Short, funneling cervix

Just curious if anyone had any information or stories to share that may be similar to my wife's situation...

We're expecting fraternal twins, and she's currently at week 28 with 1.38 CM of cervix left. It started funneling around Week 22 at 2.5-2.6 cm or so, and keeps dropping by about .2cm per week. The Dr. put her on home bed rest right away at Week 22, and I didn't think much about it - I figured that the Dr. knew what she was doing, and that the bed rest would fix whatever the problem was. However, the cervix kept shrinking, and we were told we'd have to go in the hospital when it got below 1.5cm.

This week (at week 28), my wife was admitted once she showed 1.38cm left, and when she was on the NST she was showing to have an "irritable uterus" and were talking briefly about giving her a shot of terbutaline (PANIC!!!), but ended up just giving her a regimen of betamethasone her first night in the hospital "just in case".

I just figured it was no big thing until I started doing some research on my own and discovered that a lot of research shows that bed rest doesn't actually help with a shortening / funneling cervix, and that it wasn't just a small risk of preterm birth, but a pretty big one, and a risk of it being a bit earlier than I would have expected.

I did some more research and learned there's not much that they can do to treat this condition this late in the pregnancy to prevent preterm labor (there's some emerging stuff involving prophalactic Indomethecine and 17 Alpha Hydroxyprogesterone Caproate, but my Dr. didn't think it was worth trying). I was reading about the tocolytics, and although the nurses in the hospital talk like you can be on tocolytics for weeks, the research journals I read online seem to say that they're usually only good for a short time (2-4 days or so), and that people with a short / funneling cervix may be resistant to them and require more tocolytic use.

Not being an expert at this, I'm not sure what the "real" skinny is on our situation. I would LOVE to hear about some sort of treatment or something for what's going on for my wife, but there doesn't seem to be one. Anything safe that will buy our babies a few extra days or weeks in the womb would be priceless to me, but right now the Dr. and nurses seem to be happy with just giving her bed rest and keep her drinking water, and waiting for the contractions to start so they can do tocalytics, and the research I read makes me think that although she doesn't have but a few contractions a day, labor may be right around the corner in the next week or two due to the short and funneling cervix.

Any advice, new treatment recommendations, or stories (good or bad), etc. that are similar to our situation would be GREATLY appreciated. If they're already posted here, please point me to them.

TIA,
WorriedDadToBe

 

Welcome to TS!

I had a cervix of 2.5 and funneling at 28 weeks and was put on bedrest. My cervix had lenghthened within a week to 4.5 with no more funneling. I stayed put for the next 9 weeks and delivered my healthy twins at 37 weeks. It is possible, and bedrest does help in many cases. I am surprised, she is showing an irritable uterus, obviously causing her cervix to shorten, that they aren't putting her on some type of medication to keep the contractions to a minimum? Of course I am no doctor, and I guess they have their reasons, but I would definately be asking questions as to why they aren't trying everything to prevent further shortening, and ultimately premature labor. I was put on Procardia for the contractions, but had to stop taking it due to a heart condition at the time.

Laying flat(no incline whatsoever), and drinking more water than she can possibly stand is the best thing right now. Also, I was drinking 3 Boost High Protein Drinks a day from 28 weeks on.

Good luck to you and your wife, keep us posted on her status.

 

I wish I could give you an absolute answer on this one. Unfortunately, it seems that every case is a bit different. You'll find ladies on here who had a short cervix, went on bedrest, tocolytics, the works, and still delivered early, and others whose docs took a less aggressive approach, and still held off til 36 weeks and beyond.

I had a cervical measurement of .9 at 25 1/2 weeks, was sent to L&D where I started contracting as soon as they did an manual cervical check for dilation, was on 48 hrs of Mag Sulfate, then 2 1/2 weeks of hospital bedrest, followed by modified bedrest at home for the remainder of the pregnancy. My docs didn't send me home on tocolytics, although I also had an irritable uterus. They basically said research hadn't proven that it did much good. My cervix had lengthened to 1.5 cm by the time I was discharged from the hospital, and that's where it stayed til delivery. I was lucky enough to hold out til almost 37 weeks, and I attribute that to being on bedrest. As soon as I hit 36 weeks, I was off bedrest, and a few days later, walked into the OB clinic 4-5 cm dilated without even knowing it.

Good for you for doing so much research and being a good advocate for your wife. I wish this deal came with guarantees! I think a positive attitude goes a long way - I was determined to make it to 28 weeks, then 32, then 36. Good luck to both of you!

