Just curious - anyone here got one, or going to get one? I'm getting mine a week on Wednesday post-pregnancy at 13w1d 
I'm a member of Abbyloopers but I just wondered if there was anyone else here in the TAC boat to share experiences with :-)
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Pregnancy
Transabdominal Cerclage (TAC)
28 replies
Sparklies · 22/10/2010 00:32
OP posts:
Sparklies ·
06/01/2011 18:51
Wow, sounds like you've had some traumatic pregnancies! I'm so sorry to hear you've had to go through all that. I'm even more sad that it sounds like you weren't watched more closely despite all that cervical surgery which are huge risk factors.
I had a normal pregnancy and delivery (albeit 36w6d) with DC1 but we suspect either birth trauma with her or the D&C or hysteroscopy I had after her caused my IC. DC2 I had 3mm left at 18w3d and had a rescue TVC placed really, really high. I tore through at 34 weeks and had it removed, labour stalled but I had a failed induction (EMCS due to scar tissue) at 35w5d because of infection. I opted for a TAC because I was wary of the tear so high up on my already proven incompetent cervix. As it happens when my TAC was fitted the doctor said there wasn't much there to fit a TVC to so I guess I made the right decision!
It's possible a preventative TVC at 13 weeks or so could work for you but if you're anything like me, you might just want the gold standard of a TAC for the best possible outcome and the least bedrest. You would be doomed to c-sections though!
You can have miscarriages up to 12 weeks with a TAC in place and a regular D&C can be done then as the TAC is not completely tight. Like you I am prone to miscarriages too - mine are in the first trimester. I had mine post-pregnancy but I was originally going to have it pre-pregnancy but I, errr, accidentally got pregnant first! 
I'm 22 weeks now and the TAC is doing wonderfully. I haven't had a scan since 19 weeks (NHS refuses to because they say there is nothing we could do even if things did look dire as they don't believe bedrest works) and my local private place the sonographer has gone on holiday for a fortnight, argh. But it was 3cm at 19 weeks, compared to 3mm with DC2 at that time. I've had no bedrest, and no complications. The operation was really straightforward and I was out of hospital after two nights. I had it at Chelsea and Westminster with Nick Wales and I would recommend him to anyone - he is lovely and a strong advocate for the TAC and has fitted apparently hundreds with total success.
I know what you mean about pushing luck because I've hardly told anyone I am pregnant because I am scared of what they will think after the drama with my last baby! I will only tell most people when he is here and healthy.
I have heard nothing but wonderful things about Mr Farquarson, you really would be in great hands.
Good luck with everything and feel free to fire any questions you want at me and I will try and answer!
OP posts:
WorzselMummage ·
06/01/2011 20:01
Wow thanks for replying so quickly!
I'm so pleased that your pregnancy is going well now, it much be such a huge relief for you.
It sounds as if we have both had horrible pregnancies. I'm not really sure if I can go though it again and DH isn't keen but I thought I ought to arm myself with all the facts and figures before we make the decision. The biological drive to breed is overwealming though isn't it. I always wanted 3 and feel as if there is one missing at the moment.. ridiculous eh! Hormones have a lot to answer for.
3cm from 3mm cervix is absolutly remarkable ! My cervix measured 2.8cm on my last TA untrasound before the rescue stitch but there was a lot of funnelling and then when I had the TVC put in my surgeon had a real problem even getting it done he was courching down for leverage cursing my lack of cervix.. I think a lesser surgeon would have given up but luckily my local hospital had a bit of a shirodkar whizz on the books... I was in surgery for an hour though and was awake for it all, it's not something i'd be in a hurry to repeat tbh :(
I have read that TACs are better for women who's cervical problems are at the top OS and that seems to be the case for me, hence the funneling. I dont know if my prom was caused by inflamation from the op, the scar tissue on my cervix or infection but i suspect infection as I had the same feeling before the prom as I had before the prom with my daughter the night before I prommed with her. I actually had an emergency Drs appointment about it 8 hours before my waters went but was fobbed off.. The whole thing was badly managed tbh, I should have had a tvc at 12 weeks but was told to wait and see what happens!
It's only due to sheer luck that my DS is here.
I'm really going on aren't I
so anyway, how was your tac done ? were you awake for it ? what about your scar ? and bedrest ( impossible with 2 kids!) can you work ?
Oh and how do you use Abbeyloopers ? all the links on the website seem to be dead.
