QuestionQUESTION: Hi- My cervix measured 2 weeks ago @ 3.09cm with funneling,I ended up in L&D two days ago for cramping and my cervix now measured @ 2.49cm, I heard the doctor say the baby was at -1 station what does all this mean? will I go into pre-term labor (I am 30wks3days)
Thanks
ANSWER: Dear Heather,
The normal length of the cervix is approximately 4cm. When women get closer to 3cm, especially when there is funneling, we start to take note of the risks for pre-term delivery. This is called an incompetent cervix. It is generally just a weak cervix that begins to efface (thin out) once there is greater pressure on it - typically in the 2nd trimester.
In the past, women weren't usually diagnosed with incompetent cervix until after she had experienced many very early deliveries or 2nd trimester pregnancy losses from no other apparent cause. Now, because of the ultrasound technology available, doctors will often discover this condition with a trans-vaginal ultrasound between 16-20 weeks (depending upon your OB history). A trans-vaginal scan is the best way to measure your cervix because it can be seen much more clearly this way. The cervix looks like a tube on the scan, approximately 3-5 cms in length, with one end at the top of the vagina (the external os) and the other end inside the womb (the internal os). It is the internal os that can begin to open first and this will look like a V shape on the scan. As the os opens further it becomes U shaped. This is called funneling. If the closed part of the cervix measures less than 2.5 cms, it is considered to be an incompetent cervix and a cerclage (a stitch) is often placed to keep the cervix from opening too early if caught soon enough.
The fact that your cervix is shortening at 30 weeks means that your body is starting the process of readying itself for labor. The -1 station has to do with your baby's progress into the birth canal as it relates to your hip bones. If the head is above the ischial spines of the hip bones, it is measured in -1 cm increments; below the spines is +1cm increments. The range is -5 (just engaging into the pelvis) to +5 (crowning and visible).
I would suspect that, since your cervix had shortened even further when you went in with cramping, your doctor probably recommended bedrest or A LOT of rest. If cerclage cannot be performed, or the risk of losing the pregnancy is greater with cerclage than the potential benefit, many doctors will prescribe complete bedrest. Although there's no solid evidence that staying in bed is effective, the theory is that keeping the weight of the uterus off of a weakened cervix might aid in lengthening the term of the pregnancy until the baby is more ready to be born. You'll probably be told to abstain from sexual activity also.
Call your doctor right away if you have any of these symptoms:
- Change in amount or type of vaginal discharge, particularly a mucousy or watery discharge
- Vaginal spotting or bleeding
- Menstrual-like cramping
- Pelvic pressure or "heaviness"
I hope this information has helped you and answered your question. I wish you well and a Merry Christmas.
Brenda
---------- FOLLOW-UP ----------
QUESTION: Hi Brenda-Thanks for the fast response.I should've mentioned this the first time. This is my fifth baby and three of my other children were born @ 35-36 weeks.Two were induced because the Doctor felt they would be safer outside my body,(labors under an hour)the third I dilated from 1cm to 10cm in a half hour i was 35 weeks. my Doctor hasn't put me on bed rest in fact he seem's to be very nonchalant about the situation. The Doctor that I had seen this last time I ended up in L & D(by the way wasn't my regular hospital) happened to be a high risk OB and felt that I would need to be admitted for two days for steroid treatment.After speaking with my Doctor he felt because that FFN test came back negative it wasn't necessary for me to be hospitalized. My biggest fear is that I will go into labor and I am now living 25 minutes from the hospital and home alone with four children that with my history of persepitas(sp) labors that I wouldn't make it to hospital. Should I speak up to my Doctor or do you think he is correct in his belief that I will go close to my due date?
Thank You so much and happy holidays
Heather
AnswerDear Heather,
Wow - well, the fFN test is a fairly reliable indicator when there is an absence of the protein for women tested. According to ACOG, "Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention". In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor). So, doctors will rely on tests with a negative reading for fFN as an indicator for pre-term labor or impending delivery within two weeks of the test date. I would not necessarily interpret the test result as meaning you will go to full-term or close to your due date, since you are only at 30 weeks.
The administration of steriods is standard for women who are suspected of going into pre-term labor, to mature the lungs of the baby. If the high-risk OB had been aware of the fFN results, it is hard to know whether he would have continued to recommend this course at this particular point in time. He may have, or he may not have - sometimes they get a feel or instinct when they deal with high-risk cases on a daily basis. Regardless, I would suspect that you will be given this medication within the next couple of weeks anyway, given your history of delivery before 37 weeks and your cervical shortening now.
Now, as to your situation - if I were you, I would definitely be making some "just in case" arrangements. You have gained enough knowledge about the possibilities of your situation to know that there is a best case scenario and a worst case scenario. It is only prudent to prepare for both - and the in-betweens. :-) I would certainly talk to the doctor and make clear your concerns about your history of pre-term and precipitate deliveries (labor of 2 hours or less), combined with the fact that you are living 25 minutes away, alone with four children.
Personally, I don't get the impression, based on all you've shared, that you will go more than 4 more weeks at the outside. BUT - I don't have all of your chart information and am "just" a nurse. :-) Again, I would make some "what if" arrangements so every eventuality is prepared for. And if you are not getting answers that sit right with your instincts from your doctor, contact the doctor who saw you at the ER for a 2nd opinion. All you are doing is taking charge of your health and your baby's.
I hope this has helped you and answered your question. I do apologize for the delay - I have a miserable strep throat. Be well and Merry Christmas.
Brenda
