Who are you calling an "incompetent cervix?!"
All about this unicornuate uterus gal’s 18-week anatomy scan and cervix check. And what is a cervix anyway? And cerclage what?! Thanks for reading!
Yesterday, I had my 18 week anatomy scan and cervix check. The baby, anatomically, looks great. Thank goodness! Our baby boy has working kidneys and ten fingers and all the other parts and is just so adorable!
However, we received some less than stellar news about my cervix. Before I go on, can we just pause and talk about the cervix?
As I was walking out of work tonight, I asked my (female) friend, “Do you know what the cervix is?”
She raised her eyebrows questioningly and said, “Kind of…?” Two simple words colored by an upward inflection. Two simple words that illustrate exactly how I have felt about the cervix my entire life until now.
Okay, the cervix. This is super important because before two weeks ago, I thought my cervix was just the little round sphincter-opening-thing that your doctor swipes during a Pap smear or that you touch to see if you’re fertile. (Am I alone in thinking this?!) I imagined that just beyond the donut-shaped cervical thing was the uterus itself. Round sphincter cervix then BAM uterus! But guess what? I’ve been wrong about the cervix this whole time.
In the back of my mind, I always figured there was more to the cervix than just the part you can feel and see during a gynecological exam because I (recently) found out that it’s important for “cervical length” to be monitored during pregnancy, especially with a unicornuate uterus (UU). If a cervix becomes too short, it is deemed to be “incompetent” (terrible term, btw. My friend said she’d rather it be called a “cervix needing some support over here!”). And a shortened, “incompetent” cervix just happens to be the number one predictor of pre-term labor. So, I knew the cervix had a length, I just didn’t know what or how…it was a mystery to me!
Two weeks ago, with my feet in stirrups and a vaginal probe heartily inserted, I studied the screen in front of me with the black-and-white fuzzy images of my reproductive system. While the ultrasound tech measured my cervix, a (far too simple) question popped into my head. A question that eventually led to a cervical-epiphany! (More like a completely basic, logical cervical-realization.)
“So what exactly are you measuring?” I asked the tech.
“The length of your cervix,” she replied, plainly.
“Okay, so what is the cervix then?”
She then went on to describe that my cervix is actually a canal…a tube…a passage…a TUNNEL! This tunnel connects my vagina to my uterus. (They should really call it a “cervicular tube” or the “cervix tunnel” or something to better help us women understand what the hell is going on in there, amiright?!) The average cervix length is 4 to 5 cm. “One study found that at 24 weeks gestation, the average cervix length is 3.5 cm. When cervical length is less than 2.2 cm, women face a 20 percent probability of preterm delivery,” (keepemcookin.com; read more here).
(Okay, be honest. How many of you knew that a cervix is a canal and not just an opening before now? Those of you who have medical degrees or have birthed babies don’t count. Am I alone in ignorant cervical conceptualizations?)
After my Cervix: 101 lesson with the ultrasound tech, she told me that my cervical length was 2.7 cm. My MFM explained that this was still within normal limits, and they would start to worry (I’m pretty sure she said “consider intervention,” but all my mind heard was “worry!”) at 2.5 cm or less.
Fast forward to yesterday’s 18 week ultrasound. In just two weeks my cervix had shortened from 2.7 cm (WNL) to 2.4 cm (below average). As soon as I heard “2.4” I knew this was no bueno.
My MFM started talking to us about treatment options. She recommended vaginal progesterone and/or a cerclage within the next week. She said that vaginal progesterone may be less likely to help with cervical shortening with a UU since the UU is impacting my cervix from a mechanical standpoint. (Side question: does anyone have a good layman's description of why vaginal progesterone helps with cervical shortening? I just did an Internet search, and all I found were research articles with terms like "membrane-based nongenomic receptors" and "uterine quiescence.") I told her I'd like to move forward with a cerclage. Even though there are risks with it being an invasive surgery, my gut said I’d rather be aggressive with preventative measures. We moved forward with the cerclage option and scheduled my surgery for Saturday, June 1 (aka: tomorrow!).
What is a cerclage?
In layman’s terms, a cerclage is a surgery where the cervix is stitched closed to prevent further cervical shortening and pre-term labor. STITCHED!
Okay, I have to pause again. Sometimes I’m impressed with my bad-ass self when I reflect on all of the procedures I’ve had to go through in the past year: ovarian torsion laparoscopic surgery, two egg retrievals, FET, and now a cervical cerclage! And before this year, I had left ACL surgery when I was 12 and a major reconstructive surgery as an infant at Children’s Hospital. Ask me about this one next time we’re out for cocktails (after my pregnancy). It’s a fun story! I know for certain that there ain’t nothing I can’t handle!
Back to a cerclage. Most cerclage procedures are done through the vagina, and some are done through an incision in the abdomen. This Saturday, I will get an epidural, and then my doctor will go up through my vagina and stitch my cervix closed (oh boy!). The surgery only lasts 10 minutes, but I’ll be recovering until Wednesday, a four day recovery period.
How am I feeling?
I’m 80% nervous for the implications of a shortened cervix (i.e., pre-term delivery), 12% angry at my body for “failing” met yet again, 4% nervous for the surgery, 2% guilty for taking the risk to carry this baby in my “broken” body (maybe I should have sought out a gestational carrier after all?), 1% grateful that we have almost met my individual out-of-pocket insurance max (by May, people, May!), and 1% annoyed that I have to use precious PTO days for recovery (that I’m saving for my maternity leave. PS: Why does America have such shitty maternity leave policies?! Read more here if you want to get angrier).
(On the bright side, I’m 100% sure that all of those percentages above added up to 100% after calculating them on my calculator three times. #honesty #dork. Also on the bright side, Cory spoiled me with gluten free chocolate chip cookies, Gatorade, two Redbox movies, and a sweet card tonight!)
I know the surgery will be fine. I’ve gone through plenty of medical procedures in my life that I know it’ll be over in a blink.
I know I can’t stress about the possibility of pre-term delivery. What happens will happen regardless of how much I stress over it. As one of my awesome “unicorn sisters” wrote in an email to me the other day, “Losing sleep and worrying about something happening isn't going to prevent it from happening.” Smart woman. But can we just acknowledge how scary the possibility of pre-term delivery is? No one wants their baby to be born prematurely, and it is really scary. This lack of control and lack of trust in my body to do what it “should” do is terrifying.
What can you do to help?
You just reading this post is more helpful than you could ever know. Helping me feel like I’m not alone. You don’t have to do anything more than just being with me by reading my words.
You can tell me that my feelings are valid, and this is some scary shit.
You can tell me I’m not alone in thinking that cervixes were just an opening to the uterus and not an actual tube thing!
You can send me positive juju in the form of encouraging comments, funny memes, or prayer/meditation/etc.
You can think of me tomorrow (6/1/19) at 10:00 AM MST and chant while doing the Cabbage Patch, “Go Kristen, go Kristen, you’re a unicorn, you’re a unicorn, you got this, you got this!”
I’m so fancy
When I told my same work friend that I was having a cerclage tomorrow, she brightened my heart by saying, “Well, you do have a fancy uterus, so it makes sense.” Fancy uterus. Fancy! I love this shift. I am a unicorn, and I have a fancy uterus!
Thank you for your support, as always! The Unicorn Community is bitchin’, and I love you all!
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