# 27 weeks, 1 cm dilated, 10% effaced



## BabyMommee (Sep 30, 2007)

Anybody have advice or experience with this? My son was born at 33 weeks. This is my second pregnancy and I've been feeling very confident about listening to my body and felt I would carry to term. Yesterday at a routine appt with my midwife she found I was 1 cm dilated and 10% effaced. Since she's at an HMO she had to consult with the OB - they advised me to go to L&D for observation and steroid injections. It was about 3 hours later my the time I got there and was admitted and jumped through all the hospital protocol hoops. They checked me again and I was the same. I said I would like to delay the steroids unless I continued to dilate. They observed me for 4 hours - I stayed the same - no contractions other than "uterine irritability" (nothing I could feel.) So what the heck does this mean? What should I do?


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## snowmom5 (May 8, 2008)

First, how dire is the situation - by 1 cm, do they mean you are more dilated than a person who's already had one child vaginally usually is (which is often "fingertip" or 1 cm; was there a change from a prior cervix check)? And 10% effaced doesn't sound like a whole lot - was there a length mentioned - are you below 3 cm in length? I'm not so sure I'd be super worried just yet, though it sounds like there must have been a reason to check it in the first place. I assume the check was manual - there are pluses and minuses to each method, but my impression is that the preferred way to check a cervix earlier on in pregnancy is usually by vaginal ultrasound because it can show funneling on the inside that is undetected in a manual exam as well as a more accurate length. Manual is better for showing outside dilation and quality (soft/hard).

What do your providers recommend? Are you contracting regularly, irregularly, or not much that you've noticed? Or, is your cervix just sorta on the "weaker" side? What led to your prior premature delivery? There are a lot of individual things that would affect my advice on what to do.

If the issue is contractions, I'd see about reducing those - whether through rest or what have you. If the issue is a weakish cervix, I'd want to take the pressure off that cervix, and there's only one way - horizontal bedrest.

What about P17 injections (progesterone) to prevent preterm labor - has your provider mentioned those? With your history, perhaps you ought to be on them to begin with.

My story - when I was 27w with twins, I was 1 cm dilated/50% effaced, and contracting irregularly and never frequently enough to call. I ended up on complete bedrest. I still had changes the following week (probably because it was a pretty stressful week and I wasn't yet strict about the bedrest), and had further changes - 1.5 cm dilated, 80% effaced with baby A at the 0+ station - significant pressure. But after that I was strict about the bedrest, up for bathroom only, and I had no further changes until 33w when I p-promed. So for me, getting the pressure off the cervix turned out to be very helpful, in spite of the fact that I was still contracting (though I was contracting less while resting than while being up and about).

good luck!


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## Cheshire (Dec 14, 2004)

Did they do an FFN test? At 30.5 weeks last Friday I was 2cm dilated (not sure if I was effacing or not) and having minute long contractions between 3 and 5 minutes apart. My doc sent me to L&D for observation and to run the FFN test.

If my test had come back positive she was going to admit me and do steroids. But, because it came back negative she said I had a 99% chance of not going into labor in the next two weeks. They gave me a shot of terbutaline (sp?) and procardia in pill form. It stopped my contractions and I was able to go home. She also called in an Rx for procardia to keep me comfortable (I've been having tons of regular contractions since 18 weeks but hadn't had any changes to my cervix until this last time). I went into L&D with contractions when I was around 25 weeks and they did a vaginal sonogram to measure my cervix.

I did a little research and it sounded like the steroids only help with lung maturity for a day or two before an early birth and then if you don't go into labor they might not work the next time??? Not sure if I have that right but something to look into.

Hugs to you, this is really stressful. Sounds like you are asking the right questions. Have you talked to your midwife about seeing a perinatologist for a second opinion?


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## Sarahstw (Jun 18, 2006)

I'm not sure what the problem is exactly? 1cm is not dissimilar to "not dilated" for someone who has had a baby before and 10% effaced could very easily just be the length your cervix always is... We don't *all* have the same length cervix... If you are not having contractions or cervical change you pretty much have no indication of going into labor...
anyhow - I've been 1cm and more like 40% effaced AND my cervix is soft, for 10+ weeks now. I'm hoping it will change soon!


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## BabyMommee (Sep 30, 2007)

Wow, thank you guys for all the ideas. I needed help to get my brain working again!

