Weekly transvaginal ultrasounds?

[Cassaba]

Hi Mamas,

I am 16 weeks pregnant. I have had 2 prior miscarriages at 9-1/2 weeks each, and I am 41 years old. So my certified nurse midwife (works in a health system/hospital setting) is keeping a close eye on me. I had a transvaginal ultrasound yesterday to measure cervical length. She said it looked good. However, since I had cryosurgery 19 years ago, she wants to continue weekly transvaginal ultrasounds to keep an eye on my cervix. I am not sure what to do. I don't like the idea of so many ultrasounds, especially transvaginal. But I can't imagine losing this baby because of an incompetent cervix if something could have been done. I haven't had any cramping at this point. In fact, after yesterday's u/s, she was not going to order any more except the 20 week one. I am the one who asked a question about the cryosurgery. She had forgotten about it.

I would really appreciate anyone's feedback.

Thanks!

[CherryBomb]

Can she give you a reason other than surgery nearly 2 decades ago? I had a LEEP procedure done 10 years ago and I don't get weekly u/s. Usually if you were going to have trouble with your cervix because of the surgery, it's usually showing itself by 16 weeks.

[PixieLittle]

If it's any consolation, the weekly cervical length checks go really quick so at least it doesn't seem like THAT much cumulative exposure (only 2-3 minutes per time). For me they would measure the length and quickly check the heartbeat and that's it. I had one every two weeks - maybe they will let you do that instead of weekly, especially if after the first few measurements you have no change.

Good luck!

[queenofjuly]

Actually, weeks 16-22 or so are the prime time for cervical incompetency to show up. If you have IC, then things can change very quickly during this time period as the baby gets heavier and puts more pressure on your cervix. A prior LEEP or any sort of cervical trauma/surgery is a major risk factor in developing IC. It does not matter that it was a long time ago. I am not trying to scare you, but these are the facts. My dr recommended that I have bi-weekly checks via transvaginal ultrasound, because I had a cone biopsy about 6 years ago. I lost a lot of cervical length between weeks 14 and 16, so much so that I ended up with a cerclage and am now on bedrest. I think bi-weekly checks are the norm, if you have a risk factor. It only takes maybe 2 minutes for the tech to measure the cervix. Some drs will do one measurement, while others will do several and then average the length. Weekly does seem a bit much, unless you have already lost some cervical length or getting close to the danger zone. Do you know what the length was? That might help in assessing what you want to do.

[CorasMama]

Yeah, considering all the factors, including the safety of ultrasound, I'd go ahead and do at least every other week, if not weekly, trans-vag u/s for at least the "danger zone" time period. Even despite the discomfort. Though one thing you can do, to minimize the discomfort of a trans-vag, is to ask them to let you insert it yourself. I mean, they'll still have to control it once it's in, but there's no reason you can't insert it yourself. And ask questions, have them tell you your cervical length and any other important factors, so that you can hold on to your being in control of your own pregnancy, and the midwife isn't the "holder of the information." (But don't then use the info to google yourself into a terror, just have the information so you can speak with your midwife on a more even level.)

[CherryBomb]

Originally Posted by queenofjuly

Actually, weeks 16-22 or so are the prime time for cervical incompetency to show up.

Good to know. When I was pregnant with my first 10 years ago they checked my cervix at 13 weeks and said it was fine and didn't need checked again because if it was going to dilate prematurely it would be showing signs In that case, I'd do it just to be safe. I've never had it checked with my subsequent pregnancies, even though I always remind them I had that done.

[Cassaba]

Thank you so much everyone for your comments. I am leaning toward every other week right now. I just don't want the wand to "stir things up" unnecessarily. But if 16-22 weeks is the danger zone for shortening of cervical length, I don't want to ignore that. I had it done at 16 weeks. So I'm thinking again at 18, 20 and 22. And I'll tell them I don't even need to see the baby. Just get in and measure and be done.

[nia82]

I had IC with DS and likely will have it again. Transvaginal ultrasounds were never done, cervical length can be measured with a normal abdominal ultrasound. That is weird... Maybe you can demand abdominal ultrasounds instead? And I asked them to not look at DS, just the cervix.
However, my ultrasounds were at 16 weeks, 20 weeks, 24 weeks, 26, 28, 30 and 32 weeks. I didn't start PTL until 26 weeks (4cm cervical length at 24 weeks, at 28 weeks it was 3cm and basically no length at 30 weeks). I had a NST at 30 weeks and was started on Terbutaline til 35 weeks and then spontaneously delivered at 36+6. My mom had cerclages with all of us to keep the cervix shut.

[queenofjuly]

Transvaginal ultrasounds are a more accurate way of measuring cervical length than abdominally and are the norm for checking for incompetent cervix warning signs (length, funneling of the placenta, etc.)--esp. in the 2nd trimester. There are a bunch of articles you can find online about the TVU checks. http://www.americanpregnancy.org/pre...lcerclage.html

If you are interested, there is a very informative community & forums for women with incompetent cervix on this support group: http://ic.hobh.org/forums/

Most likely, you will be fine. It is just a precaution, and your provider is being cautious---which is good. If your cervical length is stable for the first few checks, you will probably be good. Only a small percentage of women with prior cervical surgery will have an issue, but it is a risk factor and a chance I did not want to take. I am glad I had the checks every other week, otherwise I would never have known that my cervix was shortening prematurely.

[Loving1]

I had an ultrasound at 20 wks where everything was fine, including my cervix. I returned at 23 weeks, because baby wouldn't turn to allow them to view her heart during the 20 week u/s. During the 23 week u/s they discovered that there might be a problem with my cervix. Follow-up with a transvaginal showed that I was dilated 1 cm & I was wheeled to the hospital for an emergency cerclage.

I had no warning signs of dilation & didn't feel anything.

Things can change so quickly that I would go with the weekly transvaginal.

[nia82]

Hmm that is odd. My obgyn in Burlingame, California and in San Luis Obispo, CA both never did transvaginal ultrasounds for my issue. I have to read up on those papers... Especially since my sisters in Europe with the same issue had abdominal u/s only as well.