Laparoscopic / transabdominal Cerclage(13 Posts)
I recently lost twin boys at 18 weeks. My gynae thought this was due to an infection which caused prom, however my fertility specialist believes it could be due to incompetent cervix.
The gynae didn't recommend any further treatment, other than to have fortnightly scans in my next pregnancy and see what happens.
However my fertility specialist has suggested a laparoscopic abdominal cerclage before we try another IVF round.
I am a bit confused because one is saying i don't have IC and the other is saying i might and should have this surgery.
Has anyone else had the surgery or knows a bit more about it? I've researched online and it seems quite new, but an improvement on a stitch during pregnancy.
So sorry for your loss, so tough.
I had a stitch with 4 th pregnancy, had one baby 5 weeks early, 2 m/c unexplained at 13 & 9 weeks and had stitch with last pregnancy and delivers 3 weeks early. That as 7 years ago so not heard of newer treatments.
Was there any evidence of infection found do you know?
Maybe others can give you more up to date advice, wishing you well and best of luck with everything.
I have incompetent cervix and have had both the vaginal and transabdominal stitch done. There is a test that they can do which involves putting dilators inside and seeing how long/heavy they have to be before your cervix starts to dilate.
I would ask about this as although the stitch has worked well for me it is not without complications. All the best.
Thank you for sharing your experiences.
I asked about further testing and I was told that there are no tests that can reliably show an IC, and really it's only detectable in pregnancy.
I realise that the abdo stitch means I can only have a c-section delivery, which is a concern, as is the surgery itself, although it will be done by keyhole surgery. Also i worry about what happens if i miscarry?
But other than this, it appeals to me over a vaginal stitch because it's in place pre-pregnancy and so if i get pregnant again, i won't be worried all the time, or on bedrest.
If you don't mind, i would really appreciate hearing more about your experience of both stitches.
Grants thank you for sharing your experience too, and i am so sorry for your losses.
There was evidence of infection in the placenta, the chorion layer, but they can't find what it was and it never showed up in any blood tests, swabs, or urine samples, even when i was admitted into hospital after the membrane rupture. The babies heartbeats were strong and healthy too.
Apparently, IC can allow bacteria to cross into the uterus from the vagina.
beetle, I'm very sorry that you find yourself here having to ask this question, and very sorry for the loss of your little boys.
Are you in Northern Ireland, or is your fertility specialist David Davis?
I ask this because I lost my daughter almost 8 years ago. I had prom at 21 weeks and delivered her stillborn after a cord prolapse at 25+4. I've done a bit of research on this! I've gone on to have four healthy children at term, delivered by c-section (for unrelated reasons). I had a cervical cerclage with all four pregnancies. I also experienced infertility conceiving my first child.
IC was the suspected use, but no evidence of it. There used to be a couple of forums that I was on at the time and a TAC was unusual but suggested by a prof working in NI and the above fertility specialist. I think the fertility specialist also did the IC test with dialatord. I assume your fertility specialist recommends this because it is the only way he can 'help' you before pregnancy (I'm assuming he won't be caring for you in pregnancy, just helping you get pregnant?). Since losing my eldest daughter, I've worked a lot with bereaved parents, with lots of instances of IC.
I think a very important point is to decide how many children you want. Repeat c-sections are dangerous (I know, I know I've had four, but heard some bad stories). From all my reading, I cannot remember any negative experiences from TAC, but your post reminds me that it hasn't seemed to have gained popularity in the time since my loss. Cynical me wonders if this is due to the cost.
Also, I do believe that the dilator test is unpopular, I've never heard of anyone who had it. I was given a cerclage because the consultant suggested it. Subsequently I see that women are usually scanned regularly after an 'unexplained' loss. I have seen this approach taken from losses ranging from later miscarriages, to pregnancies well progressed into the early part of the third trimester. There have also been women who have subsequently had an emergency stitch and have been on bed rest for a substantial amount of their pregnancy.they did go on to term. There have been a couple who have also lost a baby. Emergency stitches, which is what will happen if you are scanned regularly and are found to have a short cervix, have a higher rate of failure.
Sorry I cannot tell you what to do, or give you greater information. I just note that TAC (trans abdominal cerclages) still don't appear to be routine over the past 8 years, perhaps due to the c-section factor. These are certainly worrying times. The first pregnancy after my loss came 9 weeks after her birth and my husband and I just survived on autopilot.
Btw, an infection from the vagina will rise to the uterus with an IC because your waters have broken. My daughters heart continued to beat for nearly a month after prom. Did you go straight into labour after prom? In my medical untrained mind that seems more like IC because your body is 'letting go' of the pregnancy, where mine seemed more like infection because i continued to stay pregnant, if that makes any sense
Sorry for the essay, these are hard times....x
beetle-the transabdominal stitch is major surgery. Why has your consultant discounted the vaginal stitch? I was able to have 1 dc with the help of a vaginal stitch but due to other complications-I also have a blood clotting disorder-ended up having the transabdominal stitch.
I had regular scans-every 2 weeks-but I had to push for this on the nhs. Tbh I am very concerned about your fertility specialist recommending major surgery after one late loss.
I would seek further independent advice if I were you. Feel free to pm me and I would be happy to pass on the details of my consultant who is an expert in this field.