Snowmom5: Yes, all the checks were manual. I asked them if we should double check with an ultrasound and they said, "Well ... the manual exams are pretty accurate." At my appt on Wednesday I will definitely request an ultrasound exam. I don't want any more manual exams just for the risk of causing some cervical changes. They had been checking my cervix every two weeks just because my son was born at 33 weeks. Somehow I had made it through my pregnancy with him without ever having a cervical check. They were alternating between u/s and manual exams. This was going to be my last cervical check until I got closer to delivery. As far as contractions go, I have had days where I feel "tightenings" that last quite a while. But I just have to go to the bathroom, drink some water, lay down for a bit, etc. and they don't become regular or painful. There has been 3 times during this pregnancy that I have felt real symptoms of preterm labor and I have been able to stop it at home with a few hours of bed rest, lots of water, cramp bark, and once, a glass of wine. The last episode has been weeks ago, though, and I've been doing really well. The day they found out I was 1cm dilated I was having NO contractions, and their monitor confirmed it. They haven't mentioned the word "weak" or "incompetent cervix" yet. They never found out why I went in to labor with my son so early. Looking back, I realize I had been having contractions and preterm labor signs through most of my pregnancy but didn't realize it. I just thought that pregnancy is tough and you buck up and deal with it. One day I woke up and 3 hours later had a son. Now I'm much more aware and listen to my body, so I was (and still am!) hoping to carry this baby to term. I am on the progesterone injections. I started them at 18 weeks. (As a side note the other bad news I got at this visit is that because I am moving outside of Kaiser's coverage area they will not provide me with a prescription to take to my new provider. The midwives at the practice in my new town have already told me they've never been able to get the progesterone injections covered so to be sure and get a prescription before I leave. So now I have to figure out how to deal with this mess too!)

Cheshire: No, I totally forgot about the FFN test. I have an appt with my ob on Wednesday so I will bring that up then. That's a good idea. The thing you said about steroids sounds like it might be right. I need to do more reading on that today. When I started questioning the steroids at L&D the doctor did say that, yes, if I get the steroids now and don't go into labor then they're just going to want to keep doing them anytime something like this happens so it could add up quick. She was supportive of delaying the steroid injections until we figured out if I was going to progress beyond 1 cm.

Sarastw: I thought 1 cm wasn't much to be alarmed about either, especially since I wasn't having any contractions. They told me because I'm only 27 weeks it was a little more alarming than if I was 30 something weeks, but mostly because my son was born at 33 weeks they want to be on the safe side.

Thanks again, guys. I was just feeling lost and like I didn't have a plan of action. Now I feel like I have some ideas to bring up at my next visit. I'll post again when I find out more.


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## BabyMommee (Sep 30, 2007)

Just read this little article: http://www.babycenter.com/404_should...-labor_5437.bc

Sounds like the steroid's benefit is greatest for 7 days, so it makes sense to absolutely have the Fetal Fibronectin Test done before getting the steroids to avoid having to get them over and over.


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## Mamatoabunch (Sep 23, 2007)

That sounds like overkill! I am pregnant w/ my 10th, 28 weeks tomorrow and dilated 4-5 and 75 or more effaced. Been this way w/ my last 5 or so pregnancies. I have checked myself as I am UP. It is entirely normal to be slightly dilated in subsequent pregnancies earlier on, in fact after a mama's first vaginal birth we are never completely closed again.
Why do they even need to check you, the less messing w/ your cervix the better w/ a prior early baby.


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## Talula Fairie (Jan 7, 2005)

Firstly, women who've had a baby before can be 1 cm dilated all the time, pregnant or not. Secondly, 10% effaced isn't much. Your body could easily stay like this for months. Unless you are having other signs of preterm labor, I would not be concerned.


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## BabyMommee (Sep 30, 2007)

Thanks guys. I'll definitely decline all further manual exams. They can pull out the ultrasound to see if I'm dilating or effacing any more. That makes me feel a lot better to hear.


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## Jilian (Jun 16, 2003)

I agree with the others and I'd also have your urine cultured for a UTI. UTIs are a common cause of PTL and early dilation.


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## BabyMommee (Sep 30, 2007)

Ok, so I had my follow up with my OB on June 10th. She checked me again with u/s. Still 1 cm, still 10% effaced, no contractions. I had a terrible time throughout the month of May with allergy-induced asthma which gave me a constant racking cough. My ob seems to think that it was all the stress of the severe coughing that caused me to dilate. She had me cough during the ultrasound and you could see that black line get wide - same thing if I beared down. This was interesting to me because my son who was born at 33 weeks came after I had a cold which turned into a severe cough that lasted for weeks. I kept saying "It feels like I'm gonna cough this baby right out," and I kinda did! She also did a fetal fibronectin test which came back negative. So I felt like that was all really good news and that I was safe with continuing to "take it easy" NOT bed rest and delaying any tocolytics or steroids until something progressed further.

