Home > Academic OB/GYN Cases, Gynecology, Obstetrics > Academic OB/GYN Cases: Abdominal Cerclage How-To

Academic OB/GYN Cases: Abdominal Cerclage How-To

I had the opportunity to do an abdominal cerclage with one of my MFM colleagues this week, which was fantastic.   This is a procedure that is rarely done, and for me is something pretty new.  I had the opportunity to do a few of these in residency, but hadn’t done one for over 5 years and never in a pregnant woman, so that was a great envelope-pushing experience for me.

For my colleagues that haven’t had the opportunity to do one of these procedures, I want to lay out how its done.  In short, the goal is to place a cerclage between the ascending and descending branches of the uterine arteries, at the connection of the lower uterine segment and internal cervical os.  When you’re done it should look something like this -

So here’s how to do it

1 – start with a woman with an indication.  Several previous second trimester losses with at least one failed transvaginal cerclage.

2 – Create a transverse incision with Pfanenstiel fascial entry.

3 – Place a retractor.  In this case we used an O’Connor O’Sullivan, but a Balfour will also work.  An Alexis retractor may not work as well as it is harder to get behind the uterus without the upper blade holding back the bowel and fascia.  In a non-pregnant uterus is easier because you can be more aggressive about moving around the uterus for access.

4 – In a pregnant uterus, be careful with it.  Try not to compress the fundus, as one is potentially pushing the pregnancy down through a presumed incompetent cervix.  A spongestick pushing _up_ on the lower uterine segment is a good way to get exposure.

5 – Open the vesicouterine reflection and start making a bladder flap.  In a pregnant uterus this will bleed more than in a non-pregnant hysterectomy.  Hemoclips are useful for occluding the thicker vessels prior to transecting them.  Use blunt dissection with a peanut / Kirschner.

6 – Reach behind the uterus and feel behind the cervix.  Massage the posterior peritoneum laterally at the level of the internal os, pushing the uterine arteries laterally.

7 – Identify the uterine artery on one side visually, noting the bifurcation of the ascending and desceding branches.  Identify a free space between the bifurcation and the cervix.

8 – Note the ureter lateral to the interal os.  When you put the uterus on stretch the ureter will be just lateral to the birfurcation, running under the uterine artery.  With adequate stretch the ureter will pop up through the peritoneum and be very visible / palpable.   If you can’t see it you can strum it on the lateral sidewall lateral to the uterine artery bifurcation – it will pop like a guitar string.

9 – Put a 5 mm mersilene tape between the jaws of a right angle retractor.  Reach the right angle behind the cervix and then along the cervix lateral to the free space you identified.   Wiggle the right angle up through the peritoneum until you can cut through the peritoneum above it.  Grab the mersilene with a snap and carefully pull the right angle back. All pressure should be in pulling the tape _medially_ as lateral pressure will drag the mersilene against the uterine artery, which is to be avoided.

10 – At this point you may have bleeding from the hole you just made.  Slowly bring the mersilene up and hold it with pressure against the cervix, which should slow the bleeding as long as its venous.

11 – Repeat on the other side.

12 – Tie the mersilene anteriorly with 6+ knots. Sew the ends together with a small prolene or silk, and then cut the ends off.

13 – If pregnant, confirm that the pregnancy is still viable.

14 – Close.  As the patient will be having a cesarean in the near future, placement of a antiadhesion barrier is worth considering. I use SepraFilm for this.

Here’s another photo with the uterine arteries marked:

This procedure can also be performed laparoscopically both in and out of pregnancy, as described in several recent articles.


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  1. February 27, 2010 at 8:55 am

    So cool! Thanks for this one. Very interesting and I hope it works.

  2. Gwen
    February 28, 2010 at 11:44 pm

    “1 – start with a woman with an indication. Several previous second trimester losses with at least one failed transvaginal cerclage.”

    Or any woman with a cervix too short or too damaged for a transvaginal cerclage. I had one of these placed after an abdominal radical trachelectomy.

    • March 1, 2010 at 5:20 pm

      You’re right that is another indication. I have done one at the time of myomectomy as well in a patient with recurrent losses.

  3. March 13, 2010 at 12:44 pm

    This is fascinating to see and have described. Thank you!

  4. JDS
    March 15, 2010 at 6:30 am

    Questions- a lot of variation in this technique.

    How far along was she when this was done? 1st Trimester easier to do, but you run the risk of sewing in an anencephalic or a Down’s baby if you move before you are far enough along to at l4east get a good anatomy US scan.

