September 22, 2008

Abdominal Cerclage

Last night, I took care of a patient that had an abdominal cerclage placed when she was 14 weeks. This was the first time I'd ever heard of such a thing. I obviously know about the usual cerclage, but this was different. If I understood right, it can be place before conception or afterwards. And it is permanent so she'll have to have a c-section. She'd had 2 second trimester losses, an incompetent cervix and a failed cerclage previously, so she went to a large university hospital to have an abdominal cerclage placed. Now she's 35 weeks, so apparently it works. Anyone else know much about these? I'd like to ask one of the docs about it or research it a bit, but I didn't have the time last night. It sounded like it's fairly new, and the patient said the doc who placed it said it seems to work much better at maintaining a pregnancy when there has been evidence that prior pregnancies were lost only due to cervical incompetence. I'm guessing it's a newer thing? But, like I said, I'd not heard of it. None of us working had. My imagination dreamed up this image of the doc making the incision, taking this big honkin' rope and just tying it around the lower part of the uterus, above the cervix, kinda like tying up a garbage bag. I've got a vivid imagination, but actually it sounds like that's sort of what they're doing. I'm curious to learn more.

On a side note, I remember my first patient who delivered before viability at 21 weeks. I bet I'll always remember how that night went, her doc, her name and he little son's name. She has since gone on to have another baby and she came in last night for a labor check with her 3rd baby at 38 weeks. I had bonded with them when she was hospitalized on bedrest. She had been 3 cm at her 20 week sono, and so she spent about a week or so on strict bedrest to try to get her to viability. I was just off orientation and pregnanct with Clara but not showing much through scrubs. She hadn't been contracting, denied any pain at all. She called at one point because she felt wet. Her water had broke. Her doc said to just watch her, because there wasn't much we could do. She told me she needed to have a BM, and I was filled with dread, worrying that it really wasn't stool she was feeling. So, I gave her the bedpan. She hit her call light within a minute or two and the look on her face gave it away: she was delivering. He was born alive, perfect, but not ready to be out of the womb. At first, she didn't want to see him. It was shock I think, but when she realized he was still alive and that she could keep him warm and next to her as he passed, she decided she did want to hold her son. She and her husband had about 2 hours with him. I saw her the next a.m. and they showed me pictures. We all had a cry together. I had typed up this beautiful poem I found on thick paper and had it laminated, which she still carries in her purse, which she showed me last night. I remember when she had her second son 2 years later. And it's was again great to see her pregnant and due anytime.

45 comments:

Goofy Girl said...

I've rotated with a doctor who does them and they are really neat. :) I think that they generally work pretty well for women who have had 2nd tri losses. It is by far the coolest thing to reach in the incision and hold that uterus once the cerclage has been placed. The way the physician I rotated with did it - it was like a band around the cervix. People came from other countries to have them placed too - or from across the country.

PS I found your blog thru google reader and have been enjoying it!

Fertilized said...

my childhood next door neighbor has had three 2nd trimester losses. she did have a cervical cerclage but i am going to ask her if the dr's mentioned this for next time

Prisca said...

Wow, haven't heard of this! Thanks for the info-will have to check into it!

AtYourCervix said...

I'm pretty sure it's called a McDonald's Cerclage.

mitchsmom said...

I was curious so I did some digging.

I found Abbyloopers.org:
"A non-profit organization which exists to raise awareness about the
Transabdominal Cerclage as well as to educate and support women
diagnosed with Cervical Insufficiency, otherwise known as Incompetent Cervix, and to provide resources
for medical professionals."

This page explains the abdominal cerclage (McDonald's cerclage is the most common "regular" vaginal cerclage that we are more familiar with):
http://www.abbyloopers.org/faq.htm

Interesting! Thanks for bringing up the topic :)

Anonymous said...

Hey, i have a transabdominal cerclage (TAC)placed pre pregnancy and now have a 11 month old to show that they really do work!! McDonalds or shirodkar are placed via the vagina and exposed to the vaginal flora and have a higher rate of getting infection. The TAC is placed in the abdominal cavity at the top of the internal os and IS permanant. Mine was placed at the University of Chicago hospital by DR. Arthur Haney. Abbyloopers is a wonderful site and has 100s of real success stories. Here is a link to the hospital site: http://www.uchospitals.edu/specialties/obgyn/cerclage/

It is terrible so many women have to lose 2 or more babies BEFORE they are even considered a canidate for the TAC. Luckily i found abbyloopers after my 1st loss and contacted Dr. H and was a canidate because i had had a c/s 1st pg. I would also think patients undergoing IVF with CI may want to go this route because of the higher rate of twins etc. Also worth mentioning i had NO BEDREST or restrictions. I don't think it is that NEW, i just think women are more informed now and are stepping up stating what they want. A retired GP once told me that 35 years ago he was taking a small strip of leg/thigh muscle and threading it around the cervix, how cool is that??

