When you're pregnant with twins, your doctor or OB-GYN will tell you your pregnancy is considered high-risk, and depending on what type of twins you're carrying (Dichorionic/Diamniotic (Di/Di), Monochorionic/Diamniotic (Mo/Di), or Monochorionic/Monoamniotic (Mo/Mo)), that level of risk could be elevated even more.
When you're carrying multiple babies during a single pregnancy, there are a whole bunch of extra conditions you need to be monitored or keep an eye out for, from preeclampsia, to gestational diabetes, to placenta previa, to subchorionic hemorrhage, to intrauterine or fetal growth restriction, twin-to-twin transfusion syndrome, and more.
One lesser known condition you should watch for is a shortened cervix (also called an insufficient or incompetent cervix), which is more common for those who are carrying twins or higher-order multiples than for those who have a singleton pregnancy.
When they told me I had an incompetent cervix, it made me feel like my body had failed my babies. But I'd actually done the exact opposite by sharing the odd and almost imperceptible symptom I'd had a few days before my 27-Week maternal fetal medicine assessment.
I experienced this first-hand when I was pregnant with our twins. Use the slider on the picture below to see the change from three months' gestation to eight months' gestation.
When they told me I had an incompetent cervix, it made me feel like my body had failed my babies. But I'd actually done the exact opposite by sharing the odd and almost imperceptible symptom I'd had a few days before my 27-Week maternal fetal medicine assessment.
If I hadn't piped up, they told me I very likely would have gone into preterm labor by the time I hit 30 Weeks.
The technician had done measurements for both babies and was just wrapping up our appointment when I mentioned, off-hand, about something subtle that had started three days prior and was nagging at my first-time-mom-brain.
When I woke up a few days before, I noticed the top of my uterus felt fairly tender. The sensation was new, so I paid attention to it throughout the day and noticed it was getting progressively more sore throughout the day. It seemed like it was more than just getting bigger as my babies grew.
I felt fine otherwise, had a ton of energy, and noticed lots of movement from each baby, so other than having a rough time sleeping and getting comfortable (what else is new, when you're closing in on your third trimester with twins?), nothing else seemed off.
The next day, the top of my uterus still felt very tender, and now it was almost sore. I assumed it was ligament pain from the major growth and stretching I was experiencing on the inside as both babies started to pack on the pounds.
I had an appointment scheduled for the next day, so since everything else felt okay and both babies were still very active, I chose to wait until I could talk to my medical team. I'd taken notes for a few days, so I could accurately describe what I'd been feeling and how long it had been going on.
The most accurate way I could describe it was as a tenderness along the top of my belly with a slight, barely-there burning sensation that would come and go.
The most accurate way I could describe it was as a tenderness along the top of my belly with a slight, barely-there burning sensation that would come and go.
When I was done explaining, she took a closer look at the sonogram and told me my cervix was looking short and that it concerned her.
She immediately went to bring the on-call doctor into our exam room, so she could perform an internal exam.
After the exam, the doctor agreed with the nurse's assessment: I had an incompetent cervix. They explained what that meant.
So, what exactly is a short cervix?
A short cervix is one with a cervical length between 15 and 30 mm between 18 and 26 weeks' gestation. This shortened length can lead to spontaneous preterm delivery before 37 weeks' along, and the risk of even more premature delivery increases the shorter the cervix length is.
According to the Mayo Clinic, "an incompetent cervix happens when weak cervical tissue causes or plays a part in a premature birth or the loss of a healthy pregnancy. The cervix is the lower part of the uterus that opens to the vagina. Before pregnancy, it's usually closed and firm. As pregnancy goes on and you get ready to give birth, the cervix slowly changes. It softens, gets shorter, and opens. If you have an incompetent cervix, it might begin to open too soon (before 37 weeks' gestation), causing you to give birth too early."
Beyond spontaneous preterm birth (half of all women who are pregnant with twins deliver preterm), an insufficient cervix that goes unnoticed can lead to miscarriage, which is why it's so important to share any weird or new symptoms you might experience, as small or silly as they may feel, with your doctor, OB-GYN, or fetal assessment team.
Some symptoms include feeling pelvic pressure, a new backache, mild stomach cramps, a change in discharge, or light bleeding. I had none of those symptoms. All I had was a slight burning sensation near my ribcage, and a bit of tenderness that popped up out of nowhere.