    Are you planning to leave the stitch in situ for next pregnancy, or clip and deliver from below? You can get to the stitch and clip it (not removing) from the culdesac from below, but you will find it easier of you place the knot posteriorly.

    If leaving it in long term, and delivering from above, utilizing a smaller, yet sturdy stitch like a figure of 8 around the cervix with #2 Mersilene retetnion suture can work nicely.

  5. March 15, 2010 at 9:29 am

    Hi JDS –

    Good questions. I don’t generally talk about specific points about specific patients, but rather use the blog for general topic discussions.

    As you might be able to tell from the pic, this was early second trimester. In general, I would leave them in unless the patient doesn’t want any more children.

    Were you suggesting clipping the cerclage while she’s pregnant and going for a vaginal delivery? I hadn’t seen than done before but it sounds doable.

    Thanks for the technical tips!

  6. JDS
    March 16, 2010 at 10:27 am

    Ran into this once as a 2nd pregnancy after an abdominal cerclage / cs…Baby #2 was anencephalic and an IUFD. The cervix was essentially closed, and to deliver at 20 weeks, rather than C/S , was able to enter under anesthesia through culdesac, palpate and grasp the knot and clip the stitch- enough to release the cervix and allow for D & E.

    • Emili
      April 15, 2010 at 8:49 am

      Hi JDS,

      You seem very seasoned regarding Abdominal Cerclages, and I thought I might ask you a question. Have you ever done or know of anyone who has had a repeat abdominal cerclage successfully? I had one put in, and had it removed due to complications during my last pregnancy (my water broke at 23 1/2 weeks and they couldn’t stop it…so I delivered my son early..he passed 2 days later). I am having problems finding a doctor who has any experience with puting another one in after one has had to be removed. I have had one successful pregnancy after c-section and a cervical cerclage (but delivered early) and one pregancy that ended in death with a cervical cerclage that failed, and an abdominal cerclage that did not keep me from delivering early. Any insight on a doctor who has experience with repeat abdominal cerclages? My doctor is actively looking, but he himself (even thought his is a high risk specialist) had never had to do a repeat.

      Please let me know if you have any insight.

      Thank you you for you help,

      Emili

  7. Emili
    April 13, 2010 at 5:36 am

    Hi JDS,

    You seem very seasoned regarding Abdominal Cerclages, and I thought I might ask you a question. Have you ever done or know of anyone who has had a repeat abdominal cerclage successfully? I had one put in, and had it removed due to complications during my last pregnancy (my water broke at 23 1/2 weeks and they couldn’t stop it…so I delivered my son early..he passed 2 days later). I am having problems finding a doctor who has any experience with puting another one in after one has had to be removed. I have had one successful pregnancy after c-section and a cervical cerclage (but delivered early) and one pregancy that ended in death with a cervical cerclage that failed, and an abdominal cerclage that did not keep me from delivering early. Any insight on a doctor who has experience with repeat abdominal cerclages? My doctor is actively looking, but he himself (even thought his is a high risk specialist) had never had to do a repeat.

    Please let me know if you have any insight.

    Thank you you for you help,

    Emili

    • JDS
      April 27, 2010 at 9:12 am

      This will be tough to find anyone with a lot of experience anywhere-

      Looking back over my practice records, I have done around 20 of these; and only 3 were “redo’s”…”A” the stitch had been removed (by another doc) and the other 2 were my patients.. “B” where the stitch I placed was clipped for vaginal delivery of a fetal demise at 18 weeks -cord accident, with a subsequent abd cerclage success; and “C” where the patient delivered out of town when her water broke and the surgeon felt he needed to extend his vertical incision through the stitch. Also a subsequent abd cerclage- success.

      Each of these were done with essentially the same approach as a “new” abd cerclage- I did not try and remove the stitch remnants from before if they were present.
      The scar tissues were not any worse than a typical repeat C/S.

      I generally leave the stitches in place for next baby, as they usually bury themselves; and provide good protection next time. I’ve had 6 repeats on the abdominal stitches I’ve placed, with good results so far.

      Probably luckier than any special talent, but it can work…

    • MeandAriel
      May 10, 2010 at 7:47 am

      Hello Emili,
      I just had a trans. abdominal cerclage (TAC) put in by Dr. Arthur Haney of the Univ. of Chicago Medical Center. Even though I live in Virginia, it was worth it for me to make the trip, as I have had two vaginal cerclages. The first one was put in as an emergecy mesaure when my sac had already began bulging around 18 weeks and the second was put in around 23 week (twice). The stich came out for the second time and I delivered early. Neither of my babies lived. Please give Dr. Haney a call. You can have the cerclage put in when you are not already pregnant, like me, or at 10 weeks pregnancy. Also, my hubby and I are older 41, and will try two more IVF cycles before we give up.
      Best of luck to you – Monica

    • dr Shashikant Raghuwanshi
      September 30, 2010 at 6:36 am

      its from India and we have doctors with experience in repeat cervical cerclage , may be of your help.

