Laparoscopic / transabdominal Cerclage

(13 Posts)
lalouche Sat 04-Jan-14 13:50:00

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.

BeetleBeetle Fri 03-Jan-14 08:08:53

Message withdrawn at poster's request.

lalouche Sat 14-Dec-13 12:50:41

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.

lalouche Sat 14-Dec-13 12:48:15

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.

imip Sun 08-Dec-13 22:20:40

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?

BeetleBeetle Sun 08-Dec-13 18:32:41

Message withdrawn at poster's request.

Pinupgirl Sun 08-Dec-13 10:53:43

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.

imip Sun 08-Dec-13 06:52:18

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

BeetleBeetle Sun 08-Dec-13 06:15:30

Message withdrawn at poster's request.

BeetleBeetle Sun 08-Dec-13 06:06:30

Message withdrawn at poster's request.

Pinupgirl Sat 07-Dec-13 18:12:03

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.

grants1000 Sat 07-Dec-13 00:01:22

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.

BeetleBeetle Fri 06-Dec-13 06:30:52

Message withdrawn at poster's request.

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