WorzselMummage ·
06/01/2011 20:14
I think that was the longest sentance in the history of Mumsnet
Sparklies ·
06/01/2011 21:22
Abbyloopers is a Yahoo Group which you have to join (they send you a questionnaire which keeps the trolls out!) as the actual website isn't much cop. Hate the Yahoo Groups format, but the support there is wonderful, if a little US orientated so there are a lot of insurance questions. Most of the mothers have lost babies too. But there are a few of us UK ladies there as well!
Worzel - yep, like you I spent an hour fully conscious whilst they fiddled around and cursed trying to fit my rescue cerclage. As you say, not an experience anyone would want to repeat! I hadn't even shaved my legs for about a week as spreadeagled in an operating theatre with a large team of men peering up my bits wasn't quite how I'd expected the evening of my anomaly scan to go! Still, like you, I had an amazing doctor who I fully credit with saving DC2 where most surgeons would have failed.
I even want a fourth because I am mad.. fortunately the TAC will be fine for subsequent pregnancies too as it's permanent - gotta love it! DH is less keen because of all the drama but it's not him physically living it. And my UK TAC doctor has said I should basically have normal pregnancies now, aside from the c-section requirement. So far what he says is true :)
TACs do really help with infection as you have probably read and with no infection, far less chance of pPROM. Can't believe they told you to "wait and see" with the cerclage, ugh, some doctors make me sick.
As for your questions - my TAC was done under general anaesthetic (yay!!) and I got lots of morphine afterwards (double yay!). It was a traditional open TAC, not a lap TAC - the odds are better for traditional ones. They monitored baby throughout via ultrasound and the first thing they said when I came round was that my baby was absolutely fine. In fact there was a queue of random people coming past my bed telling me this over the next few hours and it started to get funny by the end, or maybe that was the morphine 
Obviously there is a theoretical risk of pPROM during surgery but it is really tiny. I think out of the 200+ documented surgeries on Abbyloopers, only one did. Doesn't half play on your mind though!
The recovery was similar to a c-section as the surgery is almost identical. Everything really hurt for the first few days, and I couldn't really lift anything once I was home for the first few weeks at first. But DH had to go back to work a week after my surgery and I managed, with a lot of CBeebies to distract the children! As for work, I'm a self-employed family photographer so I just took the time off, and did my first session post surgery at about 4 weeks. I would have thought depending on your job you could go back as soon as 2 weeks if it was easy to get to and you just sit down all day. The wound stopped being sore even if I poked it at about six weeks, and stopped being sore unless I poked it around the two week mark. It's below the hairline, right where a c-section scar would be.
libelulle - Sorry to hear you had such a horrible and long NICU experience, crikey. Yes, I can see why you'd do anything to avoid that again.
I don't think there is any specific NHS criteria as it is down to the the doctor. Most do seem to expect a failed preventative TVC or some sort of congenital problem, or a scarred cervix etc. It is really hard to find a TAC surgeon, especially one with a lot of experience, and I'd guess there were no more than half a dozen. However, it's not all bad news. Some TAC surgeons are big advocates for the TAC and will fit it in many cases where a TVC could probably work too if they think the IC is genuine and the patient is willing to accept the risks. The two US surgeons, Dr. Davis and Dr. Haney both fit into that category, and Dr. Davis will do it at cost for foreign patients who don't have US insurance, I think the costs are a few thousand pounds plus flights/hotels. Dr. Davis hangs out on Abbyloopers a lot and both those doctors offer free email/telephone consultations so it could well be worth contacting them to see what they think.
I never had a failed preventative TVC (in fact I had a successful rescue cerclage) and my UK NHS doctor agreed to one. I think if anyone on the NHS would approve a TAC in your circumstances, he would. You could always email him and ask? I don't have his address to hand but you can find it on the Chelsea and Westminster website I think. He is a big advocate.
Okay, sorry for the huge essay too!! Hope it was helpful for both of you and I haven't repeated myself too much - I have pregnancy brain!
OP posts:
libelulle ·
06/01/2011 21:41
Thanks Worzsel! Hadn't even occurred to me about the bedrest bit - I was thinking more of the (im)possibility of having another prem birth - but you're quite right that makes TVC recede even further as a possible option.
DS is doing really well thank you - we were incredibly lucky. My membranes prolapsed at 25+3 (along with DS's feet...) and I spent 8 days immobile on my back in the labour ward before finally going into labour due to an infection. So I had time for steroids and DS only needed 24 hours ventilation (and 9 weeks on CPAP). Bar a few minor infections, he had no major setbacks at all on NICU, so his prognosis is as good as it possibly can be - though of course only time will tell.
