Pregnant after a Loss

Cerclage Questions

Hey ladies.  I don't normally post here since I'm not pregnant again yet but I have a few questions so the ladies on TTCAL suggested I stop by here to see if you guys could be of some help.  We lost our Lo at 19 weeks due to IC and PPROM according to my regular OB and my specialist that I am now seeing.  With our next pregnancy they have already told us that I will need a cerclage and weekly shots to help prevent preterm labor.  My questions are if you have had a cerclage how far along were you when you had it done?  Which kind do you have a TAC or a TVC?  How great is the risk that they could accidently nic my membranes causing my water to break?  Did they put you on any kind of bed rest after you had it?  I am sorry for so many questions but I have been reading up on IC and cerclages so that I am prepared in the future.  Unfortunately googling this has caused me to afraid to have this procedure done because I am afraid that it will not be successful and that I will end up with another loss.  Thank you for any advice you can give me.

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Re: Cerclage Questions

  • First of all I'm so sorry for your loss.  I remember posting all of these same qustions over here awhile back so I know what you're going through.  My doctor and I opted to do a TVC it's a much less invasive of a procedure a TAC is a very serious surgery and requires future surgeries with every pregnancy despite the outcome which wasn't something that I wasnted to go through.  Googling it can freak you out but getting a TVC placed was a rather simple procedure; I went in they gave me a spinal (which wasn't bad at all), couldn't feel the rest but was awake which is probably the worst part becasue there's a few people (doctors and nurses in the room) and it's awkward but the whole thing lasted about 15 minutes.  I was on bedrest for 5-7 days following the procedure and then went back to work afterwards and haven't had a problem since.  Part of the key to having a successful outcome of a TVC is that it's a Preventative cercalge and not an emergency cerclage, a preventative is placed somewhere between 12-14 weeks whereas an emergent is placed once a problem occurs and then it's usually too late.  I had mine placed at 13 1/2 weeks.  They had originally wanted to give me the p17 shots as well but I haven't needed them so I haven't taken them.  I have however had a lot of ultrasounds to check my cervical length and everytime I've been worried but Everytime it's been at like a 4 which is really great and what it shouls be around for someone who is having a complication-free pregnancy so I feel like this cerclage has been my savior.  Doctors plan to remove it around 36 1/2 weeks and that is a very simple outpatient procedure that they do right in their office, you come in the put you up in stirrups and snip the string and pull it out, no biggie.  There is 1 draw back to having a TVC though and that's no sex, but to be honest with you me and my DH would probably have been too afraid this time around to chance it anyways but just an fyi.  I wish all of the best for you. ?

    ?DD 9/17/10 22wks I carry you in my heart.?
    bfp#2 2/14/11? cerclage placed at 13 weeks
    ?DS 9/29/11 36 wks 3 days 8lb 20 1/4" ?
    bfp#3 12/15/12 CP 12/27/12
    bfp#4 2/25/13
    beta#1 51 beta#2 163 beta#3 1,370
  • I had TAC placed back in May while pregnant.  Yes, it is an invasive procedure but I went to the one of the best (Dr. Davis in NJ) and it wasn't bad at all.  Plus, the success rate is higher with TAC than a TVC.  I never had a failed TVC either.  I'm not sure what the previous poster means by having future surgeries with a TAC except for maybe c-section (TACs are permanent).  Like lrachelle, it was the best decision I could have made.  I have no bed rest.  I was on my feet the day after surgery and flew home 3 days after surgery. 

    Definitely do some research as you will know what is best for you.  There is an IC forum with women who have had both TACs and TVCs and they are all very supportive. 

    My Blog
    We love and miss you Jillian (18w) and Peanut (6w). Welcome to our TAC miracle Jacob!
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  • Firstly, I'm sorry for your loss. I lost twin boys to IC at 18 weeks.  ((HUGS))

    For me, it was all about the numbers. It's explained below.  I would NEVER, ever in a million years take back my decision.  The surgery was so simple.  Did it hurt afterward? Yes.  Was there recovery for a couple of weeks?  Yes.  Did I get my healthy take home baby who is playing with his feet on a blanket right now?  You bet I did!  I was extensively monitored, and with direct pressure on my uterus, the very top of my cervix would funnel.  With the TAC.  Guess what was holding my cervix?  The TAC was!  If I had had a TVC, gravity would have ripped me an even bigger cervix. 

    ETA: I was not on bedrest. I did have 17p prescribed by my OB but it wasn't a big deal.  I was allowed to have sex and did only a few times.  Too scared!  My cervix was 2.5cm at 16w with the twins.  At 25w with Isaac, it was almost 5cm!

