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IC and Twins
My DH and I just found out Monday that we are expecting twins. I am currently 8w3d according to the ultrasound. I was just wondering if anyone here has had a successful twin pregnancy after getting a cerclage. I'm so scared about my body supporting two babies when it couldn't support one the first go around. Any advice or info would be great.
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Re: IC and Twins
I guess I can give some perspective on this. My wife was pregnant with twins after a unexplained 2nd trimester loss due to PPROM. Our Peri didn't want to do a preventative cerclage because they didn't know if our prior loss was due to IC or some other factor. We did some research and found that it is generally true that the usual types of cerclage (the McDonald and Shirodkar stitches) are NOT proven to be any more effective for multiples than not doing a cerclage. So we ended up deciding to follow our doctor's advice and not get a cerclage but monitor every 2 weeks for possible IC.
Long story short, after a pretty boring first 16 weeks of pregnancy, my wife's cervix went from over 3 cm and closed at 16w to under 1cm and funneled at 18w. She was in the hospital for a few days while the doctors tried to come up with a plan to save the pregnancy. Ultimately, I was the one who found another doctor that did a type of cerclage that our doctors didn't do called a TVCIC. We went to see him, but unfortunately just hours before he was going to put the cerclage in for my wife, she went into pre-term labor. She ended up losing one of the twins at 19 weeks, but the doctor was able to save the second one with a procedure called Delayed Interval Delivery, and she's still pregnant with #2, getting close to 26 weeks now.
All of that said, here's what I would suggest. If you definitely know that you have IC, you should try to find a doctor that will either do a TVCIC or a TAC cerclage for you. If you can't find that, then get a doctor who will place a modified Shirodkar cerclage or a Double McDonald cerclage as high as they possibly can place it.
TVCIC is transvaginal cervico-isthmic cerclage. It is a type of vaginal cerclage but it is placed much higher on the cervix than the usual types and has had better success rates for multiples than the traditional types of cerclage. Only a few doctors do them--my wife's was placed by Dr. George Davis in New Jersey, who is one of the leading cerclage surgeons in the country. There's a handful of other doctors who do the TVCIC cerclage--you can email Dr. Davis at askdrdavis at aol.com and he might at least be able to give you his thoughts on your case and suggest someone near you (if you can't come to him). TVCIC can be done as removable to allow for vaginal birth.
TAC is a transabdominal cerclage. It is the most effective type of cerclage, but placing it is done via abdominal surgery (similar to a c-section) and it is NOT removable, but it has the best success rates. Any babies born after the TAC is placed will have to be by c-section. But it works better than anything else. One issue may be insurance--usually TAC is not done for someone unless they previously have a failed vaginal cerclage, so it may not be covered in your case.
Ideally, whatever type of cerclage you get should be placed around week 12 of the pregnancy.
If you have questions about any of this, just ask. I have done an insane amount of research on all this over the last few months and do not want anyone else who is expecting twins to end up getting the same advice we got from our doctors, who frankly should have known better than they did and should have offered us some of these options like TVCIC and TAC. If you hear the same advice from your doctors, ask them about these other options. If you don't like what you're hearing, get another opinion. You need to be your own advocate with this sort of thing--IC with twins is a complicated situation and it is critical that you educate yourself and speak up for what you want.
Cerclage in twins is extremely controversial. But I highly believe in it and know many doctors who also do. Randomized controlled trials do not show benefit of cerclage of any kind in twins, and the most widely known/respected doctors are saying not to do it. It's highly disappointing. Their point is that twins still deliver early.
However, IC is IC is IC. There is no other way around it. If you had IC with a singleton surely twins will not fair any better without something. If you can do anything to help prevent it or delay delivery, why not do it?? Sadly many people who practice academic medicine don't practice real life medicine and have never suffered any loss personally.
Find yourself a good team who is willing to listen to you and get you what you need. Best best of luck and hope to see you on the multiples board.
I have an incompetent cervix and suffered two second trimester losses. One at 24 weeks and one at 20 weeks.
I am currently going on my 24th week in this pregnancy with boy/girl twins. I had my cerclage placed at 13 weeks. My cervix is still long and closed .. so I would have to say so far the cerclage is working! Here's hoping it will continue to work!
Good luck .. I wish you the best!