Brilliant that you managed to hang on until 27 weeks after your PROM - what a nightmare. How is your son doing now? His lungs must have taken quite a battering if you had no waters from 22 weeks. I'm also not sure I can go through pregnancy again (or how we'd cope with another DC:)), but I'm completely bamboozled by how strong the urge is! I wonder if it's partly wanting a 'normal' pregnancy after being cheated of 3 months of the last one.
Sorry to hijack the thread slightly sparklies - my respect to you for taking the DC3 plunge! I think my IC was also caused by birth trauma from first DD, or a subsequent hysteroscopy. Am amazed they don't do a standard cervix check at 20 week scans really. In my case I weirdly almost asked them to check at a 23 week scan I had for another reason, but chickened out.
I'd also be interested to know what kind of incision you had - I'd assumed TACs were placed laparoscopally, but from the abbyloopers site it seems maybe not? Incidentally Worzsel the link to join is
www.abbyloopers.org/join.htm - for some reason it isn't linked from the front page.
God don't I go on
Sparklies ·
07/01/2011 00:25
Some hospitals do a cervical length check as part of the anatomy scan (Kings College do, for instance) post 20 weeks but plenty, maybe most, don't. My local hospital didn't.
The only reason mine was picked up was because I was on a visit to the US at the time. We were there for seven weeks and although I had my anatomy scan booked for 24 weeks back in the UK, I had a bad feeling something was wrong and paid a crazy $750 to have the scan done at 18 weeks at a recommended clinic in the US as they don't seem to mind doing them a little earlier over there (nor do they here if you pay to go private). They did cervical length checks as a matter of course. I wasn't expecting the problem to be with my cervix as I'd had an almost full term birth with DC1, I was convinced something was wrong with the baby. As luck would have it, the clinic had one of the best cerclage surgeons in the US - they kept asking me if I'd come to his clinic deliberately because of him and I was all . It being America there was a lot of talk of miracles and God, heh. Don't get that on the NHS!
After fitting the rescue cerclage that evening (and being soooo glad for having decent travel insurance, we didn't pay a penny!) the doctor said he was pretty sure I'd have delivered within 48 hours if I hadn't. No NHS scan (as they're all usually post 20 weeks) would have saved my DC2. They didn't expect me to make it much beyond 24 weeks if at all but that stitch was damned good and when things were stable (like you, 8 nights in hospital, but with a different outcome!) I flew back to the UK and she hung on until 35 weeks :)
I was told by my US doctors to be on the strictest of bedrest - toilet only (guess I was lucky to get that!). Showers once a week. Guess what my UK doctors told me.. yep, I could and indeed should walk around the block once a day. I followed the US doctor's advice, frankly, although at about 28 weeks I started venturing out in a wheelchair. It doesn't surprise me your doctor comes from the US. I really believe in the power of bedrest - on days when I was more active I had a shedload more contractions. I was also prescribed nifedipine/procardia in tablet form for irritable uterus which is not used here at all except occasionally in patch form I believe to stall labour long enough for steroids.
I'm very confident with this TAC though. It's far superior to any TVC, and I'm not hugely active thanks to having crazy bad SPD from about 16 weeks anyway. My cervical length is terrific, there is no funnelling and my doctor's alleged 100% success rate with the instructions to "have a normal pregnancy" reassure me a lot. Abbyloopers members also generally do not need bedrest either which helps. And, as has been mentioned, you just do not do strict bedrest with existing children!! With DC2, I had been working fulltime so DC1 just remained in nursery when DH was at work so I didn't ever have sole responsibility for her. These days as I work from home I have to wrangle the pair of them and there is no way I could do that flat on my back. Another great reason for the TAC indeed!
Some doctors even prefer to fit the TAC post-pregnancy because everything is more swollen and the "landmarks" internally are easier to find, the TAC will be the right tightness as you're already pregnant, and it's all a bit clearer generally. There's the same success rate with both and generally about a 50/50 split between pre and post pregnancy. There's a higher failure rate for lap TACs done post-pregnancy for some reason and they're not recommended unless the surgeon is really, really experienced. Some US people have had them fitted using this thing called the Da Vinci robot which is just.. odd, but cool! I think a lap TAC is probably fine pre-pregnancy though and of course the recovery is easier.