    The best answer I can give you is straight from my blog (the link is in my sig):

    Two options to fix IC

    The TVC

    The most prescribed way in modern America - the transvaginal cerclage (TVC). It's placed preventatively around 13 weeks and is done through the vagina - basically your cervix is sewn shut near the bottom. There is typically a full bedrest situation afterward, and is about 75-85% effective. Effective, to the medical world, means live birth. Even live births that are severely preterm with lifelong medical complications are considered success stories. Full term, healthy birth is probably less than the 75%. This cerclage is placed low on the cervix and the pressure of the baby can still push down, causing you to dilate and funnel. There's a lot of pressure being placed on the cervix itself. Water can break at any time and can even tear the cervix where the stitch is placed. Here's an illustration, courtesy of Abbyloopers.org:


    image





    2. The less common, but more effective way is through the abdomen - the transabdominal cerclage (TAC). A c-section like incision is made and a band (made of merselene) is placed tightly high on the cervix. Dr. Haney said that you can lift a person off the ground with this band, it's THAT strong. It can be placed pre-pregnancy (his preference) or during pregnancy (up to 11 weeks or so). It's there forever, and will already be in place for future pregnancies. I will ONLY be able to give birth via c-section. Recovery time is quick and as Dr. Haney said, "You will have a bionic cervix." It won't go anywhere. He said that he cannot prevent me from getting GD or pre-eclampsia, or any other kind of pregnancy complication, but he can guarantee that my cervix will be rock solid. It can be placed via robot (Da Vinci) or laparoscopically, but the old school method is best - manual insertion by a skilled surgeon. Dr. Haney said that in my situation, he would give me a 100% success rate for my cervix to carry to full term (38 weeks)!!! Another illustration of the three different cerclages, again courtesy of Abbyloopers.org:

    image

















     

    Some links to very helpful information about the Transabdominal Cerclage procedure:

    Abbyloopers - "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."

    Aetna Insurance description of TAC.

    Dr. Arthur Haney - my miracle worker at the Univ of Chicago Medical Center, who will be performing PERFORMED (!) my TAC.

    Outcome - Research Article, Wishard Hospital, Indianapolis, IN

    Oxford Journals Article

    image
    Twin boys born too early at 17w4d and 18w2d in February 2010
    Transabdominal cerclage placed September 2010
    DS born at 35w1d in February 2011
    Twin girls born at exactly 36w in February 2013
    Lilypie Third Birthday tickers
    Lilypie First Birthday tickers
  • imagejerriesgirl:

    I had TAC placed back in May while pregnant.  Yes, it is an invasive procedure but I went to the one of the best (Dr. Davis in NJ) and it wasn't bad at all.  Plus, the success rate is higher with TAC than a TVC.  I never had a failed TVC either.  I'm not sure what the previous poster means by having future surgeries with a TAC except for maybe c-section (TACs are permanent).  Like lrachelle, it was the best decision I could have made.  I have no bed rest.  I was on my feet the day after surgery and flew home 3 days after surgery. 

    Definitely do some research as you will know what is best for you.  There is an IC forum with women who have had both TACs and TVCs and they are all very supportive. 

    I'm thinking she meant c/s, too.  FWIW, you could have a TVC surgery and STILL need a c/s.  My saving grace is knowing that I'll never have another cerclage surgery.  And, once you've had the TAC placed, you'll know exactly what it's like to experience a (simple) c/section.  The other benefit to the TAC is that you can have it placed prepregnancy, like lrachelle did.  I had mine at 11w pregnant.

    Good luck, OP!

    image
    Twin boys born too early at 17w4d and 18w2d in February 2010
    Transabdominal cerclage placed September 2010
    DS born at 35w1d in February 2011
    Twin girls born at exactly 36w in February 2013
    Lilypie Third Birthday tickers
    Lilypie First Birthday tickers
  • I actually had a TVC with my last pregnancy. We were pregnant with twins and they checked my cervix at 16 weeks and found that it had funneled down to 0.5cm. My MFM did a cerclage the next morning. He actually had to push back my membranes and put 2 stitches in. I had a spinal and was awake for the procedure. I had a little cramping afterward but nothing major. After I went home from the hospital though I did have some cramping that I wasn't sure about and called my OB the next week. He had me come in and then sent me to L&D for monitoring and sure enough, I was having contractions. I had to stay overnight so they could give me meds to calm my uterus. I was on bedrest for the rest of the pregnancy. At 28 weeks however I started pouring blood. My OB's first thought was that a stitch had come out but that wasn't the case. I had a placental abruption that was totally unrelated but we lost them anyway.

