Thursday, August 15, 2013

Transabdominal Cerclage Q & A

Lately there has been alot of traffic to the blog and questions here (and in real life) regarding the transabdominal cerclage.   Im going to host a little Q & A below to answer the most commonly asked questions.
Prior posts on my TAC experience can be found here and here.

How did you find out about the TAC?
During Bedrest with Virginia.   I had a lot of time to do a lot of research and happened upon it when researching rescue cerclages.  No one was willing to give me a cerclage with Virginia given the late gestation and complete effacement.

Why not go for a TVC (transvaginal cerclage)?
Personally, I just feel that the stakes are too high.  I had rapid cervical changes, major funneling, and aside from some sporadic braxton hicks contractions I had NO idea that anything was happening.  I feel the TAC gives me the best chance to carry to term and the best chance to avoid bedrest.

Who did your procedure?
Dr. George Davis in New Jersey.  He performs hundreds of these each year and placed 9 other TACs the week I had my surgery. is the best resource for looking for other providers and general info regarding the TAC.

Did they operate through your prior incision?
Nope :(   My c-section incision was too low. 

What type of anesthesia did you have?
I was intubated and under general anesthesia.  My understanding is that spinal anesthesia is only used for patients getting their TAC during pregnancy

How was recovery?
I had the open (not laproscopic) TAC and recovery went really well  considering that it was an open abdominal procedure.  I had minimal bleeding and really the focus of my recovery was resting my abdominal muscles.  I was was driving after 10 days, I was able to pick up Virginia towards the end of week 2 and I was up to full workouts by week 5-6 and back to ab exercises 2-3 weeks after that.  

Can you feel the TAC?
Nope.  Early in my recovery I had some twinge like pain that I assume was at or near the TAC but nothing since then.

Will you need IVF for a future pregnancy?
I have actually even been asked this by 2 physicians ... yikes!  No, the TAC is tight enough to prevent dilation but it is not locked and sealed ;)  My doctor indicated there is some evidence of fertility issues in some women after the procedure but it is relatively uncommon.  

Could you still deliver prematurely?
Yes.  I don't plan to though :)  According to Dr. Davis, this procedure essentially takes the cervix out of the picture.  It is a so called "cure" for cervical incompetence.  What it doesn't prevent though is preterm labor or any of the other possible reasons for a premature birth.  We feel confident that we have eliminated my largest risk factor.  I will be followed very closely and cautiously for preterm labor, especially considering that I had a classical (vertical) c-section which increases the risk for uterine rupture.  

Will you have to have another c-section?
Yes, but I would need one anyways due to my previous classical incision.  The TAC stays in place and is not intended to be removed.

Any other questions?  Feel free to comment and Ill answer them there :)


  1. Thank you so much for this FAQ. I am hoping to undergo a TAC soon (pre pregnancy) as I have had a loss at 18 weeks and subsequently needed many months of bedrest with my daughter, who was born at 37 weeks with a failing vaginal cerclage. I am so happy to hear that general anesthetic is used, as I am extremely nervous about yet another surgery and would not like to know whats happening. Did your doctor mention anything about the TAC raising risk for uterine rupture? I had a t-shaped incision with my daughters cesarian birth and am curious about another incision to my uterus. Thanks!

  2. I am so very sorry for your loss and traumatic pregnancies. Have you talked to any of the TAC docs yet? My TAC was done by Dr. Davis in NJ and I find him to be so knowledgable, supportive, and reassuring. I too have the concern about uterine rupture because of my classical incision. Dr. Davis indicated that the TAC does not increase your risk for rupture. He explained that the cervix will still efface naturally and under contractions but it should not increase your chance of rupture. This is how I remember our conversation at least... certainly set up a phone consult with him and Im sure he can explain further. The TAC however will not involve an incision to your uterus. Many people compare the procedure to a c-section because your abdomen is opened in a similar fashion but there is no cut made to the uterus. Instead a mersaline band is tied around the top of the cervix/bottom of the uterus. hope that helps.. definitely let me know if you have any other questions! Good luck with your road to the TAC!