 


"There are descriptions of cervical assessment before pregnancy to try and detect those who may benefit from a stitch. These include checking cervical resistance or compliance, with a dilator, or specialised instrument. Whilst promising, no studies have yet found a predictor of poor outcome as good as a previous pregnancy loss.
Transvaginal ultrasound (TVS) during pregnancy has shown some promise. The usual length of the cervix is about 4cm as measured on TVS. Women with a cervical length of less than 2.5cm have been found to have a 50% risk of preterm delivery in one study. Other studies have looked at opening of the internal section of the cervix ('funnelling' or 'beaking') in response to pressure on the top of the uterus. It does seem that this finding early in pregnancy is suggestive of cervical incompetence and that the findings are progressive throughout pregnancy.
These studies are really still at an early stage and it takes a great leap to presume that on the basis of these findings alone a stitch will improve things. Larger observational studies and a cerclage study on the scale of the MRC/RCOG will hopefully follow and define the place of this investigation. At the present, this type of scan is generally confined to research centres in the UK and is certainly not to be considered 'standard of care'."

A positive outlook is of utmost importance at this point of time.  It has never been particularly pleasant for me, as I enjoyed my physical activities, especially my gym sessions and my running around and clowing around with my toddler and my preschooler.  Sometimes the guilt sets in when they want to be carried, or they just want you to take them to the pool. Do join forums and support groups, it helps to a certain degree.  But towards the end of the day, you will have to find peace within yourself to prepare yourself mentally for what is to come.

WEEK 10 : Week by Week Incompetent Cervix Pregnancy Guide - PRE-CERCLAGE ARRANGEMENTS

NOTE : For the regular advice on Week 10, 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.
Ok, this may be the week where one of the things you would want to do before bedrest commences, would be to bring out those boxes of pregnant clothes which you have stored away some couple of years ago waiting for this day! :)  If this is not your first baby, you are probably starting to show, even if you are not, your probably can't squeeze into your skinny jeans anymore.  Your colleagues whom you have not broken the news to may think you should start laying off those daily afternoon tea (which comprised of 3 scoops of chocolate mint ice cream and 3 packets of Twisties and 2 large mango smoothies... and they do wonder why you don't drink coffee anymore at 4pm when your blood type previously was essentially COF2E2?) as you do look fuller and rounder.

Of course if is your 1st pregnancy and you don't even know you have incompetent cervix yet, you may still  be hitting the gym 5 times a week looking like a fitness instructor still.  But if you are reading this, perhaps it's time to just be a little aware.  Unfortunately this condition does not show itself until much later, well into your 2nd trimester.  Perhaps that's why old people always warn us against too many activities during pregnancy - they know many things can happen.  Besides, this is one condition that is almost symptomless and not very common. You may want to read myWeek 9 post for some of the horrors that can befall upon us. 

For those of you with twins, of course you are starting to look pregnant! I'm not really sure about twin pregnancies - whether you do need to go in earlier for a cerclage. I have read somewhere that yes you may need to but perhaps only a week or two earlier, as they really do need to be sure that your placenta is fully formed and you are past your 1st trimester (at least at the tail end of it) before they attempt a transvaginal cerclage.  They also want to ensure that there are no structural abnormalities and that the foetuses are of a certain growth rate before they decide to place the TVC.

In any case, start preparing for that dreaded (or welcomed) bedrest.  Have you made meal arrangements? Laundry and cleaning arrangements? What about your older kids? Mentally prepare yourself, and mentally prepare dear hubby. He will have to juggle a full time job, a little bit of housework, managing and caring for the kids (who are probably still preschoolers/toddlers) and of course work arrangements with your boss.  Yes, you will have to let him/her know at some point VERY soon.  You may even get the green light from your OBGYN to go ahead with normal activity except heavy carrying, exercise and pelvic activities, but I always tell myself "Prepare for the Worst, but Hope for the Best"

WEEK 9 : Week by Week Incompetent Cervix Pregnancy Guide - POSSIBLE CAUSES OF THE IC

NOTE : For the regular advice on Week 9, 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.
What I remember about Week 9 isn't all good. I lost a baby before my surviving No.2 at 9 weeks due to, it seems, chromosamal issues.  But a loss is a loss. Eventhough it was just a 9 weeker.  It was heart wrenching. I wrote about it Losing Jamie as part of enduring the loss, but the pain did not really go away. Of course when I got pregnant again (it was 2 cycles later after the D&C, quite unexpectedly) I was scared shit at Week 9, but no... baby stayed with me. All the way through the cerclage and little baby G is 2 and a half years old today! 

