Thursday, January 7, 2010


Before I start this post I this post I want to make a few points clear. I am not in the medical field. All of the information I post is based on my own experiences, information from my doctors, and my own private research. It is not intended to be medical advice, nor to replace your own research. It is simply just for the sake of knowledge.

After we lost Mason there was numerous opinions on what route would be best to proceed for us in the event of another pregnancy. My OB that I had at the time we lost Mason was very blunt and said that he felt that if I had a trans-vaginal cerclage I would just break through it and lose another pregnancy. Just as a refresher, the TVC (trans-vaginal cerclage) is a band or a stitch placed at the top of the cervix during the pregnancy through the vagina and is in most cases removed before labor begins. There are many studies on the TVC that show varying success rates from 75-85% for a singleton pregnancy. The rate is even less for twins. There are many possible complications from infection causing pre-term labor to the cervix dilating through the stitch tearing the cervix. This is what my OB was afraid of in my case. He referred me to the fertility clinic that we had used to concieve in for a consult on the TAC(trans-abdominal cerclage).

At the consultation, the Fertility specialist said that they don't usually do a TAC until a TVC has failed. In my case I was so dilated with Mason that a cerclage was not possible. He also stated that he did not feel that I needed to go as extreme as the TAC and referred me on to a perinatologist. The peri I saw happened to be the same specialist that was called in to consult when I was in the hospital with Mason. She is the woman who told me my cervix was too dilated to do an emergency cerclage and held my hand and cried with me when she told me there was nothing that could be done to save Mason.

I went to my appointment with her to gain more information. She is a very by the book person. She told me that she would not do a TAC without having a TVC first except in cases where part of the cervix had been removed for cancer. She went on to tell me that she was not even sure that I had IC, she was wondering if my clotting disorder caused the loss of Mason. I left feeling very frustrated and went home to do my own research.

In case you are wondering what the big deal is about the TAC I will explain it. Basically, it is major abdominal surgery with recovery compared to a c-section. In layman's terms they make an incision and then using a stitch or a band, they permanently attach the bottom of your uterus to your cervix. That way there is essentially no way for the cervix to dilate. For those of you wanting more medical explanation here is a copy of some of my research.

All procedures are performed with the type of abdominal incision decided based upon the size of the uterus and maternal body habitus. The uterus is usually pulled out of the mother's body and maintained moist with warmed saline. The procedure requires removing the bladder from the cervical area while tunnels are created near the uterine artery on each side. A mersilene band (a polyester suture) is placed around the upper portion of the cervix and tied in a square knot tightly enclosing the cervix which is not removed after the pregnancy. Because many fragile uterine veins are in this area, the most common complication is bleeding. Methods of stabilizing this bleeding depend on the situation and anatomy, while avoiding compromise of the supply of blood to the uterus. In recent years, perioperative treatment with indomethacin has been used for a total of 48 hours, as a uterine relaxant. Indomethacin is a drug that belongs to the family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin reduces pain, fever, swelling, and redness.

Prenatal care following the procedure would also include cervical exams every two weeks, careful attention to signs and symptoms of preterm labor (with aggressive use of tocolysis if labor persists) and planned delivery by cesarean as soon after 37 weeks as fetal lung maturity can be documented. Because of the latter intervention tactic, 37 week delivery is considered “term” for the purpose of our follow-up information.

As you can see the TAC means an automatic c-section as the stitch is intended to permanently stay in place. It is usually done before pregnancy, but can be done early in the pregnancy as well. Doctors only like to do it as a last resort because it is such major surgery. It is very frustrating to the women involved because often times the woman has to have multiple losses before a doctor will go to this length.

I did go on to have a twin pregnancy with a TVC and I made it to 35 weeks. They are healthy now, but I also did full bedrest from 11 weeks on and I still was dilated to the stitch at 22 weeks. It almost went south and it has done so for many of my IC sisters.

If you want more information on the TAC here is a link to a yahoo group devoted to it. It is called Abby Loopers and it is a great place for information and support.