I'm hoping for a boring pregnancy too! So far this one has been a lot less stressful at this stage, just as I hoped. Of course I am still nervous and anxious but it's a huge difference between having been told by knowledgeable doctors "Prepare for a micro preemie" and "You will have a normal pregnancy". It's just my fears rather than anything grounded in reality although there are never guarantees with any pregnancy.
Hehe, another essay from me! I guess it's just nice to have UK people to talk to TACs about because most of the time it's people in the US!
OP posts:
WorzselMummage ·
07/01/2011 11:07
Thanks for the wealth of info Sparklies, it's really helpful! I hadn't realised that the TAC was an open procedure, I'd just assumed that it would be done laproscopically but i supposed it's easier for the surgeon to see what they are doing. I recovered really well after my section with DS even though it was an emergency jobby due to an abruption. I felt back to normal after a week or so so the surgery doesn't scare me... as long as they knock me out and keep me well medicated 
One problem could be my work, it can be fairly heavy and i'm on my feet for 12 hours at a time but if a TAC meant i could behave almost normally would would have to make allowances for me, I only work 2 nights anyway. It would be impossible to work with a TVC and i don't get paid sick :(
My local hospital don't offer CL scans routinely and although I had asked for one and have all the IC risks they refused to do it. I asked the sonographer at my anomaly scan if she would do one and she refused saying it would take too long and they couldn't do it abdominally anyway. Then, when I saw my one of my consultants understudies I told him I had been getting pains in my cervix and DS felt very low and he sighed, rolled his eyes and said they would arrange for me to have another scan in a weeks time and when that one came round they did the CL abdominally in about 10 seconds and discovered all the funnelling :(
My parting words with from sonograpger were " I hope you get to keep your baby" :(
I had my stitch the next day at 22+2. I wasn't given nifededine, antibiotic cover or progesterone despite asking for all of it. I went to the Drs feeling infected and tight and was fobbed off on 22+3. My waters went in the early hours of 22+4.
It was decided not to remove the stitch until I started contracting. We were offered a termination as we were told that our DS wouldn't survive as i'd lost all my fluid and his lungs wouldn't be able to develop, less than 20% survival chance I overheard one of the Drs say and then an even smaller chance of being normal, whatever that is.
It was a hellish 5 weeks and then I had the abruption so had to have a emcs and ds, who we'd be told would die soon after birth due to pulmonary hypoplsia was born with his eyes open, looking around the room breathing for himself! he never needed ventilation and had cpap for 6 weeks of so. A rocky trip thought NICU, typical for a 26/27 weaker but he is absolutely perfect now and there is nothing wrong with his lungs!
I'm going to press post now as i don't want to lose this essay but i've got more to say lol
WorzselMummage ·
07/01/2011 11:25
LIbelulle, These little prems so amazing aren't they, I am so pleased that your DS is doing well too. It's such a relief when they start doing things term babies do isn't it Is your DS still titchy ? I think George was 6lb when we started weaning at 5 and a half months and I've only just recently been able to stop saying " but he was born 3 months early" in every conversation about why he's small/walked late etc etc and I can tell you it's a bloody relief!
The bulging waters feet prolapse sounds utterly terrifying and you're probably aware how lucky you are that the cord wasn't involved. Its things like that that make the decision to have another so difficult isn't it all the luck required.
Sparklies I can't tell you how reassuring your posts have been and I too wish you a long and boring NORMAL pregnancy, you deserve it!
TwinklePants ·
07/01/2011 16:44
Hello ladies,
I have been eagerly reading through this thread as I too am currently being closely monitored as a "high risk" pregnancy after a LLETZ and a deep cone biopsy that I had late 2009 for early stage cervical cancer (now in remission).
I had lots of problems after my surgery as my cervix literally kept stenosing (closing up) with scar tissue which stopped my periods and made it practically impossible for me to get pregnant. I had my cervix dilated and a cycle of IVF in September last year and am now 18 weeks pregnant with our first baby (a little boy - he flashed at me at a scan I had on Tuesday! )
After I got pregnant I was referred at 9 weeks to a high risk obstetrician who I have been seeing every 2 weeks for a scan where she looks at my cervix to check that it is still tightly closed. She also does a speculuum (sp?) examination every month or so. She was very adamant that because of my scarring my cervix is likely to stay tightly closed for the whole of my pregnancy and I will probably have issues dilating when it is time to give birth. For this reason she has recommended that I have an elective c-section.