 

It seems that nothing is actually "proven" to help with anything! Your wife will just need to follow her doctor's orders. Bedrest & terb worked wonders for me (not to mention the Home Monitoring System, as well). I drank a ridiculous amount of water every day...just about 2 gallons & only got up to use the bathroom.
Good luck & hang in there,

 

thanks for the responses so far everyone. I probably mispoke about the irritable uterus before - her uterus was irritable the first day of admission, but got better that night after fluids. we didn't have a clue that was going on until that day. anyone know if that might mean the cervical shortening might slow down or reverse if it had been a factor all along ..?

also, I'm curious if any twin moms with a short cervix had any success with 17p progesterone ( 17 alpha hydroxyprogesterone caproate) to prolong their pregnancy..? or fish oil supplements ..? it doesn't seem to be standard practice to use these on twin pregnancies (or short cervixes) yet, but a lot of studies are going on right now with these, and if either might help in our case I may ask or Dr. to look at them...

Thanks again to everyone
WorriedDadToBe

 

Is she unable to feel her contractions?

It sounds like her uterine irritability has a lot to do with her being dehydrated, which is really easy to do with twins. I was drinking 2 gallons a day to keep my contractions to a minimum. It was insane.

I don't have any experience with the shots...you might want to put that in a new post, as I think there are quite a few that do have experience but may not see this post.

Good luck!

 

So many questions are coming to mind...............is she contracting at all? Is it just her length is shrinking or is she dilating too? I was under 2 in length, 80% effaced, 2cm dilated, funneling with a bulging bag at 29 weeks and with bedrest and meds I hung on until 36 1/2 weeks.

 

She's able to feel her contractions sporadically - a couple here and there maybe 20 minutes apart, nothing for a few hours, then a couple more sometimes about 20 mins apart. Not sure if this is ok or something to worry about at 28.5 weeks...

Re: her length - she's 1.38cm & funneling (which, depending on what article you read, the funneling may or may not add that much to the preterm labor prediction with twins), but she's not dialated yet - at least as far as we've been told (that's a good thing, right?)

It's so encouraging to hear everyone's stories that's been worse than ours that turned out okay - I'm just hoping that it's not a one-in-a-million sort of thing, and that it might be possible for us to have a similar success story

 

Oh I was where you were and wanted so many people to tell me their story. I had done all the research I could bear on-line, and sounds like we read the same stuff. I haven't heard of too many docs doing the progesterone shots, but know that it is done. It is kind of in the testing phase though, so I am not too sure that you would want to be the testers.

Anyhow, I contracted a lot and had a really irritable uterus. At the same time as your wife is in her pg, I had an almost identical situation. I stayed on hospital bedrest from 29 weeks to delivery at 35w1d. I just stayed on my side propped up by all my pillows and only got up to go to the bathroom, and shower every third day. I was on Nifedipine (Procardia) a med that worked for me, or so I think. I stopped that a week before the babies were born, and attribute much of the success to keeping them in to that but more so to staying down.

My kids were in the NICU for 8 days and then we all came home! They are super healthy and perfect little angels now.

My brother and SIL have twin boys who were born at 27 weeks and they spent 3 months in the NICU, BUT they are home now and you would never know that they were born early, they are 9 months old.

My advice:
1. DRINK lots!!!! (water, and I drank a lot of gatorade)
2. Pee a LOT (contractions with a irritable uterus are triggered by dehydration and ALSO a full bladder). I hate that it is like that. It was a vicious cycle!!!! But, I would try to go before I felt too full and that would help with contractions.
3. If it is at all an issue, have her take Colace to make sure that she isn't struggling with going to the bathroom, that isn't great for the ol cervix.....no more pushing that needed.
4. Take it easy, you are in a great place to be past 28 weeks!

Please feel free to send me a private message if you have more questions, I would love to help. And please keep supporting her, it sounds like you are going to be an amazing father (Happy Father's Day, by the way) since you are doing all this to help! Keep us posted!

 

First off, congratulations! I hope that you are getting the encouragement you need! I have heard of much worse cases that have gone full term. My experience sounds almost identical to your wife's, and I ended up carrying until 34 1/2 weeks (no NICU time). I too had a shortened, funneling cervix (found at 24 weeks), and was starting to dilate by 28 weeks.

I was admitted to the hospital at 24 weeks for a week, and then again at 28 weeks for 3 weeks. I started on oral terbutaline around 25 weeks. That helped with my irritable uterus, along with a combo of many other drugs (nefedine, percocet, progesterone, colace laxatives). I started on the progesterone shots around 28 weeks. I really believe that the combo of bedrest and drugs helped prolong my pregnancy.

