High-Risk Pregnancy

MFM says no to TAC?

I have a cervical cerclage with this pregnancy, placed at 20 weeks. I have been on strict bed rest since. I only plan on one more baby since this pregnancy has been such a joy...I mentioned the idea of a TAC cerclage next pregnancy to my MFM, basically to avoid bedrest. With having a child at that time It would just be easier and being out of work is a big deal. Anyways, he thought I was crazy.

He basically said that to have it placed it is a major surgery, that would in turn lean to another major surgery (c-section) and possibly others (or complications), with it being a foreign body that does not get removed. He said he only does them as a last resort and that if there is cervix to work with, he uses it. The shortest mine has gotten so far is 1.5cm.

I just wanted to be pro-active for next time and feel as secure as possible, unlike this time. Has anyone else been told they should not have a TAC?

Re: MFM says no to TAC?

  • Hi!

    I only learned that there were options other than the TVC while into my 1st cerclage pregnancy. After much research and reading about others' experiences, it appeared to me that the TAC was performed on a mom for which the TVC did not work. I understood it to be more invasive than the TVC.

    Only recently however, I stumbled upon another cerclage option called the TVCIC. Have you heard of it? It is placed under similar conditions as the TVC and the main difference I understood between the two is that the TVCIC is positioned much higher (almost as high as a TAC would be placed). It seems that with the TVCIC, one is less likely to require bed-rest than the TVC and it can be done as an outpatient procedure. I only know of a Dr. Davis who resides in NJ to perform them. He can be contacted and responds quickly via email if you have questions about this.

    For more info: Here is an excerpt from a post regarding the TVCIC from Dr. Davis on the IC forums site (listed under the Bed-rest Mamas Check-In resource list).

    imageexcerpt:

    Transvaginal Cervico-isthmic Cerclage (TVCIC). An alternative to TAC


    The success rates with a TAC are phenomenal (98-99%) but not everyone needs this approach. Many women are unsure about having this degree of invasive surgery or want an effective approach that could still allow for a vaginal delivery.

    Most practioners are aware of the standard vaginal approaches to cerclage, namely the McDonald or the Shirodkar. There is another, less common procedure that can be done vaginally that approaches the level and effectiveness of a TAC. Most commonly it is referred to as a Transvaginal Cervico-ishtmic Cerclage (TVCIC for short).

    Depending upon your situation, you may want to speak to your doctors about this option. If you have questions about the procedure, please feel free to contact me either through this forum or at AskDrDavis at aol dot com.

     

    Nutmeg, cilantro, sage, mint, thyme... these are a few of my favorite things! Visit The Nest!Visit The Nest! We have four children; one left us too soon.
  • The way my dr explained it was they use it for women who have had more than 1 early loss, a pre-term birth despite a TVC, little to no cervix left, etc.  IT IS major surgery- much more so than a TVC and I'd be surprised if a dr did it strictly to prevent bedrest.

    Just an additional note- I was on bedrest with #2 for almost 12w.  This time around I had a preventative cerclage at 13w.  ITs doing so well, I am still at work full-time at 28w so you never know!!! 

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  • I have a TAC and have had a completely normal pregnancy.  My MFM was against a TAC, saying that it was an extreme measure.  But, I wasn't comfortable with the TVC success rates (and the chance of bedrest) vs the success rates of a TAC.  So, I did my research and contacted one of the best TAC surgeons in the country.  I didn't need my MFM's permission so I went and did what DH and I were most comfortable with and confident in, which was the TAC.  Yes, it's major surgery, but I was prepared, the surgery went well, and my recovery was quicker than I expected.  I've been monitored like a high risk pregnancy with biweekly cervical checks and weekly p17 shots, and have been doing great.  My cervix has been consistently long.  Yes, the TAC might have been an extreme measure but the TVC couldn't give me the high chance of success that the TAC could, and I might not be almost 32 weeks without it. 

     Do your research and do what YOUR comfortable with, not what your MFM is comfortable with.  You have to be your own advocate.  Good luck!

     

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  • For me, it will depend on the outcome of this pregnancy honestly. In the little reading I have done, it seems that TAC is indicated if a prior TVC failed. So far my TVC has held and if I make it to full term, or close I would feel confident that my outcome with a preventative TVC would be at least equal too, if not greater than that. 