      • Swati Joshi
        October 28, 2012 at 5:24 pm

        Dear Dr.Raghuwansi

        I had two losses (2010 @ 25 wks and 2012 @ 22 wks with failed mcdonald)
        Do you know any experienced surgeon in India who does pre pregnancy TAC either with laproscopy or open method?

  8. zrey1980
    May 7, 2010 at 4:56 pm

    I am 14 weeks pregnant and this is my second pregnancy. I had twins in my first pregnancy and it was a girl and a boy, but i lost my son after two days of delivery. I had lot of complications during pregnacy like, bleeding, dribbling when it was about two months. Now my doctors advices me to do a cerclage but i am clueless. Please advice me.

  9. SSingh
    May 15, 2010 at 5:52 pm

    Great post and easy to find on google.

    Consider laparoscopic cervical cerclage for these cases. Especially if you know prior to pregnancy, it may be easily placed and avoids a laparotomy. We have done many in pregnancy as well and have over a 100 cases in our series now (mainly in Canada but taught it in Australia and Ireland as well). We used a #1 Prolene suture instead of the mesh and leave it in after C/S and have had multiple deliveries in the same patient with this approach.

    Check out our article:
    Whittle WL, Singh SS, Allen L, et al. Laparoscopic cervicoisthmic cerclage: surgical technique and obstetric outcomes. Am J Obstet Gynecol 2009;201:364.e1-7.

    • Kate Sunn
      January 18, 2011 at 10:42 pm

      I lost my twin girls at 23 weeks due to suspected IC causing the PTL. I want to have a lap TAC performed by Dr Ades in Melbourne Australia who uses the Toronto method described in your paper. Should this type of cerclage be able to hold twins? I have been told that only traditional “open” TACs are successful but I am reluctant to have the open surgery if the laparoscopic way is just as good.

      Is the Prolene as strong as Mersilene?

      • SSingh
        January 20, 2011 at 5:21 pm

        Hi,

        We have had successful twin pregnancies with this approach. The use of the ‘mesh’ is not based on science or any good reason other than it being used vaginally for many years. The Prolene suture has been used vaginally as well, causes less inflammation and scarring and has similar outcomes.

        Lastly, by having it placed when you are not pregnant you avoid all the risks of anesthetic in pregnancy and the stress of losing the pregnancy if any complications occur. Pre-pregnancy laparoscopic cerclage is the preferred route.

        I had the opportunity to teach Dr. A. Ades this technique in 2007 and am glad that he is providing this option for women.

        Good luck.
        S. S.

      • January 23, 2011 at 11:24 am

        I don’t believe there is an head to head data between laparoscopic and open procedures. Theoretically they should be the same, as after the procedure the same stitch is in the same place. Placing a laparoscopic stitch when one is pregnant may be difficult or impossible, however.

        I prefer merseline (5mm web/fabric), as in my mind it would cut into the uterus/cervix less than a thin monofilament Prolene suture. I don’t believe there are data to prove either preference, however.

    • Sherryl
      September 5, 2011 at 5:03 am

      I know it has been over 1 year since this was posted, but just came across this post. I had a miscarriage at 24wks with a TVC due to infection making me go into labor back in May 2011. Prior to that I had lost another one at 20wks due to PPROM.

      I found a doctor in the southeast Florida area – his name is Dr. Charles Leroy. I think he does the Laparoscopic cervioisthmic cerclage technique. Does anyone know this doctor, does anyone reccommend him?

      I have been doing more research prior to committing to the surgery. I am pretty sure I will go through with it as it seems to be the logical way to prevent my cervix from opening. Last time the perinatal was doing weekly internal sonograms, we saw how the cervix began to open after the 12 week, each week a bit more and more until we reached week 22 which seemed more stable, but then the infection messed everything up.

      All comments help. Thank you!
      Sherryl

      • Lena
        October 2, 2011 at 5:35 am

        Hi Sherryl, my name is Lena. I went through almost the same issues as you. My first 4 pregnancies I miscarried at 20 weeks, they called it a spontenous abortion but I HATE that name. During these 4 pregnancies my cervix opened to soon causing infections. During my 5th pregnancy I had a vaginal cerclage which did not hold and I gave birth at 23 1/2 weeks. The baby died 3 days later.

