How I am managing to keep my wits about me, I’m not quite sure. My appointment this morning revealed further cervical shortening to between 1.5 – 2.0 cm, depending. The beaking is a now very pronounced and alarming funnel (alarming to me, just upon seeing it).
The good news is that my blood pressure is nice and low, I did not gain any weight this week, and tomorrow I will be 27 weeks (still WAY too early for this baby boy to make his arrival, but further than I was when this shortening first presented itself).
I won’t lie, as I see the shortening and leave each appointment, I wonder how things would be had I decided to push for an elective cerclage. But, it is more of a passing thought than something I beat myself up over. As it is, I’ve made it 13 weeks without one and to have been able to live my life, vertically, as a pregnant woman, has had a significant positive affect on my psyche and my family. So, yes, I wonder but I don’t dwell.
My MFM is still very encouraging (and not in a blowing smoke kind of way). She recounted that yesterday was Kaiser’s regional MFM meeting, where the hot topic was reducing pre-term births. Basically, in speaking with other MFMs of varying backgrounds and experience, they would all have approached my care in the same way (with some perhaps not even prescribing progesterone (since my shortening didn’t present until post 24 weeks and the thinking/research is to only prescribe vaginal progesterone if shortening occurs prior to 24 weeks)). She also said that there is discussion about whether all pregnant women should undergo weekly cervical monitoring as a way to prevent pre-term birth. It is estimated that in 600 patients it might prevent one pre-term birth. A cost analysis is underway to determine if the costs of weekly cervical ultrasounds from weeks 16-24 for a pregnant population of women would be far less than a NICU stay for a pre-term baby (which is a bit nebulous as it depends on when the baby is born and what kind of care/intervention baby needs). Fascinating that it could become the standard of care as the US focuses on reducing pre-term deliveries.
My takeaway was that we are doing everything that current research and wisdom would dictate, short of administering prophylactic steroid injections. And, the theory with steroid injections and lung development is that they are effective prior to 34 weeks, they are the most effective if you deliver within 2 weeks of having a course (and one course ‘covers’ you for two weeks), BUT that a rescue course can be administered and has proven effective. So, in theory, my best bet would be to try to hold off doing the first round until 30 weeks, which would cover me until 32 weeks and do a second course then which would cover me until 34 weeks. At or after 34 weeks, steroids are no longer considered an effective intervention.
She still does not recommend any lifestyle change although you can be sure that I will be off my feet as much as possible and I will dial back social engagements and household chores. She recounted the story of a current patient who was 4 cm dilated at 25 weeks and is still pregnant at 33 weeks. Cervical shortening and even dilation are not necessarily the same as pre-term labor. The fact that my cervix is closed at the external os is a good thing.
So, I will return next week, we’ll do fFN test #2 and another cervical measurement and IF my cervix is under 1 cm and/or if the fFN test is positive, I can opt to have the first round of steroid injections. Or not, although if the fFN test is positive, I will.
In baby news, I was able to see him open and close his mouth and stick out his tongue. It was the cutest thing. And, he opened and closed his eyes, also adorable. I just hope he continues to develop in utero for at least the next 10 weeks.
I’ll take any good thoughts/prayers/vibrations/stories/experiences you want to send my way or share. I hope that in chronicling this journey as specifically as I have that it brings awareness to the issue of cervical shortening and the various treatment options. I hope to be one of the success stories.
“Faith consists in believing when it is beyond the power of reason to believe.”