According to my OB who specializes in high risk pregnancies, along with sources such as pregnancy.org, familypracticenotebook.com, and healthline.com, the average woman’s cervix during pregnancy should be above 3 cm in length. As pregnancy progresses especially by the 34th week, it is normal for the cervix to begin to shorten to prepare for eventual birth. But you do not want it to shorten before the baby is term or you risk your cervix beginning to open and efface allowing the baby to be born too soon.
Because I am at risk for my cervix opening as the baby grows, I have to be monitored often via ultrasound to check the length of my cervix. As of now at almost 25 weeks, the length of my cervix is checked bi-weekly to make sure I am staying above 2.6 cm in length. If I go shorter than that, my cervix could completely shorten causing it to open, my cerclage stitches to rip, and the baby would to be born too soon. I am a high risk pregnancy and the likelihood of this happening even with my cervix stitched closed is probable if I do not restrict activity. At 20 weeks my cervix shortened from 3.0 cm to 2.6 cm, however in week 23 my cervix had lengthened to 3.2 cm. Because the cervix is a muscle it can lengthen and shorten, but once your cervix has started to efface or thin out, it is often too late for it to lengthen as the birthing process is likely to have already begun.
The length of the cervix is expected to shorten as a pregnancy progresses, but a length of 3.0 cm to 3.5 cm isn't expected until 32 to 36 weeks:
· At 16 to 20 weeks, normal cervical length is 4.0 to 4.5 cm
· At 24 to 28 weeks, normal cervical length is 3.5 to 4.0 cm
· At 32 to 36 weeks, normal cervical length is 3.0 to 3.5 cm
Source: FamilyPracticeNotebook.com
2. Why am I taking Procardia and 17P Progesterone Injections?
At 17 weeks, my cervix began funneling and I started having contractions. A funneling cervix means that your cervix is attempting to dilate and open, but with the cerclage stitch it is intended to prevent it from opening all the way. Because I was having this complication early on, I was immediately placed on a medication called Procardia, an antihypertensive medication generally used to treat high blood pressure and heart disease. It is also used successfully to treat pregnant women to slow contractions. My doctor is monitoring me, but Procardia has caused my blood pressure to fall very low, has increased my headaches during pregnancy, and has caused some irregular heart palpitations. However, it works wonders for stopping contractions. I take it two times a day and if I do not take it on time every single dose I will immediately notice contractions.
My doctor also started me on weekly 17P progesterone injections at 17 weeks to help prevent pre-term labor. Although this injection is unpleasant and has caused me to have a rash, as well as enhanced my pregnancy symptoms, it is doing its job.
Source: http://www.keepemcookin.com/prevention.aspx
3. What’s the difference between cervix length and cervix dilation?
When I speak of cervical length I am referring to just that – the length of my cervix. The average length of a cervix during pregnancy is 3.0 cm or higher. When your cervix begins to shorten during the birthing process, it will eventually diminish and will open allowing your water bag to drop and break, and your baby to be born. With an incompetent cervix it is important for the doctor to keep track of the cervical length to ensure that your cervix is not preparing to open. Because I was diagnosed with an incompetent cervix during my last pregnancy, my doctor placed a transvaginal cerclage during the 13th week of my current pregnancy to help keep my cervix closed. If I did not have a cerclage the likelihood of my baby “falling out” of my cervix and being born too soon is very high.
4. Why am I on modified bed rest and what does it mean?
When you have been diagnosed with an incompetent cervix in previous pregnancies, the likelihood that you will have it in subsequent pregnancies is high. Any pressure from the growing baby causes your cervix to weaken and potentially start to open or dilate. This means that your cervix could literally open and your baby could fall out, many times with no symptoms until it is too late. Walking around, standing, even sitting for long periods of time all put pressure on your cervix from your growing baby.
Being ordered to be on modified bed rest does not mean I am ill. Trust me, I would much rather be walking around, but I have had to make adjustments in my life so that I can get this baby to term. Modified bed rest simply means that in order to keep my cervix closed and prevent my cerclage stitches from ripping, and my baby from falling out, I need to stay off my feet as much as possible. There seems to be a misconception that lying in bed equals illness as after all, I look healthy. Regardless of who in my life gets it and who doesn’t I will do what I have to do for my baby boy to get him to term.
With my last pregnancy at almost 22 weeks, my cervix silently opened to 5 cm and my water bag fell into the vaginal canal without breaking. My daughter began to fall into my cervix to begin the birthing process. Luckily, despite a lack of pain or contractions, I had a bloody mucousy discharge that prompted me to go into the hospital where I was immediately placed on hospital bed rest in trendelenburg (feet elevated and head pointed down toward the floor) to try to get her to a viable gestation. She made it to 24 weeks and 2 days inside my womb, but if I had not recognized something was wrong she would fallen out prior to me getting to the hospital and my story could have been a lot different.
For my current pregnancy, I had a transvaginal cerclage (or cervical stitch to hold my cervix closed) placed at 13 weeks to help prevent my cervix from opening as my baby grows and puts more pressure on my cervix. Although the success rate is high to carry to term with a cerclage, it is NOT a guarantee that it won’t open – it’s a preventative measure for those with an incompetent cervix to try to get the pregnancy further along without spending time on bed rest. A cervical cerclage stitch can tear and you can still end up delivering early.
In my particular circumstance, I began to experience some complications at 17 weeks when my cervix starting to funnel and attempt to open and I began having contractions and uterine irritability. The cerclage prevented my cervix from opening, but I could feel pain and pressure. Prior to that ultrasound I spent Mother’s Day shopping with my family. I had stood on my feet for long periods of time over the course of the Mother’s Day weekend, and had walked a lot. I realized by the end of my weekend I made a huge mistake because I could feel definite pressure and was hurting in my lower abdomen and back.
My doctor immediately placed me on modified bed rest meaning that I could stand for very short periods of time as needed but I was not allowed to stand on my feet for long periods of time (which included grocery shopping, cleaning to include vacuuming, etc) and I was no longer allowed to pick up my children until the baby is born. The doctor said he would rather see me lying down a large percentage of the time but recognized I still needed to care for my two girls. I’ve been doing my best to adhere to the doctors orders and definitely can feel when I have stood too long as the pressure on my cervix begins to hurt and I can feel my cerclage stitches. Being on bed rest has helped tremendously as my cervix went from 2.6 cm in my 20th week to 3.2 cm in my 23 week.
For more information on bed rest, please visit whattoexpect.com who needs it and why?