    Now, we are pregnant again and they don't think I will have to have another cerclage. They attributed the IC to the twin pregnancy/hormones. They are however, watching me very close and I am having weekly u/s at either my OB's office or my Peri's office. Right now my cervix is measuring 2.6cm but they aren't saying I will need one yet. My OB said he is more comfortable with the cervix at least 3 but that I am still considered in a normal range. We will see Tuesday if it has changed.

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  • Thank you for all the information that you ladies have given me so far.  I am really leaning towards having a TAC done pre-pregnancy because I only have to do it once verus having a TVC and having to do it with each pregnancy.  Did your normal OBs or Peris advise you not to do causing you to do it on your own?  We have our pre-conception appointment with our Peri on Sept 20 and I plan on bring the TAC up.  I just want to be prepared for what I should do if they try to advise me against it.  Was it hard to get your insurance to cover the TAC?  I have read in a few places that most insurance agencies won't cover it until the TVC has failed.  Thank you again for answering all my questions. 
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  • One more thing. Do you think that Dr. Haney could refer me to someone down here (I'm in NC and I know he was at Duke for 23 years) if I couldn't go to him?  How would I contact him?
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  • imagemyangelislucy:
    Thank you for all the information that you ladies have given me so far.  I am really leaning towards having a TAC done pre-pregnancy because I only have to do it once verus having a TVC and having to do it with each pregnancy.  Did your normal OBs or Peris advise you not to do causing you to do it on your own?  We have our pre-conception appointment with our Peri on Sept 20 and I plan on bring the TAC up.  I just want to be prepared for what I should do if they try to advise me against it.  Was it hard to get your insurance to cover the TAC?  I have read in a few places that most insurance agencies won't cover it until the TVC has failed.  Thank you again for answering all my questions. 

    TBH, I didn't consult with my OB prior to making the decision.  I told her at 9 weeks pg that I was having it done in 2 weeks and if she didn't support me, I knew I'd find another OB who would.  I think they would warn that it's more invasive, but I don't know that they'd "forbid" it.  It's your body and you are in charge.  Go in armed with information.  The practice of insurance companies only covering for failed TVC's is absolutely barbaric, and is hopefully no longer the norm.  No one should have to continue to lose babies to "prove" something.  I have Aetna and we paid $160 out of pocket for a $16k surgery.  I believe BCBS covers as well.  If you have any issues with insurance covering, you CAN fight it and make it work. It's actually the same cost as a TVC surgery.  I had an emergency cerclage attempt after I had lost Twin A.  The cerclage wasn't placed because of infection, but guess what they charged my insurance company? $12k. 

    image
    Twin boys born too early at 17w4d and 18w2d in February 2010
    Transabdominal cerclage placed September 2010
    DS born at 35w1d in February 2011
    Twin girls born at exactly 36w in February 2013
    Lilypie Third Birthday tickers
    Lilypie First Birthday tickers
  • imagemyangelislucy:
    One more thing. Do you think that Dr. Haney could refer me to someone down here (I'm in NC and I know he was at Duke for 23 years) if I couldn't go to him?  How would I contact him?

    I'm absolutely sure he would!  His profile is here and he answers emails personally. He's FABULOUS. 

    https://www.uchospitals.edu/physicians/arthur-haney.html

    image
    Twin boys born too early at 17w4d and 18w2d in February 2010
    Transabdominal cerclage placed September 2010
    DS born at 35w1d in February 2011
    Twin girls born at exactly 36w in February 2013
    Lilypie Third Birthday tickers
    Lilypie First Birthday tickers
  • imagemyangelislucy:
    Thank you for all the information that you ladies have given me so far.  I am really leaning towards having a TAC done pre-pregnancy because I only have to do it once verus having a TVC and having to do it with each pregnancy.  Did your normal OBs or Peris advise you not to do causing you to do it on your own?  We have our pre-conception appointment with our Peri on Sept 20 and I plan on bring the TAC up.  I just want to be prepared for what I should do if they try to advise me against it.  Was it hard to get your insurance to cover the TAC?  I have read in a few places that most insurance agencies won't cover it until the TVC has failed.  Thank you again for answering all my questions. 

    My peri was quite insistent that I did not, but I already had my mind made up.  Dr. Davis took care of asking the insurance company for me.  All I had to do was provide the carrier and number.  I was pre-approved for one night and when I had to stay the second night, they submitted the necessary information (i have BCBS).  Easy-peasy.  I think that's also a plus with going with Dr. D or Dr. Haney, they know how to get the insurance companies to cover you. 

    When I asked Dr. D about a recommendation in Atlanta, he knew of of one doctor who had some but wasn't comfortable referring me to him.  I was ok with that.  I know of someone on the IC board who had one done by a doctor in Gainesville, FL.  That's a little closer to NC.

    My Blog
    We love and miss you Jillian (18w) and Peanut (6w). Welcome to our TAC miracle Jacob!
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