Abdominal cerclage for Incompetent Cervix

[AngelMiasMum]

We lost our babygirl at 21 weeks due to cervical incompetence. I had a perfect pregnancy but at a routine ultrasound they realised that my cervix was only 13mm and funnelling. The following day it was 8mm. I had an emergency vaginal cerlclage inserted that ruptured the membranes so the water broke. I was induced a week later and our daughter died during labor. Our world fell apart.

I have been told by the hospital that next time when/if we fall pregnant (I have endo and a blocked tube), I’ll need a vaginal cerclage at week 12-14.

However, after spending months doing research I have come across so many women that have still lost babies with a vaginal cerclage in place. Their stories are heart breaking..

I don’t want to risk losing another baby. But I know if I get a vaginal cerclage I will still worry so much every single day of the pregnancy. There is also no way I would risk working, but the bed rest would drive me crazy and also increase my chance of getting blood clots (I have Factor V Leiden).

I am hoping that I can have an abdominal cerclage instead, as the success rate is over 90%. However there is not that many doctors in Australia that perform this procedure because it is such a big operation. I have heard that some doctors are using key hole surgery to perform it, which would make it safer but its apparently controversial.

I would like to get in touch with anyone that has had (or considered having) an abdominal cerclage here in Australia.

Thanks
Kristin

*angel Mia*
born 19 Oct 2008
due 4 Mar 2009

[chelle79]

Kristin,
I haven't ever heard of abdominal cerclage. My ob is considering me having a cerv cerclage at about 14 weeks due to having extensive removal of tissue from cervical cancers removed. I hope you get some answers soon hun! Sorry for your loss, stay positive and all the best :babydust2:to you.

[naebie]

Sorry for your loss, I too had a loss due to cervical incompetence, and 2 years later went on to have a successful pregnancy with a cervical cerclage placed transvaginally at 14 weeks. I was only placed on moderate bedrest after an ultrasound at 24 weeks showed a cervix length of 13mm and funneling to the stitch. After my cerclage was removed I went another 3 weeks before going into spontaneous labour at 41 weeks!

I have heard of transabdominal cerclages, but don't know of anyone who has had one in Aus. or any dr in Aus who performs them.

[AngelMiasMum]

I'm so sorry for your loss Renee, good to hear that all went well with your new bub :) My GP is sending me to Dr Cook at Wesley Hospital in Brisbane, hopefully he can help. I'll keep you posted :)

[AngelMiasMum]

Oh good luck Chelle, I know there are a lot of "good news' stories out there regarding the vaginal cerclage. Not sure if thats the way I want to go after our loss, hopefully we can get an abdominal cerclage.. but you never know..

[lissyd]

Hi,My name is Melissa and i was wondering if you found out any info on the abdo cerclage?as i have a incompetent cervixs and have lost 3 babies due to it and have 2 live kids .I lost twins last july at 24 weeks and now 9 months on want to try again a big risk but something i want to do .My obs/gyno wants to do another vag cerclage but i have a lot of scarring .I lost my twins not so much because of the cerclage but i had a massive infection in the placentas.So any info you have found out would be great .I am in toowoomba QLD.
Cheers,Melissa

[AngelMiasMum]

Dearest Melissa, I am so sorry for your losses.. there are no words that can explain how much I would like to take away the pain for anyone that has lost a child.

I have done months and months of research and there is no way I would try another vaginal stitch (TVC). The number of women I have come across that have still delivered too early because 1) the stitch caused an infection or 2) the cervix opens down to the stitch and they tear open. The point is that the TVC might be able to help your cervix to a certain degree but it can not stop the baby from being born. I had to have my stitch removed and it was the worst feeling, knowing that my baby would be born after they did it. Many doctors believe it has no proven value to stop a preterm delivery. Having said that there are many women that had a TVC who has been able to deliver at term. But its often hard to know why things go the way they do.

I was told an abdominal stitch was not an option for me by my Ob who I found out is not informed on the issue. She gave me a lot of incorrect information, and was it not for my own reseach I would have believed her.

I have found a lot of support in a group forum on google called Abbyloopers, there is 1000 mums there that are considering having/or have had an abdominal stitch. Reading their stories is heartbreaking and also give a lot of hope.

The abdominal stitch can be done pre or post conception (often at 12 weeks), it can be done similar to a c section or through key hole surgery. In all these cases the abdominal stitch is permanent, and you have to deliver by c section.

The two best abdominal stitch doctors in the world are in the US, Dr Haney and Dr Davis have a great successrate of 97% (with zero pregnancies failed because of the stitch). Obviously there are other reasons why preg failes. Dr Davis does the abdominal stitch for 'cost' for overseas women (approx $US4000). If I had the money I would go over there.

I have been able to find 3 other doctors that perform the abdominal stitch in Australia (Brisbane, Sydney and Melbourne). The doctors at Mater had only done 1 or 2, so that was not an option for me.