In the meantime ... We've moved. I had my first appt today in our new town at a practice of midwives I've heard very good things about. I was SO hoping that they wouldn't be alarmed by all this and I wouldn't get a big red stamp on my forehead that says HIGH RISK, but it seems like that's what I've got. She wants me on bed rest, Terbutaline, and seen weekly. I left very disappointed. Nothing has changed. I'm still 1cm - no contractions.

I emailed my previous ob today and asked her to give my new midwife a run-down of things until they can get my medical records up here. I'm hoping hearing it from another medical professional won't sound as alarming as a 29 week pregnant woman coming for a first visit dilated to a cm.

I'd love to hear any more advise anyone has. I just can't see bed rest at this point. I need to do more research on Terbutaline, but maybe that would be a good preventative to start soon? I just LOVE being pregnant and hate the idea that any future pregnancies will end up being HIGH RISK and bed rest and NICU and all that junk.


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## boobs4milk (Jun 25, 2006)

i've had preterm babies, so i don't take any of this lightly. when they did the vag u/s they should have given you a number in cm. anything under 2.5 cm cervical length before 34 wks is cause for watching and usually requires bedrest to take the pressure off the cervix.

i'm almost 22 wks, and at 19 1/2 wks i was told my cervix was shortening after some irregular and not really painful contractions. my son was born at 30 wks after PPROM at 26 wks, and my daughter was born at 37 wks after 20 wks of modified (12ish wks) and then strict (8 wks) bedrest. my cervix was 2.2 cm long and 1-2 dilated at 24 wks. i don't know how that correlates to percentages, but i do know it freaked my dr. out!

this time, i'm on the 17P injections (since 20 wks) and procardia. procardia has less side effects than the brethine (terbutaline) and it can be taken for longer periods of time. also, i can go longer on the procardia (6-8 hrs) than the brethine (4 hrs).

i'm on week 2 of modified bedrest. i am up about 1 1/2 hrs per day on average, not all at once, but i do a tiny bit more than just potty breaks. i get myself water or food when no one else can and i sit up to eat dinner with my family but make it quick. it must be working out because today my cervix was the same length as it was 2 wks ago!!!

i hope that you can get things figured out in a way that fits your family needs and situation. i'm on bedrest with 4 kids and 2 stepkids, so i know it's tough! i'll be here for the duration.

just a side note: the ffn test is NOT accurate if done within 24 hours of a vaginal exam, vaginal intercourse or vaginal u/s. if you get the ffn and are expecting to get a cervical check, ask them to do the ffn first. i never could get one because i'd always just had a vag u/s or exam.

good luck!


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## Sarahstw (Jun 18, 2006)

Terbutaline, in my understanding, is a tocolytic ie. it is used to stop contractions. You keep saying that you are not having contractions - so what is the indication for Terbutaline? I don't understand.

I gotta tell you (again) that I too have been dilated one entire centimeter (maybe even 1.5) since somewhere around 26 weeks, my cervix has also been soft and 40% effaced. I'm still sitting here (at 38 weeks tomorrow), having had many BHs (since mid second trimester) and some super mild contractions wishing that it would change already!

I would get a second opinion...


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## Leslie0905 (Jun 21, 2009)

I went to see my Dr. at 32 weeks specifically to get my cervix measured because I previously had a LEEP surgery that removed a portion of my cervix, so I wanted to see what I was up against. I had a hard day at work so was hot and tired. None the less, he was getting ready to do the transvaginal ultrasound but decided to do a physical exam first. He found that not only was my cervix short (baby kicked him in the fingers), but I was 2cm dilated. My cervix is only 1cm in length (REALLY SHORT), so I was immediately sent to the hospital and admitted. I was also having contractions (according to the monitor), although they really didn't bother me. 2 steroid shots later and a prescription for procardia, I was immediately placed on bedrest. I'm at 33 weeks now, and go to see my Dr. on Tuesday of next week, exactly at the beginning of my 34th week. Every situation is different, but in my case I followed my Dr's advise, as any unnecessary pressure on my cervix will lead to an exit. Not to mention, baby girl was breech. I'm praying she has turned around by now, but will know for sure next week


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## BabyMommee (Sep 30, 2007)

At my last appt my midwife wanted me to go to the hospital some time this week to be monitored for contractions just to make sure I wasn't having any that I wasn't feeling. I decided to go in the middle of the day when I had been on my feet enough that I was feeling tight and ready to lay down. I had to park far away from L&D and go up stairs so by the time I got there I was definitely feeling a tight uterus. I was monitored for almost two hours and it showed no contractions (still just slight uterine irritability.) They told me there that it sounds like just taking it easy and listening to your body is all that should be needed at this point. I'm SOOO hoping that my new midwife will feel the same way at my appointment next week. I've been feeling great and have been doing a good job taking it easy so hopefully my cervix is still the same. Thanks for all your advice and stories, mommies! It helps to hear from you.


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