Ultrasound number 5, we get the bad news – Friday 16 March – 24 Weeks

The two and a bit weeks since the last ultrasound seem to go by very slowly.  We read all we can about a shortened cervix.  Jay has had another visit with Bec at the maternity clinic in the mean time.

“It is very very rare for a girl of your age to have a shortened cervix without any underlying causes.  Causes we would look for are any trauma to the cervix either through treating cervical cancer, or perhaps some infection.  You have had neither.  It is also very rare to have this kind of thing with your first pregnancy.  I am inclined to think that this may just be a case of you having a short cervix and that it isn’t a shortening cervix at all.  It’s just an anomaly of you and nothing to worry about at all.”

We are tentatively relieved to hear this.

“I have arranged for another ultrasound for you next Friday.  We will keep monitoring the cervix, just to make sure.”

The Friday arrives and Jay and I make our way to the ultrasound room.  Jay is called in and is mortified to find that a (quite cute) male sonographer will be performing the ultrasound.  It is a vaginal ultrasound as well.  A female nurse enters the room.

“This is Helen.  She will be here whilst I perform the vaginal ultrasound.  You are not allergic to latex are you?”  Jay shakes her head.  “Okay, I am just looking at the cervix today so this will be very quick, but before I do that, I am going to take a look at baby.”

The wand is swept over Jay’s tummy.  There is Baby C, head down.  “He is very low in the pelvis.”  I am not sure if this is a good sign or not.  “All looks good, now we are going to check the cervix.”  As soon as he inserts the wand, I know that something is wrong.  “I just have to step out and get a doctor, okay?  I’m going to leave the wand there.”  Jay nods nervously.  She looks at me.

The sonographer steps out of the room.  “It’s 1.1cm, Mum.”

“Are you sure?”

“Yes, I saw it on the screen when he measured it.”

A doctor enters the room.  “Hi, I’m Dr G and I am a consultant radiologist here.  Right, let’s take a look.  Oh, yes, definitely short in the cervix.  I’ll let Bec know.  When are you seeing her next?”

“Today,” I say.

“Brilliant.”

We leave the room and make our way around to Clinic D, the maternity clinic.  Our appointment is for 11, but at 12pm, we are still waiting.  Eventually, Bec calls us into her room.  The softness and sympathy in her face tells me that something is very wrong.  She places a hand on Jay’s knee.  “I am sorry to say it is a shortening cervix and your cervix is very short.”  Jay looks petrified.  Tears well up in her eyes and I can see she is fighting them back as hard as she can.  “This does mean you are more likely to go into early labour.  But at 24 weeks, which you are tomorrow, the baby is considered viable and will be resuscitated.” Oh, that makes us feel so much better.

Immediately my mind is reeling.  What does this mean, what are the survival rates, what about disabilities?  I have a thousand questions.  Jay is just sitting with her head down.  “What is going to happen?” I eventually ask.

“Well, we have found that in cases like this, the outcome for the baby is no better if you are at home or in hospital, so what I suggest is that Jay go home and stay with you where she can get some care.”  Jay nods.  “Also, get as much rest as possible.  Bed-rest is indicated, but again it isn’t proven to improve the outcome.  If baby is going to come, he’s going to come.  But it doesn’t do any harm not to give gravity any help.  Also, I am going to prescribe some progesterone pessaries as they have been proven to improve the outcome for these cases. You need to take one of these each night.  You insert them into the vagina, Jay, like a tampon.”

“What about a cerclage?” I ask.  I’ve been doing my homework.

“It is too late for Jay now.  Even then, they are controversial.  They are not really proven to improve things, although I am sure the many women who have had them would beg to differ.”

Bec leaves the room to call someone from the Young Women’s Clinic.  I look at Jay.  Her eyes fill up with tears.  My heart breaks into a thousand different pieces.  This is all wrong.  A young girl of her age should not be going through this.  “Look at me, Jay.”  She doesn’t move.  “Jay, look at me.”  She raises her eyes.  I put my hands around her face.  “We will get through this.  No matter what, we will get through this.  So, we make sure you are on bed rest and that we do EVERYTHING possible to keep that wee boy inside of you for as long as possible.  You heard Bec, babies are viable at 24 weeks and you are there already.  That means that they have the technology and means to fight for your baby.  We will get through this.”

Bec comes back into the room with Ally.  “This is Ally from the Young Women’s Clinic.  She will also be involved in your care from now on because of your age.  You will get counselling and you will get other help.”  I am sensing a team of specialists are being put together.  “So, what I want you to do is to come back in two weeks time.  You will be resting as much as possible and then we will do another ultrasound in two weeks.  After that we probably won’t do another ultrasound as the information that it gives us won’t really alter the outcome.  We don’t want to irritate the cervix unnecessarily.”  I nod, but I don’t see the logic.  “Jay, every day now that the baby stays inside of you counts.  With each week that passes, its chance of survival increases by 50%.  We are aiming to get to 28 weeks, that would be fantastic.  After that we aim to get to 32 weeks.  50% of these cases do go to full term or in the late 30s, so you are still okay.”  Jay nods.

The walk back to the car is a sombre one.  No hot drink and food stop for us.  Just straight home.  We devise a plan.

“Mum, I don’t want to stay with you without seeing Em.”

“Okay, how about you stay with us Monday to Thursday nights and then I take you home on Fridays to spend the weekend with Em and then pick you up again on Mondays. That way, someone is always with you.”  Jay nods – it’s a good plan.  “So, do you want me to drop you off at home now?”

“No, I want to come home with you.  Em can pick me up later.”  I understand.

We text the people that need to know and our phones start buzzing.  When we get home, I make Jay comfortable in the chair that I normally sit in – the chaise part of the settee.  I make her a cup of tea and put together a box of activities for her – colouring in stuff for her artistic bent, reading material, etc.  It is going to be a hard couple of weeks, but very worth it if the plan comes together.

Come on Baby C, you can do it.

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