With the current pregnancy, again I had a scare at Week 9.   I was still actively carrying heavy files walking the courtrooms, singing in choirs, hitting the gym 4 times a week and carrying my baby G and sometimes even my 25kg 6 year old because I knew once the cerclage is in I couldn't do all that anymore.  But God has other plans for me.  Apparently I needed to start slowing down! I bled. At the OBGYN, I was told I had subchrionic hematoma, not a large one, but worrying nonetheless. (Read Week 8 here) 

So it was the beginning of bedrest. 5 weeks earlier. No good. But all in the name of having another baby in my arms, planned or not. The trauma of loss is not something I wish upon my greatest enemy.

Well, for those of you who still have the luxury of going about life until THE CERCLAGE DAY... enjoy it! But just be very aware of any changes.  I have come across women who reported that there are already cervical changes at this point. It is perhaps most worrying for those of us with a SHORT CERVIX rather than an incompetent cervix. But then again, some women with short cervix reported that they went on to have very normal pregnancies without the need for a cerclage.  Despite hearing stories from my mom about how one of her colleagues used to need a cerclage (did they have such a thing back then in the 60s/70s?) because of an incompetent cervix, I have scoured the internet and I am not too sure when it was first diagnosed.  But judging from the general ignorance about the condition from people around me when I first told them of it, it appears to be a very uncommon condition lacking in research.  Women are still losing their babies in late pregnancies (my OBGYN has just told me of one of his new patients who just lost her 9th baby and her previous OBGYN NEVER diagnosed incompetent cervix!) and developed countries are still petitioning for compulsory cervix length measurement today! http://www.change.org/p/nhs-england-cervical-incompetence-nhs-to-make-cervical-checks-mandatory-from-16-25-weeks-save-babies-lives

So what is exactly is the cause of this condition?  Many websites state that the cause of your incompetent cervix may never be known.  But these are some of the common causes :
:

• Changes in hormones during pregnancy
  
• An abnormal cervix or abnormally short cervix
  
• Damage to the cervix, such as during surgery (previous abortion or a cone biopsy procedure) or after a difficult delivery of a baby
  
• Certain medicines, such as diethylstilbestrol (DES). This medication it seems was prescribed to our moms in the 70s to prevent miscarriage, the side effect of which is it caused an incompetent cervix in the female babies (US!!!)

Unfortunately this condition is almost without symptoms.  Your baby is healthy, and it is a physical , technical defect of your cervix rather than any hormonal defects  and it is sad that most babies do not survive because they are just too premature.  By the time you get to the hospital your waters have already probably broken, or membranes already ruptured, of which then there is nothing much that the doctors can do for you or your baby.  While those with 1st trimester loss may be able to find solace in the fact that there is nothing they can do or not do to save their babies, for us moms with incompetent cervix, we often than not blamed ourselves for not knowing our bodies, or for having done too much.  I almost lost No.1 my dear Ian because I spent almost a week on my babymoon walking and touring and taking pictures, and then instead of resting upon returning, I went to the gym for my kickboxing and step aerobics classes.  That night I bled clots.  Still, I didn't think much of it (well, all those websites say it is normal for pregnant women to bleed once in a while, don't they?) and waited till the next morning before I see my OBGYN.  I remembered the horror on his face when he exclaimed upon doing a vaginal exam, "Girl, you are dilating!"  I was 23 weeks 4 days and 2 cm dilated, no cervix length left.  At times, in retrospect, I thank God I didn't know anything about incompetent cervix at that time, as I would have gone into hysteria.  I was calm and didn't think much of it still when I was wheeled into the OR an hour later, and had an emergency TVC placed.  I was on strict bedrest for the rest of the pregnancy and stitch removed at 37 weeks. Ian was born a week later.  He is 6 today.

Not many women have a happy ending like mine to tell.  My heart bleed each time I look at the pictures of their little tiny angels, all dressed up to go back to meet their Maker.  I cry with all the moms whom I have became friends with the last 6 years (I found this wonderful support group on facebook Incompetent Cervix Awareness when I was on bedrest with Ian) whenever I read about their losses and their struggles to have their first rainbows in their arms (Rainbows are surviving babies, Angels are those who did not make it).

Therefore, I have since learnt that it is always best to listen to your body, and don't worry about being labelled a paranoid.  Enjoy your pregnancy, yes, but at the same time, be alert. BE EDUCATED. And always have God by your side to guide you.