    Obviously there are lots of factors to weigh here. My (limited) knowledge is that only a few doctors around the country perform TACs so my questions would be, Will my insurance cover it? How far will I have to travel to get the procedure done? Since it is major surgery what is the actual risk of complications? These would all be factors to weigh against the possible bed rest issue.

    There are TONS of pros and cons to consider for both and I'm not looking forward to making that decision when the time comes and it most certainly will since this is our first child and we would like at least one more. 

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  • imagebuggles:

    Hi!

    I only learned that there were options other than the TVC while into my 1st cerclage pregnancy. After much research and reading about others' experiences, it appeared to me that the TAC was performed on a mom for which the TVC did not work. I understood it to be more invasive than the TVC.

    Only recently however, I stumbled upon another cerclage option called the TVCIC. Have you heard of it? It is placed under similar conditions as the TVC and the main difference I understood between the two is that the TVCIC is positioned much higher (almost as high as a TAC would be placed). It seems that with the TVCIC, one is less likely to require bed-rest than the TVC and it can be done as an outpatient procedure. I only know of a Dr. Davis who resides in NJ to perform them. He can be contacted and responds quickly via email if you have questions about this.

    For more info: Here is an excerpt from a post regarding the TVCIC from Dr. Davis on the https://ic.hobh.org/forums site (listed under the Bed-rest Mamas Check-In resource list).

    imageexcerpt:

    Transvaginal Cervico-isthmic Cerclage (TVCIC). An alternative to TAC


    The success rates with a TAC are phenomenal (98-99%) but not everyone needs this approach. Many women are unsure about having this degree of invasive surgery or want an effective approach that could still allow for a vaginal delivery.

    Most practioners are aware of the standard vaginal approaches to cerclage, namely the McDonald or the Shirodkar. There is another, less common procedure that can be done vaginally that approaches the level and effectiveness of a TAC. Most commonly it is referred to as a Transvaginal Cervico-ishtmic Cerclage (TVCIC for short).

    Depending upon your situation, you may want to speak to your doctors about this option. If you have questions about the procedure, please feel free to contact me either through this forum or at [email protected].

     

    I have not heard about that one! I have heard his name though and thought he was one fo the best at the TAC from readings online. Maybe thats the one that he is known for and not the TAC? Too bad NJ is so far from Tx!

  • imagechristykell:

    For me, it will depend on the outcome of this pregnancy honestly. In the little reading I have done, it seems that TAC is indicated if a prior TVC failed. So far my TVC has held and if I make it to full term, or close I would feel confident that my outcome with a preventative TVC would be at least equal too, if not greater than that. 

    Obviously there are lots of factors to weigh here. My (limited) knowledge is that only a few doctors around the country perform TACs so my questions would be, Will my insurance cover it? How far will I have to travel to get the procedure done? Since it is major surgery what is the actual risk of complications? These would all be factors to weigh against the possible bed rest issue.

    There are TONS of pros and cons to consider for both and I'm not looking forward to making that decision when the time comes and it most certainly will since this is our first child and we would like at least one more. 

    My MFM actually does them often, just in extreme situations he says.

    I just know that I only feel comfortable with my TVC because I am on bed rest. If all goes well this time, maybe I'll feel better about a preventative TVC next time. Gravity just scares me! I just know I cannot go another pregnancy with being out of work for four-five months and I just can't imagine bed rest with an existing child at home. I really have no help with DH's work schedule. Fingers crosed all goes well and I feel better about a TVC next time hopefully without having to be down for so long.

    I just think it's sad that they want "a loss" before deciding to do TAC. I feel like I would want to do everything I could do to avoid a loss, not wait for one to happen.

    How have you been doing at home? I bet it's so much more comfortable.

  • imageAprilLynn09:
    imagebuggles:

    imageexcerpt:

    Transvaginal Cervico-isthmic Cerclage (TVCIC). An alternative to TAC


    The success rates with a TAC are phenomenal (98-99%) but not everyone needs this approach. Many women are unsure about having this degree of invasive surgery or want an effective approach that could still allow for a vaginal delivery.

    Most practioners are aware of the standard vaginal approaches to cerclage, namely the McDonald or the Shirodkar. There is another, less common procedure that can be done vaginally that approaches the level and effectiveness of a TAC. Most commonly it is referred to as a Transvaginal Cervico-ishtmic Cerclage (TVCIC for short).

    Depending upon your situation, you may want to speak to your doctors about this option. If you have questions about the procedure, please feel free to contact me either through this forum or at [email protected].