Dr Stephen Cook at Wesley Hospital in Brisbane has performed this operation, but i'm not sure how many. I have a referal to see in in June (he has long waiting list).

I signed up for private health in Feb so I'll wait 12 months before I have any surgery. The scariest thing for me would be to fall preg with twins, as I don't think a vaginal stitch would hold. I will let you know how my app with Dr Cook goes, in the mean time I'm trying very hard not to fall preg..

Pls note I'm not a doctor and the above is simply based on my research. Good luck, I would love to hear how you go.

Take care, Kristin

[AngelMiasMum]

Link to Appyloopers group:

http://health.groups.yahoo.com/group/Abbyloopers/

"Welcome! The purpose of this group is to provide a discussion format for Abbyloopers, soon to be a non-profit organization which serves to discusses transabdominal cerclage, a specialized procedure for the treatment of premature delivery due to the condition of Cervical Insufficiency, or otherwise referred to as Incompetent Cervix.

We have been featured on the University of Chicago Medical Center's Website, as well as in the Chicago Tribune.
http://www.uchospitals.edu/specialties/obgyn/cerclage/

This is a great place to obtain information as well as support for those who already have or need this type of cerclage."

[lissyd]

Thanks Kristen for the info.I to had a emergency stitch put in with my daughter who is now 12yrs old .I woke one morning at 25 weeks with slight pain and a light bleed ,i was rushed to hospital and it was found out i was 4cm dilated membranes bulging,a stitch was inserted and i went on to 33 weeks and then my waters broke and i deliverd a 5pound 12 baby girl that was healthy .I was living in VIC at the time and was rushed down to royal womens after the stitch was done. I stayed down there till i hit the 32 weeks then was brought back to bendigo hospital ,but i remember when i was in the royal womens a girl was there from Tassie and she had a abdo stitch after i think it was 6 losses between 18-24 weeks gestation,she went on to have her little boy at 34 weeks that weighed in at 6 pounds and healthy.So it has been around for a while as that was nearly 13 yrs ago,so there is hope.My son that is 7 now was born at 32 weeks ,i had a stitch put in with him at 14 weeks and had no problems till my waters broke at 32 weeks he was 6pound 2 and only spent 2weeks in special care .So please dont give up on your dream if you cant have abdo stitch ,as the stitch with the twins i had last yr was doing its job it was the infection that caused me to lose them and my ob said even with out a stitch women can still can get infections in the uterus.So i wish you the best of luck in your journey to have a baby and i also would lve up dates on your progress.I have a appointment with my ob this thursday and i wont to ask him about seeing a ob down at the mater as they would see more people with our problems more so than here in Toowoomba.
Good luck Kristen

[bluebear]

Hi, I have just had my second letz procedure done and the dr's have told me my chances of holding a pregnancy beyond 20 weeks are almost nil.
I have been trying to consider what other options I have for another baby. After reading your post I have booked an appointment to see my local gp to get a refferal to see Dr cook.
I live in Hervey Bay, but my sister lives in Brisbane and goes to the wesley hospital for her pregnancy's. She is currently 23 weeks pregnant with her 4th baby. SHe thinks the Dr's at the Wesley are great.
I'm desperate to try anything for another child. I have been blessed with two beautiful children, but I feel my family is not yet complete.
I lost 2 pregnancies last year before having the two letz procedures done and that was heart breaking, but I want to try again. At the moment I can't as I have to wait for the results of the last letz and do a follow up pap smear, but if it all goes well this time then maybe I can try this Dr Cook. If things don't go well I will have no other choice next time but to have a histerectomy. But there are still options for another child after that, even if the little precious is not carried by me. Right now I have to believe that.
Thank you for giving me hope again.
Tammie.

[AngelMiasMum]

Hi ladies

I had my appointment with the doctor at Wesley Hospital in Brisbane but unfortunately it didn't turn out that great.

We have been very set on finding a doctor who can perform the abdominal stitch, as it has a success rate of 97%. In fact many doctors says it cures an incompetent cervix completely. In forums I have read the stories of women who have lost 3 or 4, some even 5 or 6 babies before they get told of the permanent abdominal stitch. They then go on to have 9 month long successful pregnancies, some even with twins.

Unfortunately the doctor we recently met with had very limited experience with the abdominal stitch. He had performed the procedure only 2 times through laparoscopic surgery (key hole) rather than the traditional method (similar to c-section). He admitted that one of his two patients was on bed rest for 4 weeks in hospital while dilating. This was in fact his first patient and unfortunately she lost her precious baby. I’m not sure if his second patient has fallen pregnant yet.

So I’m sorry to say that this doctor’s experience is very limited.

The good new is that last week I found out that there is a very experienced doctor in Brisbane, Dr Brunello. He has performed the abdominal stitch approx 20 times and also overseen another 20 operations (which is a lot more than the other doctor’s 2 operations).

