A cervical cerclage (cervical stitch) at 21 weeks saved our twins lives

cervical cerclage

Author – Illiana Bell

Over 12 months of no periods, no ovulation and no pregnancies, my partner and I decided to consult a Gynaecologist at the Royal Woman’s hospital, Melbourne.  After blood tests and ultrasounds everything was reported within normal range… still no periods and of course no ovulations. The gynaecologist was concerned that the Depo Provera shot I had in 2011/2012 had completely messed up my hormones.

I was put on medications to bring on a period and then another lot of medications to bring on ovulation. After finally getting a period I was still not ovulating. Finally, I got a period without medication, however they only occurred every 3 months. This left us with a really small window to try and conceive. After 12 months, what felt like a life time., we were going to try one last time on the medication.  And if this round did not work a referral would be completed to an IVF clinic.

Our journey to conceiving twins

5th January – Cycle day 1.  Yes, I was one of those ladies that wrote down every single period, every blood test date and result.  As well as every pregnancy urine date and the negative result.

21st January – I did my first blood test; I was convinced that this cycle was going to work as I felt “different”

23rd January – My gynaecologist phoned and said I did not ovulate and I’m showing no signs of ovulations. He told me to take time to think about the next step… IVF

29th January – I went to my Local GP and I begged to do another lot of bloods as I was convinced I was pregnant OR that I had at least ovulated, my doctor was hesitant but agreed.

30th January – Results were negative.

8th February – I clearly remember messaging my partner and telling him that something was up and that I felt different. He put it down to a UTI….. Still not convinced on my way home from work, I stopped at the chemist and brought 3 first response pregnancy tests.

A positive pregnancy test!

8th February –  A. POSTIVE. PREGNACNY. TEST. WITHIN. SECONDS!!!!! (Well, actually 3 positive tests).

I made an online booking with my doctor at 7:45am the following day

9th February – 8am I burst through the doctor’s room, I AM PREGNANT! “Impossible, you didn’t ovulate”. I showed him the 3 tests I did and I did another one with my GP. Again a “Strong positive”. I rushed off to have my bloods taken. 1.5 hours later my doctor phoned me to confirm I was pregnant with a HCG Level of 1134.  I continued to do blood tests every 3 days to make sure my levels were rising accordingly.

8th March-  8 weeks and 6 days – I was booked for my very first ultrasound.

TWO BABIES!!!! We were having twins!!

 

Twin Pregnancy

My pregnancy from this point was easy, no morning sickness, slightly more tired than usual, sore boobs. Nothing major.

I had routine check-ups weekly at my Antenatal clinic.

Week 16 I questioned If I could have an ultrasound slip as I wanted to “check up on the babies”. MY Obstetrician convinced me that it was not needed and I was okay and my babies were okay. I remember complaining every day to anyone that would listen that my 20 week scan was FOREVER away.

25th May –  4PM.  Finally, my 20 week scan was here!! My partner and I were sooo excited to finally see our babies and to find out the genders, twin A – Girl and Twin b- Boy

Both growing on track, perfectly, placentas looked great, everything looked perfect.

The sonographer asked that we do an Internal Ultrasound to check my cervix length- the look on her face I will NEVER forget. I immediately asked what was wrong. She assured me it was okay, however my cervix length was shorter than what she would like it too be. She consulted with a senior sonographer who advised to send me home, and to phone my Antenatal clinic in the morning.  I was to to discuss further treatment with them as I may need a cervical cerclage (cervical stitch) or bed rest. I questioned if I could do anything now. The sonographer told me that no one would see me at this time of night (6pm). Confused, scared and not having a clue what to do we went home.

twin belly

 

Little did we know that this was just the start of intensive monitoring

26th May – At 9am I phoned the Antenatal clinic, no one was working this particular Friday so I was put through to birth suite. Who advised to come in STRAIGHT AWAY. Birth suite worked hard to consult with the Private Ultrasound clinic where I had my scan done, however they would not release the images to the obstetrician on-call and would only discuss measurements over the phone.

It was discovered that my cervix was 14mm.  I sent for another internal ultrasound once I arrived at birth-suite. <y cervix measured 17mm with funnelling.  My partner and I were told that I needed to stop work immediately so that I could start strict bed rest and progesterone pessaries. We were told to come back on the 30th May for another internal ultrasound.

30th May – I arrived for my ultrasound at the Hospital. The Obstetrician that we consulted with had met me in the ultrasound waiting room. I didn’t think I would get to see him. That I would be shuffled around to whoever was on that day, due to being a public patient. However this Obstetrician was really invested in me and my babies health. He promised to be there each step of the way.

Immediately after the ultrasound I was told to go straight to birth suite.  The Obstetrician would phone my partner to come in. We were told that my cervix was shorter again. It was now measuring 13mm with proximal funnelling.

 

A cervical cerclage was our only chance to save our twins

Here we were, at 21+5 weeks pregnant with our little girl and little boy. I was being counselled by the Obstetrician that we needed a cervical cerclage placed the very next day. That this was our only chance to save the twins. We were told that I had an 80% chance of losing the twins by going into premature labour during the procedure / my waters being broken by the obstetrician performing the operation, due to the complexity of it all.

The Obstetrician I had been seeing was not operating the following day. I didn’t have enough time to wait until the following Monday when he was scheduled on. He promised to meet me in theatre and to watch over the surgery and to be there If I needed.  The obstetrician gave me faith and hope that his colleague was going to do the best job he could. That he trusted him more than anyone in the hospital to do it.