LDRN said...

Sorry I'm a little late to this one, but I have heard of these & they are excellent!!! I have only had one at my hospital, but I'm excited to see them become more popular!

Jody said...

Wonderful post girl..sorry I'm so late in finally getting a min to read lol.

Yes early losses are so hard...esp when they're born alive. Heartbreaking. We as nurses are such a source of support at this time tho..and I think we have to count it a blessing.

I too made a poem to hand my pts. after delivery. Haven't thought about doing one for the losses...good idea.

Keep it up!

Kara said...

Very very different from a McDonald. I also have a transabdominal cerlage placed by Dr. Haney. I never experienced a loss but had extenisve cervical surgery and was told I would never be able to carry to term. Thanks to the TAC and Dr. Haney..I have my babies, both born FT at 37.5 weeks and 38 weeks.

I'm a moderator at abbyloopers and would be happy to answeer any questions.

Anonymous said...

I HAVE HAD 3 LOSES AND WANT MORE CHILDREN I WILL BE TRAVILING 2 GALVESTON 2 MET A DR. 4 AN ABDOMINAL CERCLAGE. ONLY THING I WORRY ABOUT IS I'M 40 ALREADY. I DO HAVE 2 BOYS 1 WAS FULL TERM AND MY CERVIX DID'NT DILATE WITH HIM AND AFTER THAT MY CERVIX WOULD'NT HOLD I HAD A BABY GIRL AT 20 WEEKS SHE DID'NT MAKE IT AND N 2000 I HAD A 26 WEEK OLD BOY AND HE IS HEALTH AND 4 WEEKS AGO I LOST A BABY BOY AT 17 1/2 WEEKS ITS SO HARD BUT I WANT 2 HAVE MORE CHILDREN SO I WAS TOLD OF THIS DR. SO I'M GO 2 TRY C WHAT SHE SAYS

joanna said...

thanks so much for your great blog. I have been tryng to get on to the Abbyloopers site but am not having any luck. Can anybody tell me if TAC works better placed prior to conception or are the results the same if placed during pregnancy? I am living in South Africa and have an appt with a Gynae who places TACs vaginally. Could that be right? I was told this by the obs who referred me to him. I have 2 children and had a LEEP which was botched up by the surgeon and had to have 2 further ops to correct it. With the result that I am left with a cervix of 1.6cms. Can anybody tell me how much it costs to get the TAC put in in the US? I will travel if I cant get anybody to do one here.

Anonymous said...

I had a transabdominal cerclage in 1999. I carried my daughter til 34weeks and she is a healthy beautiful 9 year old now. Back when I had it done they were very rare, but I am seeing and hearing about them more often.

logan & amelia's mom said...

I have had 2 send trimester losses. First at 20 weeks was dx with incompetent cervix. Was pregnant again 2 months later. Had McDonald cerclage placed at 14 weeks. At 22 weeks had funneling and buldging membranes. The cerlcage failed and I delivered my daughter. i've talked to a perinatoligist about a Shridokar cerclage but am intrested in abdonimal cerclage. Has anyone had a Shridokar?? are most of the abdonimal cerclages placed prior to pregnancy??? what to expect after the surgery??

joanna said...

I have just had a shirodkar placed prior to pregnancy. I have NO cervix left after surgery a few years ago, but the shirodkar gave me an extra 1cm in length. Even with this I will have to be scanned every 2 weeks from 20 weeks and might need bedrest from 30 weeks. My OB did not want to place a TA cerclage as he says it is associated with too many complications. They have excellent results with Shirodkars. I hope this helps.

Anonymous said...

Did you have any complications with the shridokar cerclage? Any bleeding or bladder problems? I would like to have the cerlcage placed prior to pregnancy. Do you have any children already or prev. preg.?

Anonymous said...

