Cerclage After Late-Term Miscarriage: Risks, Benefits & Considerations

Question
I am 34, live in the UK and in April this year (2005) gave birth to my daughter at 25 +6 weeks gestation. She lived for 29 hours but died.

2 weeks before I delivered, at exactly 24 weeks, I had a jelly type blob, but on internal exam - my cervix was closed. A week later at 25 weeks, I had bright red blood, and was kept in for 2 days with no repeat bleeding. On both occasions I was tested for infection and was clear. I had a chest infection and was put on antibiotics. I was scanned at 25+3 (suspected gestational diabetes as was measuring 32 weeks) and all seemed normal, although the babies head was 'buried' low and they could not measure it. Aside from this, measurement showed a big baby but correct for dates. Molly was 2lb 2oz when born.  3 days after the scan I delivered. I had no real labour and just got to the hospital in time.

I am now pregnant again (12 weeks) and the first scan (9 weeks) indicates all is normal and I am not classed as a high risk pg. My consultant had my cervix measured approx 10 weeks after I delievred, and told me at this scan that I had a short cervix (1.5cm) but that this may be normal for me? He is prepared to do a cerclage if we want it, and is also measuring my cervix at 13 and 16 weeks. They are loathe to place the stitch due to know risks, but my reserach indicates that a cervix this short is an issue - what should I be considering and what should I ask at my scan this week (I will be 12 + 5 at this scan)

Your advice and recommendations would be invaluable.

Thanks
Emma

Answer
Any cervix that measures less than 3cm increases the risk of preterm labor. With your history and a cervix of only 1.5cm in length, your risk for preterm labor is evident. I would recommend that a cerclage is placed around your cervix. Certainly if the next sonogram shows a shorter cervix or if "funneling" is noted, a stitch should be attempted. You may benefit from some tocolysis prophylactically (Terbutaline, Brethine). Modified bedrest may also help, although there are no data to confirm this. Try to be aware of any contractions and notify your doctor immediately if you notice any changes. Drink plenty of water. Good Luck.