Hope that helps encourage you a bit. And Happy Father's Day!

 

I too had a short and funneling cervix with my twins. I was placed on bedrest and meds at 20 weeks when my cervix measured 1.7. Bedrest actually improved my situation and my cervix lengthened by my next appointment, it was over 2.5 but I then had funneling when the tech applied pressure. My doctor was confident that this was the best course of action and we decided to continue with the meds and bedrest. I ended up catching a stomach bug at 27 weeks and that caused me to go into labor. By the time I got to the hospital, I was too far along to stop. The hospital is the best place for you wife to be at this point, it is great that she is being monitored at all times. Good Luck and I hope that you can keep cooking those babies!!

 

I had 2mm (yes 2mm) of cervix left at my first length check at 16 weeks. I was admitted immediately, put on complete trendelenberg position bedrest, and had an emergency cerclage the next day. That got my cervix length back to 3.5cm. The peri kept me on bedrest though, since I had shortened so drastically so early. I was also on Indomethacin for my irritable uterus.

The indomethacin eventually lowered the fluid levels for baby A, so they took me off of it since my cervix was staying a nice length of 3.5cm. Two weeks later, I had shortened down to 1.5cm (23 weeks). They put me back on the Indomethacin and a week later I was down to 1cm (despite the cerclage). This was the 24 week mark for me, and they admitted me to hospital bedrest. They also put me on Procardia in addition to the Indomethacin.

I remained stable for 4 weeks, with a short cervix (1cm) but stable. They also gave me a round of 2 steroid shots at exactly 24 weeks. They took me off Indomethacin at 26 weeks because it should not be taken in the third trimester due to the risk of premature closing of the ductus arteriosis. I remained stable on just the Procardia...no contractions. At 28 weeks they sent me home back to strict home bedrest, with a weekly visit to the peri.

I did well for 3 weeks, but on the way to the peri for my 30w5d appointment, I felt regular contractions. When I arrived and told them, they sent me up to L&D and they found that baby A's water had broken. Upon admittance, they immediately gave me a rescue dose of steroids. They would have tried keeping me pregnant for at least one more week to get me to 32 weeks, but baby A was footling breech and they were too fearful she'd prolapse her cord by pushing it out with her feet. So at exactly 31 weeks (48 hours after my rescue dose of steroids) I was delivered.

My girls spent 5 and 6 weeks in the NICU as mostly feeders and growers. Lily was on room air from the get to, Grace needed just a little oxygen support and one day on the vent to administer surfactent.

My peri was the first to say it's not been proven that bedrest prolongs a pregnancy, but he said it certainly doesn't hurt. I spent 15 weeks on bedrest and although it was terribly difficult, it was totally worth it in the end.

As far as the P17 shots, I think at 28 weeks your wife is nearing the end of when they would normally be administered. I've heard nothing but good things about them though, and at my yearly appointment recently I grilled my OB/GYN about whether I could get them if I were to get PG again. They were not administering them with my twin pregnancy (not enough research, and it was a university hospital).

Honestly, her length at 28 weeks is not completely horrible. And she's on hospital bedrest, which will help immensely. She's in good hands and I hope she can make it a good while longer.

 

update - had a TVU today, the day before week 29 and one week exactly after the last one. After one week of hospital bed rest (which only seems a little more restrictive than what she was doing for home bed rest for the previous 6 weeks) the cervical length is vitrually unchanged at about 1.38 cm (yay!)

however, the top of her cervical funnel is a little bit wider. anyone know if this means anything..? from the looks of it i'd wonder if the funnel might make it easier for baby A to step through his sack and break it, but I haven't researched this much yet. any thoughts anyone ..?

TIA,
WorriedDadToBe

 

Glad to hear her length is stable. I know I mentioned this in my other post but my cervix was funneling, it was noticed at week 29 and I was able to hold on until week 36, not a moment of NICU time.

We are thinking of all of you, thanks for sharing the update!

 

Hey there, I ws hoping to hear an update, just as Diane mentioned. We are all thinking of you and your family! Way to go on the measurement today!

I wouldn't worry about the funneling as you can't do anything about that. It would make sense that it is wider because your babies are growing, and I thought that at this stage, mine grew rapidly. Are they talking about keeping your wife in the hospital for the duration of the pregnancy? As long as she is doing all she can to keep on her side and lying down, those babies will be happy and growing, and hopefully stay in a little longer.

Please keep us posted, and we will try to help!