 

Our babies were too premature to survive

I was told that I was going to have a spinal block. The stitch would be placed in theatre in case anything was to happen.  If I were to go into labour and it was not able to be stopped I would give birth prematurely to our babies. There would be nothing that anyone could do about it.

I was told that if this were to happen, our babies would be handed to us and we would be able to have the time we needed with them until they passed……

 

Trying not to think the worst

That night, I remember asking my partner what names he liked; he kept asking me why I want to know so badly for. I remember bursting into tears and telling him that we needed to have names for them once they are born and I need to know if we will cremate them or not. My partner told me to relax, try to sleep and not to think the worst, however I couldn’t help it!

7th June. 21weeks + 6 days – The Obstetrician that promised to be there, was indeed there, he calmed me down, spoke to me throughout the procedure and promised that it was all okay.  10 minutes later my cerclage was successfully placed!!!!!!!!!!

Strict bed rest and progesterone

After weekly / fortnightly check ups my cervix was stable.

22 July (28 weeks 3 days) – I complained to my partner that I didn’t feel right, even after a shower and something to eat. We decided to head into the hospital after consultation with them on the phone.  It turns out I was, in fact, contracting.  I had the foetal fibronectin test and my results were a 14% chance of birth within 7 days . I was immediately transferred to the Royal Woman’s hospital in Melbourne, via ambulance after a shot of steroids and still contracting.  After 3 days of no contractions and smooth sailing, my partner went back home (3 hours away) as it all had settled down and I had no obvious signs of labour.

26 July – On day 4, I remember waking in the middle of the night to the worst intense cramps I have ever EVER experienced. I buzzed for a nurse, she took one look at me and said “that is a contraction love, I know one when I see one, I’m phoning the doctors” I was hooked up to a CTG, given pain relief and nifedipine (to stop contractions). Nothing was working, everything was so painful.  They were unable to get a good trace on the CTG as twin A was in a funny position. The nurses contemplated phoning my partner as they were convinced that this was it and I was going be giving birth. After a being examined by the doctors I was not dilating and my stitch was working. I was given more drugs and continued being monitored by the CTG and bed side ultrasound.

Around 9am, everything settled. Contractions slowed right down and I was finally able to sleep.

 

Finally, I was allowed to go home

After 7 days at the Royal Woman’s hospital, we were told that I was able to go back home as my fibronectin test was low – indicating no chances of labour within the next week.

30+6- my growth scan showed some worrying results, twin a was only measuring on the 11th percentile and twin b 51 percentile, Doppler’s were okay however twin A’s cord was presenting lower than twin A was.

31+4 admitted to maternity ward due to threatened premature labour-another 2x shots of steroids administered and contractions settled after a high dose of nifedipine I was sent home

 

Worrying growth scans for both twins

32+6- My growth scan was still worrying for both twins, however we agreed that they were currently safer in the womb then outside! We were told over 3 times by our obstetrician to contact the hospital immediately if I feel any different, even if I am not sure what it is.

By 33+6 I was back in the birth suite with contractions, I was due to see my obstetrician at my antenatal appointment; we were monitored by the CTG machine and given panadeine forte as well as nifedipine. When we met with my obstetrician he told us that he was admitting me into the maternity ward for monitoring as my scan the previous day has showed that the twins were not on the correct percentile and it was decreasing.

My obstetrician was calling a conference with delivery staff, doctors, nurses, paediatricians and the obstetricians.

 

Ongoing CTGs for twins

During my stay in hospital I had CTG’s 2 times per day and an ultrasound every 3rd day to check the Doppler’s on both twins.

CTG monitoring for twins

By 34+6 I was transferred to another hospital, 2 hours away.  This was due my local hospital not having enough beds in the special care nursery.

I was reviewed by the new hospital I was staying at.  It was decided I was to stop all medications, (progesterone and nifedipine).  Plus continue with CTG’s 2x per day and ultrasounds every 3rd day.

35+5 – after my ultrasound the obstetricians decided it was safest to deliver the twins via c section at 36+1.

 

The birth of our twins

15th September. 36+1 – 8am I was wheeled into theatre, where I was put onto a bed and given the epidural.  8:50am my partner entered the room, sat next to me, asked me if I was “doing ok”. I told him I was ready to meet the twins.  The Anaesthesiologist told us that they were currently breaking twin As waters, & then within what felt like two seconds we heard a cry and twin B was born.

My partner was taken over to twin B. He cut the cord and waited with him for 10 minutes while he was checked over.

I questioned where twin A was and if she was okay. My partner had this shocked look on his face while staring into the far back corner. Twin A was being worked on, and had been since she was born.  She was not breathing and was purple.  My partner asked if he could go over there to be with her. Once my partner got to twin A she let out a massive squeal and was finally breathing.

My partner sat with twin B besides my head where I got to give him a kiss and talk to him.

 

 

Twin A briefly came over for around 5 minutes and was taken to NICU.

My partner was able to go to recovery with twin B and give him his first feed. I was then taken to recovery after my being stitched up getting the cervical cerclage in my cervix taken out.

I was able to have around an hour of skin to skin time with twin B before we went back to my room.

 

cervical cerclage                                                  cervical stitch twins

 

My partner spent the day between me, twin b and twin A in NICU- due to her low birth weight of 2.050kgs

Around 7pm that night I finally met my girl, my twin A!! I was able to have skin to skin with both of my twins.  Finally we were all together as a family.

 

 15 September 2017

Estelle Lulu Adams 2.050kgs born at 9.05am

Thomas Michael Adams 2.50kgs born at 9.06am

We spent a total of one and a half weeks in special care nursery to establish a feeding plan.

 

cervical cerclage twins

 

 

 

 

 

 

 

 

 

 

 

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