This is my fourth pregnancy, after three traumatic births. I have two healthy daughters, and the third birth was a stilborn boy. Currently, I am in the 31th week of pregnancy, with cervical stitches, and this one is a boy. I am having pain in my back, and contractions, once in an hour. I am scared. My Ob/Gyn is on vacation and I looked over the Internet that in this stage of pregnancy I may have false contractions. No spotting. Can you help me understand what is could be?
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premature labor, cervical stitches
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Your OBGYN is obliged by law to provide coverage when he/she is on vacation. With your obstetrical history you should be in frequent contact with your hospital care system. With a cerclage in place, even though it is likely that you are just having typical 3rd trimester cramping, you should never hesitate to check in with the covering MD and ask if they would like you to go to the hospital for monitoring and an evaluation, and to check your urine and to make sure the cerclage (stitch) is still holding. If it wasn't you would most likely be having some bleeding. Make sure you feel the baby moving and you should be going for Non-Stress Tests because of the history of stillbirth. You should never feel 'cut off' from prenatal care , even when your OB takes a much needed vacation!
This could be early labor.
It would be best to be
checked soon.
It would be best to be
checked soon.
This could be early labor.
It would be best to be
checked soon.
It would be best to be
checked soon.
Cervical cerclage (stitches) is a surgical treatment for cervical incompetence/insufficiency. I assume this intervention has been performed in the 2nd trimester of your pregnancy, around the 14-17 th weeks. There are two techniques stabilizing the cervix in pregnancy:
(1) McDonald, the most common, is a strategic stitch used to cinch the cervix shut. A #4 Mersilk purse string on a Mayo needle or a Prolene #1 suture is inserted around the exo-cervix approximate to the level of the internal os (12 o'clock). A surgeon's knot is placed. This stitch is commonly removed around the 37th week.
(2) Shirodkar, less common and technically challenging, is when the sutures pass through the walls of the cervix so they're not exposed and involves dissection of the vaginal mucous layer and retraction of the bladder and rectum to expose the cervix at the level of the internal os. The Shirodkar procedure sometimes involves a permanent stitch around the cervix which will not be removed and therefore a Caesarean section will be necessary to deliver the baby.
I believe you have read and signed an informed consent form prior this procedure where a thorough explanation of the method, benefits, and risks have been described. If the provider has not attuned that you will be delivered through a c-section, then your stitches are likely the McDonald's type.
If you have contractions at your 31st week, regardless those are fake (Braxton Hicks) or real, you must be hospitalized immediately. You will be examined for the labor plan. Depending on the fetal monitor, tocography, and the state of amniotic fluid, your stitches will either be removed and your labor will be augmented, or you will receive a tocolytic therapy (under the fetal monitor) until the 36-37th weeks. Good luck.
(1) McDonald, the most common, is a strategic stitch used to cinch the cervix shut. A #4 Mersilk purse string on a Mayo needle or a Prolene #1 suture is inserted around the exo-cervix approximate to the level of the internal os (12 o'clock). A surgeon's knot is placed. This stitch is commonly removed around the 37th week.
(2) Shirodkar, less common and technically challenging, is when the sutures pass through the walls of the cervix so they're not exposed and involves dissection of the vaginal mucous layer and retraction of the bladder and rectum to expose the cervix at the level of the internal os. The Shirodkar procedure sometimes involves a permanent stitch around the cervix which will not be removed and therefore a Caesarean section will be necessary to deliver the baby.
I believe you have read and signed an informed consent form prior this procedure where a thorough explanation of the method, benefits, and risks have been described. If the provider has not attuned that you will be delivered through a c-section, then your stitches are likely the McDonald's type.
If you have contractions at your 31st week, regardless those are fake (Braxton Hicks) or real, you must be hospitalized immediately. You will be examined for the labor plan. Depending on the fetal monitor, tocography, and the state of amniotic fluid, your stitches will either be removed and your labor will be augmented, or you will receive a tocolytic therapy (under the fetal monitor) until the 36-37th weeks. Good luck.