        During my 6th pregnancy which was my last, I went to a perinatoligist (high risk specialist) and he placed an abdominal cerclage meaning they stitched the cervix from the top becauser they found out through test that I had a short cervix. I also had weekly internal sonograms after the stitch was placed and was placed on strict bed rest for basically the entire pregnancy. I still delivered early but I delivered my daughter at week 36, she weighed 5 lbs. 13 oz. The name of my doctor is Michael Moretti. His office is in St. Vincent’s hospital in Staten Island, NY. He doesn’t take regular OB patients, he only deals with high risk pregnancies.

        I hope this helps you. Good luck!!!!

    • Swati Joshi
      October 28, 2012 at 5:38 pm

      Dear Dr.Singh

      Do you know any experiecned doctor in India for TAC?

      I had two losses (2010 @ 25 wks and 2012 @ 22 wks with failed mcdonald)

      Do you know any experienced surgeon in India who does pre pregnancy TAC either with
      laproscopy or open method?

      Regards
      Swati Joshi

  10. Stacy
    June 9, 2010 at 9:17 pm

    Hi Dr. Fogelson,

    It’s Stacy Tsai (one of the residents from UH). Thanks for the posting. I found it very useful. I have one scheduled for tomorrow.

    Thanks,
    Stacy

    • August 14, 2011 at 5:31 am

      That’s awesome Stacy! Good luck in your MFM fellowship!

  11. July 8, 2010 at 5:04 am

    Sir,
    I am 27 year old. My baby was delivered premature on the 20 weeks in to pregnancy when I was pregnant first time. That is when Dr’s informed me about my cervical incompetency. Later I got pregnant again with twins. Drs did vaginal cerclage when I was 12 week, but on 18th week both babies were delivered.

    Initially my cervix was 6 cms in length, but due to second delivery and related complications the length of the cervix got reduced to 2 cms. It’s been one year since this happened and we are planning to get pregnant again. But this time we were advised to go for abdominal cerclage.

    We are currently staying in Minneapolis, MN and I would appreciate if you could help me with good Drs references in Minneapolis area.

    Thanks,

    Lakshmy

  12. July 14, 2010 at 1:06 pm

    Lakshmy – I’m sorry I don’t really have any contacts in the Minneapolis area. I suspect that there would be an MFM with the right experience at the local university hospital.

  13. Kelly
    July 22, 2010 at 1:50 pm

    Hi Dr Fogelson,

    Thank you for helping to raise awareness of the Trans Abdominal Cerclage. I had a TAC placed in Australia in May 2009, and when researching the prodecure, I found little information. I think the more awareness, the better. I was lucky enough to have a proactive OB Gyn who advised me that this was my only option to bring home a live baby. I had stillborn twins at 20 weeks in January 2009 after a failed emergency TVC at 18 weeks. It was discovered too late that there was little external cervix due to previous cone biopsy surgeries, so the TVC only held for a week before I went into PTL.

    I am now currently 17.5 weeks pregnant with identical twin boys and my cervix is looking fantastic…all thanks to my TAC! (At this stage in my last pregnancy it was 1.1cm and it is now 4.2cm!)

    For the other ladies who have commented and are considering a TAC, there is a wonderful site called Abbyloopers.org which provides information and support through their Yahoo group.

    Wishing you all the best,

    Kelly (Melbourne, Australia)

    • Sammie
      January 21, 2011 at 1:46 am

      Hi Kelly, iam happy to hear your pregnancy is going great. I ‘am also from Melbourne Australia and interested in your story.
      I’am due for an app in 6weeks to opt for an abdominal cerclarge. ( i have had 5 misscarriage due to ic). Im just wondering which Doc did ur surgery for?

      please reply

  14. Ozzie
    October 29, 2010 at 5:30 am

    Hello,

    I am pregnant for the third time with a TAC placed at 12 weeks. I am 34 weeks. I know you don’t need to remove the stitch and can use the TAC for a few babies but I was wondering how easy it is to get pregnant with a TAC in place. I don’t understand how can anything including sperm can go up there in the uterus if it’s tighly shut.
    Sorry this seems a strange question with probably a very simple answer. Blame it on my pregnancy brain.

    Also, how long do you recommend the TAC to stay in place or for how many babies?