I had an abdominal cerclage done at 12 weeks gestation. I didn't have previous miscarriages but had a previous surgery to remove a uterine fibroid. The fibroid was so big that the Dr. had to cut my cervix to remove it, hence, it left my cervix "incompetent". I never knew I would need an abdominal cerclage until I was already pregnant. Luckily I had a wonderful OBGYN who referred me to another excellent Perinatologist. He decided that I was a good candidate for the abdominal cerclage. My daughter was born at 39 weeks - a happy, healthy perfect baby. She's now 22 months old - and is doing wonderfully.
I never needed to be on bedrest but did take it easy during my pregnancy.

Shellbell said...

I am currently at 23 1/2 wks after an abdominal cerclage. Would love to here others experiences with the process. I am always scared/worried about new pains especially through the back. Does this fear of another loss ever go away? I would love to hear advise from others who have gone through this.

Anonymous said...

I'm posting from a hospital in Boston where my wife received an abdominal cerclage this morning. We've experienced 2 2nd trimester losses and praying this is the answer. Thanks for your blog and good luck!

Anonymous said...

I wish you and your wife much success. I will keep you in my prayers.

Lacey said...

My doctor has told me that I will be having an abdominal cerclage,due to us loosing our first beautiful baby girl at 23 weeks from incomp cervix... the surgery is suppose to happen in about two weeks. she has not decided if she will do it herself or send me to Dartmouth or Boston.
Im so nervous and I hope everything goes well, I am curious on how exactly the procedure will be done, will they make the incision in the same place as my last emergency c secion? and in that case when I become full term will they then again cut the same incision? Im also wondering how long is the hospital stay and are you normally on strict bedrest afterwards?
thankyou all soo much I would appreciate any input..

Lacey said...

My doctor has told me that I will be having an abdominal cerclage,due to us loosing our first beautiful baby girl at 23 weeks from incomp cervix... the surgery is suppose to happen in about two weeks. she has not decided if she will do it herself or send me to Dartmouth or Boston.
Im so nervous and I hope everything goes well, I am curious on how exactly the procedure will be done, will they make the incision in the same place as my last emergency c secion? and in that case when I become full term will they then again cut the same incision? Im also wondering how long is the hospital stay and are you normally on strict bedrest afterwards?
thankyou all soo much I would appreciate any input..

laxmi said...

My name is Lax, I had 3 miscarriages (2nd tri) in a row and no live baby till now. Could you please go through below my details and let me know the best perinatoligst and OBGYN any where in US who had great experience in abdominal cerclage and recurrent miscarriages in 2nd tri (14 to 16 weeks). I am ready to move anywhere in US for a baby. Thanks in advance.

1st miscarriage:
Date: 08/20/2007
When I was 17 weeks 5days pregnant, water broke in the midnight with out any pain, cramping or bleeding. I went to ER immediately, at that time baby is alive but the doctor suggested inducing labor due to lack of water (sac) and doctor said my cervix is not open.

2nd miscarriage:
Date: 07/26/2008
When I was 14 weeks 3 days pregnant, Water broke in the early morning with out any pain, cramping or bleeding. I went to ER immediately, at that time baby is alive but the doctor suggested inducing labor due to lack of water (sac) and the doctor said my cervix is not open. Pathology report shows normal.

3rd miscarriage:
Date: 08/22/2009
When I was 14 weeks 5 days pregnant, I noticed pink color (White and red mixed) discharge in the early morning. I went to ER immediately, in the ultrasound they found baby heart beat is normal but my cervix is dilation 3.5 CM and the baby (water bag) came down to the cervix. Perinatologist said it is not possible to do the cerclage at that time and recommended inducing labor. My water bag didn't break at this time and the baby delivered in Sac. Pathology report shows normal.

During 3rd pregnancy, Perinatoligist had given Prometrium till 13th week and dilute shots per week after13th week.

Mzz Albor said...

Hi, i recently had the abdominal cerclage placed in August 21,2009 at 12 weeks in ucsf San Francisco with Dr. Parer i was reffered by my OBGYN after 3 losses and im now 22 weeks pregnant with a baby boy and evertything is going great. im on bedrest since the incision just to be in safe side but i really reccomend this procedure to women with IC. i pray for evrything to go well bcuz i still suffer with the fearof lossing my baby boy.. take care everyone,,,,

Carrie said...

I am 13 weeks pregnant with 2 previous 22 and 23 week losses. I just went in to have a regular cerclage put in today and the doctor was not able to get enough cervix to do it. I am now in the process of deciding whether or not to get an abdominal cerclage done. I think I will but where to go. I am thinking either Dartmouth, Burlington or Boston. Any advice? The docs are pretty much leaving the decision upto me. Thanks.

tamlmitchell said...