Thank you for all the feedback, it's really helpful to chat this through with ladies who have been there and understand.
Imip, the PROM became apparent after i stood up on waking from a nap. I was 1cm dilated when i got to hospital half an hour later, but it was closed again and 11mm 24 hours later. I went into labour 48 hours later which was only painful 30 mins or so before i delivered.
I am living outside of europe at the moment but hoping to come back to the UK next year.
Pinupgirl, the fertility specialist does it by keyhole surgery. You get the surgery in the morning and you're home by the afternoon. The surgery takes an hour. So, it's not as invasive as it used to be (i.e. cutting through the abdomen), but i know it's not to be taken lightly.
I believe that with a vaginal stitch during pregnancy, there is increased risk of infection and PROM, and as i had both of those present in this miscarriage, I think the fertility specialist wants to avoid my needing a vaginal stitch. Also, maybe because we have to have IVF, he is more radical about avoiding further preventable miscarriages.
I was being scanned fortnightly with this pregnancy, and this still happened. I do worry that if i don't have this surgery here while i can, when we move back to the UK next year, if i am lucky enough to be pregnant, i will struggle to be seen or get treatment until i lose more babies. Pregnancy after IVF is so full of anxiety as it is, throw in this late miscarriage too and i don't know if i can stand the thought of a potentially high risk pregnancy with a vaginal stitch and bed rest.
It's so confusing right now, i don't know what to think. One of the Dr's is on holiday now until the 28th Dec, so i won't be getting any answers soon
Ah, ok, if you were scanned during this pregnancy then I'd be fighting for a cerclage. I can't advise which one, I've only had one type. Yes, there is an increased risk of infection and prom, but usually the most riskiest part is when it is put in. When all four of mine were placed, I went into labour, but it subsided, with morphine. From there, I usually only had minor complications.
On the basis of your history, I'd be surprised if a dr would refuse you a cerclage in the UK. I can see why you prefer the TAC. I was also very scared with my first cerclages given the infection/prom risk. I was very lucky. You've got some time on your side in the next few weeks to keep researching so you feel comfortable with your choice, what does your partner think?
I'm currently 29 weeks pregnant with DC3. I had a TAC at the Liverpool Women's Hospital 18 months ago. DC2 was born at 26 weeks - I was rushed in at 25w with 3cm silent dilation and prolapsed membranes. So far this pregnancy has been trouble-free and anxiety-free. I've had no extra scans and very little extra monitoring but am entirely happy that the TAC is doing its job, along with some baby aspirin and progesterone to help it along!
One question I'd investigate carefully is whether you really want the TAC done laparoscopically. Prof Farquharson at Liverpool is a world-leading expert and his take was that success rates are drastically lower and the risk of complications higher when the procedure is done that way rather than as full open surgery. There are very few UK surgeons that I know that would risk doing the procedure via laparoscopy. The open TAC is major surgery, sure, but I found the recovery relatively straightforward. I 'only' had one prem baby, who is now a happy and healthy 3-year-old, but I was still found to be an excellent candidate for the op, and to be honest I would not have gone ahead with another baby with just a vaginal cervical stitch - with two kids already, the extra monitoring and the risk of failure were too great for me, as were the risks of another extreme prem baby.
I suggest you head over to www.abbyloopers.org where there is a massive amount of information about TACs of all stripes, along with a messageboard. I found it invaluable when researching my options.
In terms of miscarriage, btw, they do have to be careful, but it's possible to have a D&C until about 13 weeks with a TAC in place. After that, you do unfortunately have to take the risk of needing a c-section if something goes wrong.
Thanks for sharing your experience LaLouche.
DH and I went back to our ObGyn, who is still standing by his opinion that I don't have an incompetent cervix and it was just bad luck. I really want to believe he's right.
I emailed Dr. Haney in the USA who has done over 250 TAC's and whilst i don't agree with him on somethings (prom in second trimester is only due to incompetent cervix apparently), he did also say that laparoscopic surgery isn't recommended.
This is enough information to help me come to the decision that the TAC surgery that has been suggested, and the method suggested, is not right for me. So we are going to take our chances and go ahead with another IVF without the TAC and hope that if we get pregnant again, everything will be fine or that a vaginal cerclage will help us if my cervix shortens.
It's a scary prospect, but i so want to believe that my body can do this and without general medical opinion on a diagnosis, i don't want to risk my health.
I wish you the best of luck and lots of strength for getting back on the emotional and physical treadmill. When you get pregnant again you could perhaps opt for a preemptive vaginal cerclage at 13 weeks or so - though it's done under general, it's not a major procedure and would minimise the worry of watching and waiting to see if your cervix was shortening, especially given the lesser effectiveness of emergency 'rescue' stitches. Although I opted for the TAC, my local teaching hospital only do MacDonald cerclages and the consultant was very clear that they are pretty effective in most cases. I also spoke to Leeds who do in-pregnancy Shirodkar stitches. It was my choice to proceed with the 'belt and braces' TAC approach, but I have one friend who had a perfectly straightforward second pregnancy with the McD cerclage in place, having also lost twins in her first.
Anyway, what I'm attempting cack-handedly to say is that there are quite a few options in between the TAC on the one hand and merely 'watching and waiting' on the other.
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