    Thank you,
    Ozzie

    • October 30, 2010 at 6:09 am

      Abdominal cerclage does not affect future pregnancy rates as far as we know. No matter how tight you make the cerclage, its not going to be tight enough to keep sperm out, which are seriously small. Furthermore, an abdominal cerclage is not actually tied as tightly as a vaginal cerclage, because it may stay in for a long time and there one day may be a need to do a curretage procedure for a miscarriage. Abdominal cerclages are placed so high that essentially they are above the cervix. Placed correctly, it shouldn’t really matter if the cerclage is tied super tight or has a 1 centimeter gap – either way a baby isn’t going to fit through. Transvaginal cerclages fail when the cervix above the cerclage effaces and dilates. An abdominal cerclage is different – placed high enough that the cervix is all below it, so that the pressure of the infant is held by the stitch rather than the internal cervical os.

      Abdominal cerclage should typically stay in until childbearing is complete. Most people do all of these deliveries by cesarean, so its not hard to remove the cerclage with the last delivery. If the cerclage is placed with the knot posterior (not what I am showing or describing), one can do a colpotomy (hole in the back of the vagina) and cut and remove the cerclage that way, thus allowing a vaginal delivery. Most docs don’t do this though.

  15. Angela Daniely
    February 1, 2011 at 5:02 am

    I have a abdominal cerclage and I think it is great because now I no longer fear the lose of a baby. I know anything can happen , but with this cerclage in place , I feel much better. The only problems that i have is when the baby moves i can feel a whole lot of pressure and it can sometime be overwhelming. I have been told to lye down in this case but do you have any other suggestions because lying down all the time is not something that is good for the body, my body at least. Also I work, I drive a lot and the pressure may just start while I am on the job.

  16. Angela Daniely
    February 1, 2011 at 5:15 am

    Angela Daniely :I have a abdominal cerclage and I think it is great because now I no longer fear the lose of a baby. I know anything can happen , but with this cerclage in place , I feel much better. The only problems that i have is when the baby moves i can feel a whole lot of pressure and it can sometime be overwhelming. I have been told to lye down in this case but do you have any other suggestions because lying down all the time is not something that is good for the body, my body at least. Also I work, I drive a lot and the pressure may just start while I am on the job.

    I am now twenty four weeks in my pregnancy and this is the longest I have went during a pregnancy since my first two live babies who are now twelve and eleven

  17. Sharon Warner
    August 2, 2011 at 10:50 am

    Hi Dr Fogelson
    Will a TAC allow the blood flow of hemorrhage from the uterus or will it cause pooling? I have had two 2nd trimester pregnancy losses due to an incompetent cervix and with both pregnancies I had a lot of bleeding during the first trimester.

    • August 2, 2011 at 10:59 am

      It should have no effect in this regard. The stitch is not tight enough to prevent blood from escaping. Many people with a TAC will keep it in place for many pregnancies, and continue to menstruate past the stitch.

  18. Shamekia
    August 2, 2011 at 12:43 pm

    Hello, Dr. Fogelson

    I have lost 3 children(twins and just last year my daughter at 22 weeks) both in the second trimester, my question is I am currently 5 weeks pregnant and would like to know when is the earliest I can have the TAC procedure? is it 10 weeks or 12?

    • August 2, 2011 at 1:03 pm

      I can’t really give you specific medical advice, and would recommend a consultation with a maternal fetal medicine physician regarding your situation.

      In general, a cerclage, abdominal or otherwise, should be placed in the late first / early second trimester. Most people wait till about 12 weeks, but the exact timing is not critical. We want to wait long enough that we can do an ultrasound that confirms that the pregnancy is without major anomaly and is completely viable, but do the cerclage early enough that no cervical shortening has occurred yet. Some patients wonder why we wait this long, but it is important to understand that first trimester losses cannot be prevented with a cerclage, as they are generally not the result of incompetent cervix.

  19. Kim Marban
    August 13, 2011 at 5:15 pm

    I am 27, have PCOS and have had multiple 1st trimester losses as well as a 18w4d loss due to an icompetent cervix in May. To get pregnant, I take Menopur along with timed intercourse. My MFM Dr. plans on doing a TVC around 12 weeks. How do I know whether or not a TAC would be better? We will be starting a cycle in about two weeks and I’m wondering if I should look further for someone who is willing to do a TAC cerclage prior to trying to concieve.

    • DM
      August 14, 2011 at 4:25 pm

      I had a TAC placed at 13 weeks when my cervix length dropped to .5cm. It was an emergency procedure that saved my child. No worry of tearing like a TVC. She was delivered by csection at 35 weeks. Best decision I ever made.

  20. August 13, 2011 at 6:15 pm

    I cannot give specific medical advice about your case as I am not your doctor and do not know enough about you.

    In general, abdominal cerclage is considered when a patient has had a failed transvaginal cerclage in the past, or there is an indication for a transvaginal cerclage but placing one is not feasible (ie patient does not have enough vaginal cervical length to place the stitch). There is no evidence that an abdominal cerclage is ‘better’ if a patient has never had a vaginal cerclage before. The vast majority of cerclages that are placed are transvaginal.’