I am 20 weeks and has an abdominal cerclage placed 4 weeks ago. I have only had one 2nd trimester loss but have no cervix left after 3 surgeries to remove precancerous tissue. Everything is going great so far. The baby is healthy and growing great. We just found out that it is a girl. I am stil having lots of pain from the surgery. I know t is major surgery, but I didn't figure this much pain for 4 weeks out. Is there anyone else who has had a TAC and had this much pain?

Just Do It!!!! said...

Well, I know my response is a couple years late, however, I had to post. I just celebrated my 3 year old twins birthday two days ago and they were a result of a successful Transabdominal Cerclage. I had two previous losses prior to the procedure. Another set of twins and my daughter. With my daughter, I had the cervical cerclage and it didn't even work. The TAC was the best thing I could have ever done. Even though it is permanent, due to my past history and age, I chose to still tie my tubes. Didn't want anymore children. The two miracle babies (what I call them) are just enough. Anyone contemplating this procedure should just do it. You will not regret it.

Anonymous said...

I had mine after losing 5 babies 4 with vaginal cerclages. You can't go wrong with this procedure. My daughter is 17 now. This is an old procedure that appears to have fallen from grace for some reason, but it works wonderfully. Dr. Monks in Austin TX performs them.

Anonymous said...

Hi my name is Tashana I live in NY and have suffered two miscarriages 16weeks last year June 17 weeks this September 7th with an McDonald Cerclage. I was told by high risk doctor that I have to have an abdominal cerclage with my next pregnancy. Just looking for an excellent doctor NY can anyone give me any referrals. I'm scared because one cerclage has already failed me:-( any help will be appreciated

Tonia said...

HELLO MY NAME IS SHATONIA, I STARTED TO HAVE CHILDREN AT THE AGE OF 24. I AM NOW 3O YEARS OLD WITH NO CHILDREN. I LOST SIX BABIES IN DIFFERENT REASON, BUT MY MAIN PROBLEM WAS HOLDING HIM IN UNTIL FULL TERM. I TRIED CERVICAL CERCLAGE TWICE AND DIDN'T WORK SO I WENT TO HIGH RISK DR WHERE SOME FRIENDS WENT WHO I KNEW. I'M NOT PREGNANT, BUT THIS PAST MONDAY I HAD ABDOMINAL CERCLAGE PLACED. I STAYED IN THE HOSPITAL FOR TWO DAYS AND CURRENTLY AT HOME RESTING. I HAD SMALL BLEEDING, BUT NOTHING SERIOUS TO BE WORRIED ABOUT. THE ONLY PAIN I FEEL IS THE HEALING PROCESS. YES I WAS SCARED AND I PRAYED FOR GOD TO SUPPORT ME AND GIVE ME A HEALTHY BABY. THE DOCTOR DIDN'T TELL ME I WAS GOING TO BE ON BEDREST, BUT I WILL BE TAKEN SHOTS CALLED PROGESTRONE AND NOT THE SUPPOSTORIES. THE DOCTORS WILL NOT GIVE YOU THIS TYPE OF SURGERY UNITL YOU HAD MANY LOSES, SO I WOULD RECOMMEND MCDONDALD CERCLAGE AND PROGESTRONE SHOTS FOR WHOMEVER HAD THREE OR MORE LOSES. IT HURT WHEN YOU LEAVE THE HOSPITAL WITHOUT YOUR BABY, BUT I ALWAYS THINK POSITIVE ABOUT THE OUTCOME IT COULD OF BEEN. MY FRIEND HAD THE SAME AND SHE WAS PREGNANT SO SHE STAYED IN THE HOSPITAL FOR TWO DAYS AND WAS ON BEDREST FOR TWO WEEKS AND SHE SAID THAT SHE WAS SORE THAT LONG. HER BABY BOY WILL BE ONE YEAR OLD IN NOVEMEBER WITHOUT ANY HEALTH ISSUES. I'M NOT A DOCTOR, BUT I HAVE BEEN IN YOUR SHOES JUST REMEMBER TO ALWAYS KEEP A JOURNAL ON EVERYTHING THAT HAPPEN TO YOU DURING THE PREGNANCY, DON'T GET EXCITED TO QUICK, KEEP FAITH IN GOD, AND RESEARCH YOUR QUESTIONS AND ASK THE DOCTORS AS MUCH AS YOU WANT BECAUSE YOU PAY THEM. GOOD LUCK!!!

Kristin said...