I had no idea that my off-hand comment would result in my husband and I sitting in a family conference room at the hospital, waiting to discuss next steps with the doctor and our fetal assessment nurse.
I had no idea that my off-hand comment would result in my husband and I sitting in a family conference room at the hospital, waiting to discuss next steps with the doctor and our fetal assessment nurse.
That, at 27 weeks' along, we would find out that me having a short cervix meant I was already three centimeters dilated, and that, as a result, our twins could be born basically anytime.
They didn't expect it to happen that week, but they suspected it was certainly possible anytime after the following week.
This meant I'd need more frequent monitoring, so they could give our babies steroids within the week they expected them to be born, to give them the best chance after a preterm birth.
This was scary news for us as first-time parents to a set of twins, knowing that they only weighed about one pound each at that point.
How can you treat a short cervix?
When you're pregnant with a single baby and you happen to have a short cervix, the suggested course of action would be doing a cerclage stitch to close the cervix.
But when you're carrying twins, this surgical procedure is much higher-risk and can't be done beyond a certain week of gestation. Studies also show the results vary when done and that it's not necessarily as effective in keeping the cervix closed when you're pregnant with twins.
The safer course of action for a mother carrying multiples is starting on a daily dose of progesterone tablets to try to prevent or delay delivery and keep the cervix closed as long as possible.
My doctor told me that I shouldn't take it too easy (read: no bed rest, at least in my personal case) because doing so could cause blood clots and could also decrease my endurance for labor, so I kept up with my normal activity, as long as I felt okay, which I did.
My team expected I could last one, maybe two more weeks. Thanks to the prescribed progesterone, I carried our twins for another six-and-a-half weeks.
And when I needed to be induced, it wasn't actually because of the short cervix issue—it was because of a separate growth restriction issue we'd known about and that our medical team been monitoring for several weeks by that point.
Side effects of progesterone pills during pregnancy
While progesterone tablets can potentially help your babies stay in utero, so they can develop longer, there are some side effects you might notice for yourself, as the mother.
In my personal experience taking progesterone while pregnant with our twins, about 10 days after starting the medication, I experienced some symptoms that led me to think I could possibly be going into preterm labor.
I had a few twinges of discomfort in my lower pelvic region on one side. They didn't last long. Then, it happened a third time and extended down into the leg on the same side I was feeling the discomfort. A little while later, it happened a few more times. Changing positions from standing to sitting to lying down didn't change what I was feeling.
The next day, I experienced similar discomfort accompanied by slight cramping that intensified enough that I had to breathe through the sensation. Again, changing positions didn't seem to make a difference. This bout lasted about 30 minutes in all, with varying degrees of discomfort, before subsiding altogether. After that, all I experienced was slight nausea and the odd twinge of discomfort.
After sharing this with my OB-GYN, she confirmed that what I'd experienced with a side effect of the medication I was on for my short cervix. I was glad to have her professional opinion to put my mind at ease as I neared the end of my pregnancy with our twins.
Always listen to your body
You know your body best. If something feels weird or off, bring it up to your physician. Even if it seems small or insignificant. Even if you assume it's just part of a regular pregnancy.
Because it might not be. And it's always better to err on the side of caution.
If it's urgent (or you're not sure), it's worth the trip to triage to make sure everything is okay.
Someone who's carrying twins or higher-order multiples is at a higher risk of experiencing a short or incompetent cervix than someone who's carrying a single baby.
A short cervix that goes untreated during pregnancy can result in preterm delivery of their babies or even miscarriage.
While there are symptoms of an insufficient cervix, some people experience no symptoms at all.
It's a good idea to ask your fetal assessment team to check your cervix at each appointment. They should do this as part of the appointment, anyway.
Mention you heard there's an increased risk of having a short cervix when you're carrying twins and that there aren't always noticeable symptoms. Ask for their thoughts on what to watch for. You'll never regret being doubly-sure than never asking.
If you do have symtpoms, or if you notice something slightly off or out-of-the-norm, even if it seems minor or like "just a regular twin pregnancy symptom," bring it up to your OB-GYN or maternal fetal medicine team as soon as you can.
They can weigh in and offer their expert opinion and medical intervention, if needed, to make sure things are progressing as they should with your twin pregnancy.
Did you have a short cervix with your twin pregnancy? What intervention did your medical team suggest in your particular case? Did you still deliver preterm? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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