    Your MFM is almost certainly aware of all of these issues, most likely to a more advanced level than I (as I am not an MFM).

  21. DM
    August 14, 2011 at 3:25 am

    I have an abdominal cerclage in place from an earlier (successful) pregnancy. I am pregnant again and am having bleeding – for about 2 weeks since learning I was pregnant, light flow and spotting (pink, brown, red, depends on the day). Is is possible the stitch could be irritating the cervix and causing this issue? If this ends up being a miscarriage will the tissue pass through the stitch at 6 weeks? I am scheduled to see my dr this week, but would appreciate your thoughts re the stitch and its implications for future pregs. thanks!

    • DM
      August 14, 2011 at 3:43 am

      Just a note that my HCG levels are rising normally. My progesterone levels were falling slightly so my dr put me on progesterone supps and they are back up where they should be now.

  22. August 14, 2011 at 5:30 am

    DM – I really can’t give medical advice, and you’re question is quite specific. Talk to your physician.

  23. DM
    August 14, 2011 at 4:22 pm

    Hi – Sorry, I am not really asking for any advice. I will get that from my Dr this week. I just am interested in knowing whether any of your patients with TACs ever had bleeding due to their stitch/irritation of the cervix. And, generally speaking, if miscarriages/D&Cs can take place/be performed with a TAC in place (and up to what point?).

    • September 22, 2011 at 11:27 am

      A transabdominal cerclage generally would not cause bleeding in the vagina, as the stitch is not present in the vaginal canal. It should be almost entirely retroperitoneal and in the abdominal cavity.

      Usually a TAC is tied down loose enough that a 10 mm currette could be placed in the uterus with the stitch still in place, allowing a D and C for a fetus up to 10 or 12 weeks in size.

  24. Bobbi
    August 20, 2011 at 3:53 am

    Hi i was just wondering how successful ivf with icsi is after TAC. Will they implant only one embryo after cerclage or two ?

    • September 22, 2011 at 11:26 am

      TAC should not affect the ability to perform IVF with or without ICSI. Number of embryos implanted is a complex decision made individually for each case. An REI would better be able to address the issue for your particular case.

  25. Nic
    September 22, 2011 at 11:10 am

    My wife had our first(her second) at 35 weeks, she had a placenta abruption. The delivery went fine. During the pregnancy we found out she was in the early stages of cervical cancer. A few months after the birth, she was scheduled for a cold knife cone. She had one and then they found out there was still some spots that were missed. We had allready had a child so we decided to just get an hystorectomy. One week before the surgury, we lost our son to SIDS, so decided to do another cold knife cone. That one got everything and talking to our docter he recommended a cercloge. With having the surgurys, there was not enough cervix for a vaginal cercloge. Our dr recommended us to a specialist in Salt Lake City, Utah. He told us that they are not recommended to put them in prepregancy, and that they put them in at 14 to 15 weeks. He called the specialist and set an appointment up with us on monday to meet him. We meet with him, and he said it would be a good idea but they usually put them in at 11 weeks, she was 14 weeks along at the time, they decided to do it on wednesday because she was so far along. Our dr also said it will be an in and out same day procedure, we found out that it was treated like a c-section so about 3 days in the hospital. He also said they make 3 small cuts in the abdomin to put it in, but its the same cut as a c-section. The dr told us the risks and that we could lose the baby during the surgury. But the risks were minimul and with the preterm baby before and cold knife cones it was still recommended. They completed the surgury and everything went well, but they had a hard time placing the stitch, because the uterus was so big. And after the surgury the ultrasound showed the fluid level in the sac was alittle lower then it was during the ultra sound. So they told us possible risks of that. Well the ultra sound we had today, they couldnt see the baby, reason being there was no fluid left and there was no heartbeat, so we lost our baby this morning. We are under the impression that if our main dr would have informed us about the surgury time that if it would have been done at 11 weeks instead of 15 so the uterus wouldnt have been so big at that time. We are kinda at a loss and dont know what to think. Everything the dr told us was completey wrong. But even the specialist said he still recommends it and the risks of what happened are really low like 10%. What are your thoughts on this and do you think it could have been prevented doing it at 11 weeks. She is getting ready to go in to get the stitch removed tonight, and get a d & E then put the stitch back in. Sorry about the long story, mispelled words and wrong names I posted.

