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Abdominal Cerclage

Posted Jan 15 2009 7:51pm 4 Comments
Last night, I took care of a patient that had an abdominal cerclage placed when she was 14 weeks. This was the first time I'd ever heard of such a thing. I obviously know about the usual cerclage, but this was different. If I understood right, it can be place before conception or afterwards. And it is permanent so she'll have to have a c-section. She'd had 2 second trimester losses, an incompetent cervix and a failed cerclage previously, so she went to a large university hospital to have an abdominal cerclage placed. Now she's 35 weeks, so apparently it works. Anyone else know much about these? I'd like to ask one of the docs about it or research it a bit, but I didn't have the time last night. It sounded like it's fairly new, and the patient said the doc who placed it said it seems to work much better at maintaining a pregnancy when there has been evidence that prior pregnancies were lost only due to cervical incompetence. I'm guessing it's a newer thing? But, like I said, I'd not heard of it. None of us working had. My imagination dreamed up this image of the doc making the incision, taking this big honkin' rope and just tying it around the lower part of the uterus, above the cervix, kinda like tying up a garbage bag. I've got a vivid imagination, but actually it sounds like that's sort of what they're doing. I'm curious to learn more.

On a side note, I remember my first patient who delivered before viability at 21 weeks. I bet I'll always remember how that night went, her doc, her name and he little son's name. She has since gone on to have another baby and she came in last night for a labor check with her 3rd baby at 38 weeks. I had bonded with them when she was hospitalized on bedrest. She had been 3 cm at her 20 week sono, and so she spent about a week or so on strict bedrest to try to get her to viability. I was just off orientation and pregnanct with Clara but not showing much through scrubs. She hadn't been contracting, denied any pain at all. She called at one point because she felt wet. Her water had broke. Her doc said to just watch her, because there wasn't much we could do. She told me she needed to have a BM, and I was filled with dread, worrying that it really wasn't stool she was feeling. So, I gave her the bedpan. She hit her call light within a minute or two and the look on her face gave it away: she was delivering. He was born alive, perfect, but not ready to be out of the womb. At first, she didn't want to see him. It was shock I think, but when she realized he was still alive and that she could keep him warm and next to her as he passed, she decided she did want to hold her son. She and her husband had about 2 hours with him. I saw her the next a.m. and they showed me pictures. We all had a cry together. I had typed up this beautiful poem I found on thick paper and had it laminated, which she still carries in her purse, which she showed me last night. I remember when she had her second son 2 years later. And it's was again great to see her pregnant and due anytime.
Comments (4)
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Hi, I lost my babygirl at 21 weeks last year and cried when I read your message. You must be such a caring nurse, I'm so happy there are people like you in the world. The abdominal cerclage has been around for many years but is not used very often. There are two doctors in particular that have perfected the procedure, Dr Davis and Dr Haney (I'm sure there are many more). You are correct in that it can be performed pre pregnancy and during pregnancy, its permanent, and can be done keyhole as well as traditionally. When I lost my baby the hosptial said they would only consider a TAC after I had lost more babies. They have obviously never experienced losing a baby. There is no way I'm willing to take that risk and I'm meeting with a new doctor who performs the TAC to discuss my options. I hope your hospital will take interest in this procedure. Take care, Kristin
hi, i am 29yrs old,i have a history of incompentent cerclager,my first pergancy was in 18weeks due to incompentent cervix,later in my second pergency my doctor had done a cervical celecrage in 14th week,n aalso i gestational diadetes where took by insulin,but my water sac broken in 19th week n i had a miscarriage again for second time.pls advice me wht is step to be taken for the thhird pergency,an should diabeties been in control for cervical operation n why did water broke after cervix celercage 
I just went to Tufts Medical Center in Boston to have a TAC placed at 13 weeks.  I had the traditional surgery and went well.  I have had a history of 22 week losses and the docs had tried to do a TVC and they were unable to get the cervix they needed.  So that is why I traveled to Boston and a wonderful lady named Dr. Craigo preformed my surgery.  I am currently 18 weeks and looking forward to going all the way finally.  Best of luck to everyone!!!
I to have had several losses most recently Sept 8, 2010 I was 21 weeks and had a baby girl. My first loss was at 19 weeks I lost my first baby a son I had just found out I was pregnant with him and was over joyed to become a mom. I to was on bed rest with my daughter when my water broke but they had me deliver her due to the fact I was only 21 weeks ( I had a cerclage placed at 13 weeks then it slipped and they replaced it) I was hospitalized for 3 weeks then gave birth to my daughter. She was born alive and survived for 45 minutes. My husband and I got to be with her as well as my brother that came from out of state to be with me. My doctor is now sending me to a doctor in our area (Orlando FL) who does these abdominal cerclages and she is doing it before I get pregnant again. Because of the problems I have had the doctor says I may not be able to go back to work but we will see. Thank you for the encouragement of your letter we are looking forward to being able to have another child soon.
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