We had our follow-up (oh, excuse me, “pre-conception counseling”) yesterday with the perinatalogist, the high-risk specialist. I don’t think I followed this up, but after the horrendous experience with the receptionist, they actually called me on the doctor’s prompting to schedule my appointment, which makes me feel better that the issue is not, you know, the doctor. Anyway.
She disagrees with our OB and is very confident that cervical incompetence is responsible for our loss. She has some very convincing evidence for this in addition to her vast experience with these types of pregnancies – namely that my cervix was open but had not effaced (lost any length) at all, and that the copious discharge I was having for 5 days prior (which can be/is likely a sign of cervical dilation) preceded the slight fever I got, indicating to her that infection was a result of my cervix being open to the outside world, eventually causing labor.
Dan is practically *excited* about this. He is excited about her certainty. Her rational proof. Her faith in the solution. He is excited that she had clearly taken the time to review our case at length, did not spend our appointment reviewing my chart but in fact discussed details from memory. I can see that.
I, on the other hand, find her certainty a little unnerving, as no one can really ever be certain in these cases, but mostly, I am terrified of the solution. Prophylactic cervical cerclage. At 14 weeks pregnant, she wants to go in and literally sew my cervix shut with something that looks more or less like a twisty tie until 36 weeks. Risks include: infection, miscarriage, permanent scarring, oh, and if they’re wrong and I go into spontaneous and rapid preterm labor? My cervix can literally rip through it. Awesome.
She assures me that last possibility is extremely rare, not even on her list of things to be concerned about with the procedure, and has never happened in any of the patients she’s done one on. History has shown me not to discount the extremely rare odds, though. This blog exists, right? It has to happen to someone, right? It’s hard not to think this way. They can also wait and monitor me very closely and do what’s called an “emergent” cerclage should my cervix begin doing anything untoward, but doing it prophylactically has far fewer risks and is far more effective (80-90% versus 50-60%). She was very clear that she thinks this is a non-ideal plan though she’ll do it if that’s what I want.
Benefits of the cerclage – mainly, the benefit is that as long as she’s right and this is the issue, it’s unlikely I’d have to spend much time on bed rest. Most women who get one are able to stick to fairly normal activity for most of the pregnancy. This is not a small thing, and if we were not concerned about the risks of the cerclage, we’d for sure want to get one just because of this. This will be in addition to the p17 shots and the weekly monitoring, so one more weapon in the arsenal against ending up with another baby is certainly welcome.
But fuck, I really do not want to get a cerclage. The risks, while small, are quite alarming. I wish I had a crystal ball.