    • September 22, 2011 at 11:24 am

      Thanks for the comment. I can’t comment on specific cases outside of a doctor-patient relationship as it represents a liability for me. Rupture of membranes during abdominal cerclage is a known risk of the procedure, if it is done during pregnancy.

      • Nic
        September 25, 2011 at 4:14 pm

        what would you say the % of ruptured membranes is for abdominal clerclages put in during pregnancy. We new it was a risk, but a better risk then not having one, she has no functionial cervix left.

  26. Melanie
    November 3, 2011 at 1:41 pm

    Hello, I have a TAC already in place and have had one successful pregnancy as a result. (I had 2 losses at 23 weeks prior to the TAC.) I recently became pregnant again and miscarried this week at 6 weeks. My cervix has felt really sore ever since. My doctor is treating me with antibiotics in case of possible infection. However, I’m concerned there may be damage to my cervix. Is there much information regarding early miscarriages with the TAC in place? Does the cervix attempt to open during a 1st trimester miscarriage? If so, would it open enough to potentially damage the cervix with the stitch in place? I have a follow-up appointment in a week and my doctor will examine my cervix more closely. Just wondering in the meantime if other women have had this experience and if everything was ok with their cervix.

  27. Mike Lynch
    November 5, 2011 at 10:56 am

    My wife had a successful abdominal cerclage in August of 1999. She was bedridden for the remainder of the pregnancy, but our daughter was born on Jan. 11, 2000. She is a healthy growing young lady! Without this procedure, she would not be ALIVE TODAY!!!!

    Good luck!

  28. Barbara
    November 14, 2011 at 9:27 am

    Nicholas,

    I am the unit coordinator for a perinatal center in New York. I am wondering if you know of any physicians in the New York area that perform the abdominal cerclage. The patient is NYS Mediciad based.

    Thank you

    • December 22, 2011 at 4:18 pm

      Barbara – I have no specific information, but would suspect that there are MFMs at any of the academic centers that can do them. I suspect that Dr Farr Nezhat would do a laparoscopic abdominal cerclage if needed.

  29. Krishnen
    November 26, 2011 at 2:52 pm

    Iam from India. My wife had a miscarriage at the beginning of 5th month in Sep 2008. The baby dint survive. Then she had PCOD problems, because of which it took time for the next pregnancy. She was pregnant again in July 2011. Upon our consultation and doctors advice, she had a TVC done at the beginning of 3rd month. She was in complete rest. When we went for a scan at the beginning of 19th week, it was found that the internal OS was opened (Funneling). Doctor adviced her to lie down with her feets slightly lifted. She was at complete bed rest in that position for 5 days. But at the beginning of 20th week, the water broke and doctor adviced to remove the stitch. She gave birth to the baby (normal delivery) and the baby dint survive.
    Now I need advice on further course of actions like,

    # to become pregnant (overcome PCOD issues),
    # perform TAC (before/after identifying pregnancy),
    # avaiability of such facilities in Chennai,
    # if TAC done before pregnancy, possibility of getting pregnant , overcome PCOD problems

    Note: Iam a Chemical engineer (sorry if i had used any impropoer terms)
    My wife is a dental Surgeon.

    Thanks in advance for Your advice/suggestions.

    • Swati Joshi
      October 28, 2012 at 5:33 pm

      Dear Mr.Krishnen

      I also had same issues as of your wife (except PCOD).
      I just wanted to know did u find any doctor in India for TAC?

      I am also searching for the same.

      Thanks,
      Swati Joshi

  30. November 26, 2011 at 4:53 pm

    I can’t give specific medical advice, but in the clinical situation you describe I would usually recommend either a Shirodkar cerclage in the next pregancy or an abdominal cerclage done prior to or early in the pregnancy. An abdominal cerclage does not interfere with getting pregnant, as it does not close cervix tightly enough to prevent fertilization.

    Polycystic ovary disease can be managed in a number of ways. If pregnancy is the #1 goal, the most effective way, in general, is ovulation induction through clomid or letrozole, followed by other agents if those do not work. Weight loss and the use of metformin can also improve pregnancy rates, and have less risk of multiple pregnancy.

  31. andrea
    April 11, 2012 at 3:06 am

    I had a abdominal cerclage procedure done in 2005 and was able to successfully complete my pregnancy after 3 miscarraiges and a failed vaginal cerclage. I had an IUD placed for 6 years after that and had it removed in July 2011. Ive been trying and have had no success in getting pregnant. Im wondering if there could b a cause from the abdominal cerclage that is stopping me from getting pregnant

  32. June 18, 2012 at 6:29 pm

    Hi, I’m very disappointed to read that many doctors are only willing to place a TAC after multiple 2nd tri losses. I feel this is a lack of education on the part of the medical community in not understanding the nuance of what cervical insufficiency presents as prior to bulging, pprom, painless dilation, etc. I know in my experience, my pprom was labeled “fluke” but a vaginal cerclage was still prescribed for future pregnancies. I’m glad I didn’t listen to them, but went straight to TAC with Dr. Haney.