Dr. Haney at the University of Chicago does the Transabdominal Cerclage (TAC). He is very well known. After two losses and a failed vaginal cerclage, I will be having the surgery with Dr. Haney in Dec.

A+ PROCEDURE! said...

I had one January 26th, 2011@ 14 weeks gestation and gave birth to triplets June 28th, 2011 via c-section. My babies all weighed over 5lbs when they were born. It's a GREAT procedure and highly recommended.

Anonymous said...

Laxmi,

try http://www.abbyloopers.org/resourc.htm

Anonymous said...

Hello...I'm pleased to have read these comments..I'm at ease. On sunday I'm traveling to houston, to attend an appt for abdominal cerclage procedure...I am 11 wks pregnant with history of two 2nd trimester losses including one with a failed cervical cerclage...I'm hopeful and praying that this procedure is gonna help me take my first baby home!!

Anonymous said...

i have an abdomial cerclage as well and am nowv30 weeks pregnant. I have not had any complications and am so excited that I will be having a healthy baby after 5 losses. my cerclage was one by Dr. Arthur Haney at University of Chicago. He is on o the bestvoctors I have ver met. His staff was excellant in helping me arrange everything with tranportation and insurance as I live in Delawre. Having this procedure was one of h best choices I have ever made. If you have questions or want more info, please email me at erikaspatton@comcast.net.......i would love to help other women with this.

Trisha said...

I have my Dr. Haney TAC and my beautiful 11 month old baby boy to show for it. I love this article and look forward to browsing the rest of your blog!

whitdot said...

I LOST MY baby girl at 22 on the 21 of January my doctor diagnosed me with an incompetent cervix he said he would place a tvc next time. I have been doing some research. I don't want to lose another baby with the chance of a tvc failing.. I read about doctor haney in Chicago.. does any one on here know if he will place a tac after just one loss without trying a tvc I want to give my next baby the best chance and don't want to find out the hard way if a tvc is going to work or not Thanks

Anonymous said...

I am having an abdominal cerclage put in this Thursday. I live in Central New York. Mine is being done at Strong Memorial in Rochester, NY by Dr. Amy Benjarmin Pratt. She was very informative and she specializes in this procedure.

Anonymous said...

Yes, Dr. Haney Will place a TAC without a previous loss ( I think you need some proof of an incompetent cervix though). He placed mine and thankfully I never had a loss, just 4 months bedrest and IC with my daughter. I'm currently 34 weeks pregnant with my tAC. Good luck!

Julie Diamond said...

I had an abdominal cerclage by Dr James Sumners when we lived in Indianapolis in 1991. I have had three children thanks to this procedure.

No one had ever heard of an abdominal cerclage then, and considering I moved back to West Virginia, my pregnancies were a bit complicated. My OB/GYN had to consult with Dr Sumners to even know what the heck the abdominal cerclage was.

Thank the Lord for Dr Sumners and what was then a crazy little heard of procedure! I was truly an anomaly and quite a curiosity in the delivery room in Huntington, WV. My OB/GYN kept saying during my c-section, "hey you guys come look at this."

Things have come a long way huh?

Anonymous said...

I kept wondering if this patient could have been me, until I looked back at the date. Strangely, the day you wrote this, I was pregnant and awaiting my own TAC surgery, which took place only a couple of weeks later! I lost my first two babies. My son Brian was born at 22 weeks, and passed in my arms 30 minutes later. At that time I was diagnosed with incompetent cervix. Next pregnancy, I had a tvc, which resulted in infection and failed. My son Sawyer was born at 23 weeks 6 days. He lived for nearly 2 weeks in the nicu, and also passed away in my arms. Now, thanks to Dr. Haney and the TAC, I am spending the morning with my two healthy daughters, both born full term, no bedrest or complications. Amelie is nearly 4 and Ivy is 18 months. The TAC is a miracle!!!!

Amy R, Peoria area

Anonymous said...

Btw, telling patients that TAC surgeries are too dangerous or have huge risks/complications is one of the biggest lies OBs tell. NOT TRUE!!! If they tell you that, they are talking about the outdated procedure from the 1950s, which displays not only their ignorance, but also how out of toych they are with modern surgical procedures. As Dr. H says, they need to put their learning hats back on, if they are good ob's. Otherwise, I'd look elsewhere. The TRUE risk is the death of another baby after a tvc.

Allison Brown said...

What is the latest you can have a cerclage? I'm 20 weeks currently.

Allison Brown said...

I mean a TAC...

TAQUISHA ROCHON said...

Did it work for you? What doctors you used? I'm in Houston

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