     

    I have not heard about that one! I have heard his name though and thought he was one fo the best at the TAC from readings online. Maybe thats the one that he is known for and not the TAC? Too bad NJ is so far from Tx!

    Actually, he IS known mainly for the TAC. He just also performs TVCIC which may be the next best option for you if you are declined the TAC.

    Nutmeg, cilantro, sage, mint, thyme... these are a few of my favorite things! Visit The Nest!Visit The Nest! We have four children; one left us too soon.
  • imageSweetieD21:

    I have a TAC and have had a completely normal pregnancy.  My MFM was against a TAC, saying that it was an extreme measure.  But, I wasn't comfortable with the TVC success rates (and the chance of bedrest) vs the success rates of a TAC.  So, I did my research and contacted one of the best TAC surgeons in the country.  I didn't need my MFM's permission so I went and did what DH and I were most comfortable with and confident in, which was the TAC.  Yes, it's major surgery, but I was prepared, the surgery went well, and my recovery was quicker than I expected.  I've been monitored like a high risk pregnancy with biweekly cervical checks and weekly p17 shots, and have been doing great.  My cervix has been consistently long.  Yes, the TAC might have been an extreme measure but the TVC couldn't give me the high chance of success that the TAC could, and I might not be almost 32 weeks without it. 

     Do your research and do what YOUR comfortable with, not what your MFM is comfortable with.  You have to be your own advocate.  Good luck!

     

    THIS, word for word.  I refused to have another loss to prove my cervix sucked.  Granted, I had a preemie, but it was totally unrelated to the TAC.

    Be your own advocate, and good luck!!!!

    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
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  • imagechristykell:

    For me, it will depend on the outcome of this pregnancy honestly. In the little reading I have done, it seems that TAC is indicated if a prior TVC failed. So far my TVC has held and if I make it to full term, or close I would feel confident that my outcome with a preventative TVC would be at least equal too, if not greater than that. 

    Obviously there are lots of factors to weigh here. My (limited) knowledge is that only a few doctors around the country perform TACs so my questions would be, Will my insurance cover it? How far will I have to travel to get the procedure done? Since it is major surgery what is the actual risk of complications? These would all be factors to weigh against the possible bed rest issue.

    There are TONS of pros and cons to consider for both and I'm not looking forward to making that decision when the time comes and it most certainly will since this is our first child and we would like at least one more. 

    I had my TAC done by Dr. Davis in NJ.  He was fantastic!  My insurance covered all of it except for about $300.  Before I actually made the decision to go through with the surgery, I talked to Dr. Davis several times on the phone and asked tons of questions, and I read through a lot of information on it.  One of the other highly recommended dr's that performs this is Dr. Haney in Chicago.  Check out the Abbyloopers yahoo group,   https://health.groups.yahoo.com/group/Abbyloopers.  Sign up to become a member so you can access all the info.  It has tons of women on the message board with success stories, some with questions like you, and some that just recently had the TAC placed.  This site also has Q & A's from some of the dr's that perform this surgery and an extensive list of dr's around the country that perform this.  

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  • It sounds to me since this cerclage was more of a rescue cerclage as opposed to a preventative cerclage that your OB put you on bed rest as a precaution. FWIW, I have had two McDonald cerclages (one with DD and one this pregnancy) placed at 16 weeks and both so far have been successful. I have not had to go on bed rest with either pregnancy so I do not think having a TAC will prevent bed rest as opposed to a normal cerclage. I think the only reason you are on bed rest is because you had already shortened and your cerclage was a rescue to save the pregnancy.

    That being said, I have had two successful McDonald cerclages with no bed rest and no complications. I wouldn't want to have the lengthy and time consuming process of a TAC if I didn't have to. My doctor (like yours) only does them as a last resort and for people who have very early losses (13-19 weeks) due to a true incompetent cervix. Since my cervix didn't start shortening until between 20-22 weeks McDonald cerclages are successful in carrying a pregnancy to term. Also, my doctor would have placed a TAC if I planned on having 5 or more kids just becaue it is is an easier, one time procedure.

    I went in the hospital for out-patient surgery, had a spinal, my OB stitched me and as soon as the spinal wore off and I could walk I went home. It was easy!

    This got long, but if you have any questions about the McDonald cerclage feel free to send me a PM.

    Jacob 3.23.08 * Grace 7.22.09 * Eli 7.26.11 * Annabelle 1.18.14

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