    Dr. Arthur Haney at the University of Chicago is a God-send to many women in this regard, as is Dr. George Davis of New Jersey and Dr. James Sumners in Indiana. More doctors would do well to pursue an education in IC and TAC placement from any of these men. Vaginal cerclages are antiquated and costing babies their lives.

    Further, there is a group on Yahoo called Abbyloopers that carries a wonderful database of TAC doctors around the world, along with a myriad of files on all things IC, TAC, and TAC pregnancies.

  33. onah
    September 19, 2012 at 4:57 am

    hi, i had 3 miscarriages 1st at 18 weeks,then 25 weeks lastly 24 weeks. i was diagnosed of cervical incompetency and biconuate ueterus. i’v done TVC twice, took some med ie progesterone suplements, nifedipine, salbutamol and antibiotics as i turn to have preterm labour did bed rest but non of these helped. So i asked one dr how can my situation be resolved but he opted TAC. Please help, with this TAC will i be able to get through term without having preterm labour and wha will happen if i go into preterm labour?

  34. swathi
    December 21, 2012 at 6:38 am

    Contact details of the hospital which performs TAC in Bangalore, Karnataka, India

    Dr.Kamini Rao Hospitals
    A Unit of BACC Health Care Pvt. Ltd
    #909, 47th Cross, 9th Main, 5th Block
    Jayanagar, Bangalore – 560 041

    Telephone – 91-80-26534444, 91-80-26534445

    For more details you can go to the website
    http://baccweb.com/index.html

  35. swathi
    December 26, 2012 at 6:02 am

    Swati Joshi :
    Dear Dr.Raghuwansi
    I had two losses (2010 @ 25 wks and 2012 @ 22 wks with failed mcdonald)
    Do you know any experienced surgeon in India who does pre pregnancy TAC either with laproscopy or open method?

    • Unknown
      May 27, 2013 at 9:44 pm

      I know it is too late, but Fernandez Hospital in Hyderabad provides all kind of medical care for repeated pregnancy losses. I have had two miscarriage and had a TAC with a succesful child and now i am pregnant again with the 2nd child with a TAC on. I am lil worried if TAC can sustain another pregnancy too.

  36. swathi
    December 26, 2012 at 6:04 am

    Contact details of the hospital which performs Transabdominal cerclage (TAC) in Bangalore, Karnataka, India

    Dr.Kamini Rao Hospitals
    A Unit of BACC Health Care Pvt. Ltd
    #909, 47th Cross, 9th Main, 5th Block
    Jayanagar, Bangalore – 560 041
    Telephone – 91-80-26534444, 91-80-26534445
    For more details you can go to the website
    http://baccweb.com/index.html

  37. January 3, 2013 at 8:30 am

    Why viewers still use to read news papers when in this
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  38. DM
    March 10, 2013 at 5:06 pm

    I have a TAC that is migrating (after 2 pregnancies) into the vaginal canal. Any experience with this? How it can be removed?

    • May 19, 2013 at 7:56 am

      It should be able to be removed via hysteroscopy in an outpatient procedure. Laparoscopy might be required to get it out. I’d be happy to help in Atlanta.

  39. Unknown
    May 27, 2013 at 9:46 pm

    Will TAc be be able to hold future pregnancy too. I am 11 weeks pregnant with a TAC. I had two preganny losses and then had a TAc. pls suggest

  40. Unknown
    May 27, 2013 at 10:24 pm

    In continuation to the above, i was on bed rest and did not work for the first child with the TAC, today with the 2d preganancy i am working 8 hour shift and travelling 26 miles every day to and for to work and taking care of my first baby who is 2 years. will TAC be able to withstand so much of physical activities that i am doing. pls suggest…desperately waiting.for yourinputs

  41. ventura
    June 8, 2013 at 1:26 am

    i am a obs/gyne in Spain how i can learn this operation? thank you very much

  42. suchitra
    July 16, 2013 at 8:38 pm

    Can anyone suggest for the above question, i am waiting for your response..

  43. suchitra
    July 22, 2013 at 12:24 am

    I m having severe cough and i have an abdominal cerclage, will it hurt teh cerclage pls help

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  1. January 2, 2011 at 3:24 pm
  2. May 30, 2014 at 1:36 pm

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