She also seems to think that it would be more risky for me to have a stitch put in as a 'preventative measure' as there is a risk of infection, PROM and m/c involved and she doesn't see it as neccessary. I must admit that I do trust her and know she is very experienced but I can't lie - I am starting to crap myself now that I am reaching the stage at which my baby is getting bigger and heavier and the slightest twinge convinces me that something is seriously wrong.
I have just requested that she see me every week instead of two weeks for this reason - 2 weeks seems like a long time to wait when the baby is developing at this rate and IMO perhaps does not allow adequate opportunity for her to spot that there is something wrong. I am hoping that by having a scan every week that we might at least be able to spot some funnelling or something and take adequate precautions? or perhaps that is wishful thinking?
My sincere apologies for the amount I have written here - I am a bit about it, but it is just so nice to 'meet' ladies in a similar condition to my own who understand where i'm coming from.
I am from West Yorkshire (oop Naarth!) by the way.
TwinklePants ·
07/01/2011 17:53
AllBellyandBoobs, congratulations on making it to 28 weeks without any problems - long may it continue. Please keep using this thread and updating as I would love to see how you get on and am wishing you well.
It is very scary to be in the 'heavily monitored' camp without any treatment (TVC or TAC) so it is very reassuring for me to see it working for someone else.
libelulle ·
07/01/2011 19:01
Yes thanks again sparklies I can't tell you how nice it is to hear that it might yet be possible to think about a 'normal' pregnancy with IC (obviously a major op at 12 weeks is anything but normal, but I mean 'normal' in the sense of secure enough to not need bedrest and monitoring to the hilt!).
Worzsel how brilliant that your DS didn't even need ventilating - must be v rare for a 27 weeker, let alone one who'd had no fluid for the previous 5 weeks. They are amazingly tough cookies these little ones. I know doctors have to tell you the dread scenarios, but it's a shame they don't at least mention how good a chance very early babies actually have nowadays.
My son also confounded their dread scenarios. I spent the week in hospital being given spine-chilling scenarios of my waters breaking suddenly and him shooting out feet first, in which case they'd need to instantly cut through my cervix without anaesthetic to release his head . As it turns out, my waters went with a trickle, and after 90 mins at 10cm dilation with no sign of him emerging they even needed to augment my contractions to persuade him out!
He is titchy for a 6-month-old obviously but actually he is just above the 2nd centile corrected age, so small but not crazily so (11lb). And seriously tough. He's actually under less consultant clinics now than his full-term sister, who has rubbish lungs, multiple allergies etc etc. He just got through his first major cough/cold/fever this week with no trouble at all! When I think back to the horrors of the summer it barely seems credible.
twinklepants I had very few symptoms - in retrospect I had an increase in discharge from about a week before. The day of the prolapse I did feel very weird - that afternoon I had a feeling of pressure/constipation, and it even crossed my mind that the baby was going to fall out if I pushed, which I dismissed as absurd paranoia even by my standards. Turns out I wasn't far off the mark - was on the loo at 9 that evening, felt a pop and a weird sack thing poking through. I'm fortunate in being a 2 minute ambulance ride away from a major teaching hospital. I had a scan within thirty seconds of arriving (consultant was there waiting) and found I was 3cm dilated. Was told I'd go into labour within 24 hours, but luckily proved them wrong there too.
Do you think there's a link between IC and writing essay-length posts? We are all doing v. well in that respect . It's amazing to be able to let it all out I must say!
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Sparklies ·
09/02/2011 21:22
Crikey - I must have missed all the follow-up posts to my last reply - really sorry about that!!
Worzel Yes, things are going great! 27w1d today - barely any contractions (except when I can't be arsed to get off the sofa to go to the bathroom and I have a full bladder!) and it's all good. C-section has been scheduled for 38w2d if I get that far 
I'm so sorry you went through all that with your son and I am so glad he made it. Wow. What a fighter he is :)
Have you managed to get a referral to Dr. F?
How is everyone else?
OP posts:
AllBellyandBoobs ·
10/02/2011 14:01
I'm currently 34 weeks and all seems to be fine (heartburn, aching hips and occasional insomnia aside :)) Actually, just entering a phase of 'I can't believe I'm going to have a baby, how will I manage? And why have I been allowed to do this?'. I think I spent so long thinking things would go wrong that I've only just allowed the reality to dawn on me, I need another 3-4 months. Anyway, as I said, all is fine, booked into MLU for delivery and hoping to get to use the pool there. I'll let you know how it goes once I'm over the shock
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