A Cerclage Removal Story

9/15/09 – Today was one of the most important days of this pregnancy.  At 36w2d, Dr. G took my stitches out  in the L&D operating room, to be as sterile as possible.  The procedure was scheduled for 10 am (originally 0930) but an emergency walked into the ER and I was bumped to around 12:15p.

Prep: I was not allowed to eat after midnight.  So they starved me for like 12 hours.  However, I did sneak some peanuts and sips of water while at home because the hunger was unbearable.  I checked in at around 0930 after calling the floor to see when to come in.  Because of my dehydration  and stronger contractions, they gave me an IV fluid and a shot of Terbutaline sub-q (ouch, that stings!) to quiet my uterus for the procedure.  I was also given IV Ancef as a precautionary antibiotic. We saw MeMe on a bedside ultrasound just to make sure she was doing well and got hooked up to the baby/uterus monitor. We sat and watched the “Newborn Channel” and answered some health history questions before it my time to go to the OR.  My mom and husb were with me.  Some of my mom’s coworkers were working  and almost all of them had no idea her daughter was pregnant or that she was expecting a grandchild.  The last time I was L&D at my hospital was when my water broke with the twins so mom only wanted to give good news this time. I love having mom with me because she makes sure everything is taken care of.  Husb is equally supportive so its like having two people wait on you hand and foot all day!

Procedure: Signed the consent, of course. Doc said no anesthesia this time and I stupidly refused IV Ativan thinking I could tough it out.  I wished I took it to calm me down because the pain was EXCRUTIATING! I almost jumped off the table and Nurse Annie, who was holding my hand, almost had her fingers broken.  People who say it is “uncomfortable” are barely touching the surface.  All that cervical manipulating, the hard speculum, and the manual check for leftover stitch material is NOT COOL. Gotta remember, nothing large or wide has been in my cooch for months so the muscles in there were not happy to be messed with.  I was tense and needed to be coached to breathe from Annie.  All in all, it took about 10-15 minutes to make sure both stitches were out.

Aftermath: My cervix did the unexpected.  Dilated a fingertip and 50% effaced.  MeMe is high, not even engaged.  I also have some bacteria growing up in there so I have to put Metrogel in my cooch for the next 5 days.  Ladies with cerclages are more prone to BV because of the increase in secretions caused by the cerclage. Go figure.  I should expect some bleeding, but having seen any yet. I finally got to eat after the procedure. We stayed in the hospital and was monitored for about 2.5 hours.  For a while, my contractions seemed stronger and had gotten to be about 5 minutes apart, but then subsided, spread apart, and felt like normal.  Annie sent me home with my prescription and said to call or come back if my water breaks, stronger contractions…etc. Typical labor stuff.

These are what the stitches looked like, but I didn’t get to take a picture of my actual stitches. Looked just like little pieces of blue wire with huge knots. I can see why Dr. S said husb would cut himself if he got close to those things. Ouch.

Placing bets: Husb’s hor0scope said he’ll get great news on Friday, today is Tuesday.  Mom still says by her birthday (9/24).  A says by next week.  Dr G would like MeMe to stay until at least 37 weeks (9/20) but won’t stop her from coming now. We’ll see if these contractions start to make my cervix act right. Next OB visit is on 9/22 at 1150.

I bet my medical chart is exciting reading.  All the things we’ve been through from 1/08 until now.  Everyone is excited and proud we made it this far.  MeMe has a crowd eagerly awaiting her arrival.

My bionic cervix – cerclage story

Here is the story of my surgery:

No food since 0130 and was starving! Husb and I checked in @ 0700 and they took us back to a room to get changed. The charge nurse asked some questions and started my IV, I guess my assigned nurse didn’t come in until 8. We heard baby’s heart with the doppler. A doc informed me about the procedure and I signed the consent. A bunch of docs introduced themselves to me since they would be in the OR room.

My case is rare. IC occurs in like 1% of pregnancies so seeing a cerclage is a learning opp for some of the docs. It took a while for stuff to get started because 2 ladies came in laboring and my official doc (Dr H) had to attend to them. As soon as 1 delivered, my show started at around 0930.
The anesthesiologist gave me pepcid & reglan to prevent nausea, then I had to drink some weird med to prevent reactions to the spinal. Then they gave fentanyl in my IV before she stuck me in the back. That stuff made me so high I barely noticed the spinal. It took a few minutes and my whole lower body went numb. I couldn’t feel my ass or move my legs. The nurse and tech had to move them for me and put them up in the crazy stirrups. My cooch was wide open to the world! They did a lot of prep. Dr H came in and he was confident and jovial. He was teaching Dr T about the procedure and they did it together. I couldn’t feel anything! But I could see the blood they suctioned out and it seemed like a lot.

After they were done (total of 15 to 30 min), they told me I really needed the cerclage and that things went well. I have 2 heavy-duty stitches keeping baby on lockdown. I was back to my room at 11 am and started drinking apple juice. Next I had to be monitored for contractions and I had none. The spinal med took like 7hrs to wear off enough for me to walk and pee on my own. I had some belly discomfort at 1330 and needed a catheter to drain my bladder. I took motrin for pain. I ended up being discharged around 1545 and was wheeled to the car. My mom came to see me in the hosp preop and stayed until noon.

Overall I feel fine and but my insides are sore.

Peri visit #2…caught in the act!

My new peri is cool as hell.  His name is Dr. S and we should be seeing him for the rest of my OB care visits for a looong time. He has been an MD for almost 20 years and MFM doc for 8 yrs.  He is an attending doc, not one of those interns or residents and his partner is a professor at UCSD.  He first tried to give us the run-around about how research data doesn’t support the use of cerclages, but he is “pro-cerclage” and performs them often. He wanted to check my cervix and go from there…

 Saw baby! Great hearbeat and measuring to date.  Moving a little, I think it was sleepy time for baby.  Baby still hanging out by my cervix and we couldn’t find out the gender.  Booo!!! We should be scheduling that scan soon.  First things first!

Now my cervix, bad girl!  We caught it being naughty and had shortened to 2.7cm, down from 4 cm 3 weeks ago.  According to Dr. S., that is concerning.  He left the room, did some stuff and came back to discuss his findings.  Turns out, he also scheduled my surgery for 4/29 @ 9am!  If my cervix had started at 2.7 and stayed there, not too bad.  But the fact that it was much longer earlier and the rate of change, my risk for pre-term delivery has gone way up again.  As baby is getting bigger, my cervix is getting weaker and could eventually dilate.  Of course he offered the watch and wait approach, but then said “I can tell you guys want the cerclage, so on Wed.  my partner will perform it, be at the hospital 2 hours early, here are the labs I want you get drawn.” He did some vag cultures and gave me a prescription for 17P shots and pre-op azithromycin.  My mom  gave me my first IM shot in my hip and it was painless.  I have to take it weekly until they tell me to stop.  After the surgery, I should see Dr. S every 2-3 weeks.

I like this doc, he knows what to do without prompting and answered some questions before I could even ask.  He also is gonna take me off of work like I requested, so I can stay home and collect State Disability Leave checks!  Yay!