Dr Brunello doesn’t think a women needs to have multiple losses to prove that she qualifies for the operation, or that she needs to prove that a vaginal stitch wont work.

He said – Why risk losing another child when you can have an operation that almost guarantees a successful pregnancy (of course other things can still go wrong like any pregnancy).

The Gold Coast couple that met with Dr Brunello has experienced 3 second trimester losses after doctors kept telling them they would be fine with a vaginal stitch instead. Now they have finally found someone that can give them a successful pregnancy. Best of all, Dr Brunello has never had a patient with a loss due to Incompetent Cervix with an abdominal stitch in place.

Because I had never heard of dr Brunello, I believed there were no doctors here that would help me because I have only had one loss. So 4 weeks ago we arranged for a free phone consultation with Dr Davis in NJ (US), who many believe has performed the most abdominal stitches in the world. Finally a doctor that told us that he could give us a full term pregnancy! Talking to him was amazing, and really gave us so much hope.

He has performed over 250 of these operations on women from all over the world. He performs it the traditional method (similar to c-section), pre-pregnancy or around week 10-12. His pre-pregnancy success rate is 100% and in-pregnancy 97%. He said it is a simple procedure that takes 20 minutes to just over an hour, and I’ll be in hospital 1-2 nights. He doesn’t recommend bed rest to his patients as most of them work up until their scheduled c-section. The cost is approx US$4000 for the operation and the hospital stay.

Because we decided we wanted to go with the best, rather than being rejected by more Australian doctors, we have booked our tickets to the US and will be flying over in less than 4 weeks. I have been in touch with many (!) of his former patients, many who are in their second or third pregnancy with the same abdominal stitch still in place. I’ve also been in touch with a lady from Sydney who had 4 losses before flying to Chicago to have her surgery there, she is currently pregnant.

I do wish we had heard of Dr Brunello earlier, but at least now I can let other people know that there is an experienced doctor in Brisbane that can help women with Incompetent Cervix. And he sounds amazing.

For those that are unable to travel to Brisbane, a lady in Melbourne had her abdominal stitch done by Prof Tom Jobling two months ago after losing twin boys and she was very happy with him and the procedure (traditional open surgery, not key hole). The doctor who I believe has performed the most abdominal cerclages in Australia is also based in Melbourne, Dr Mark Umstad. He does the TAC the traditional way through open surgery and I believe he has done approx 40 operations. A lady who had her operation done by him a few weeks ago said he was amazing.

My advice to anyone with incompetent cervix:

Do as much research as you can, gain all the knowledge, consider your options, and then decide what’s best for you; the TransVaginal Cerclage (TVC) or the permanent TransAbdominal Cerclage (TAC). Only you can make this decision.

Once you have made that decision, start interviewing doctors until you find one that you are comfortable with and that has the experience (very important). Don’t let any doctor tell you otherwise. You can listen to their advice, but remember that it is their opinion based on their experience and might not be the best option for you. It’s your body and its your choice to make an informed decision.

My surgery is on 28 August and I’ll let you know how it all went when I get back 2 weeks later. We can TTC on the next cycle and I'm so excited about the prospect of having a successful pregancy.


Hugs
Kristin

[loulou13]

Hi there
Im sorry for your loss. I to have suffered 2 lost baby girls. Bayley at 20 wks incompedent cervix even with stitch placed. and then Matilda at 23wks also with stitch. I also have endo. I had my tubes removed so my pregnancys have been IVF. I have know had an abdominal stitch placed and about to have our 5th round of IVF. I had my procedure done in Perth at the King Edward Memorial hospital, I think that i wass the first there to have the stitch placed thru keyhole surgery. My IVf team Put me in touch with Professor Hart who performed the surgery. I understand that the success rate is around 90 percent. So as u can imagine we are hoping that we will be welcoming a new addition into our family so time soon. I wish u all the luck.:)

[AngelMiasMum]

Hi loulou

I'm so sorry for the loss of your two precious babygirls. And then having endo as well, its just not fair is it. I'm so glad you have been given an abdominal cerclage (TAC). The success rate is great and it lasts for all your pregnancies.

Its becoming more normal here in Australia to perform the procedure, although there are a few doctors here who have provided the TAC to their patients for many years already.

You are the first girl from Perth I have heard of so congratulations on leading the way over there :)

I just wanted to mention that I know of 3 ladies with 3 different doctors in Australia where the key hole TAC failed and they lost their babies. This is because the operation is a lot harder to perform laparascopic than the traditional method of open surgery. Please make sure you insist on scans of your cervix every second week (or even weekly?) from week 18 to 26. I'm sure you will be fine but please keep this in mind and be your own advocate.

Good luck on the IVF, I'm sending you lots of baby dust. Hopefully we'll both have our miracle babies in our arms soon.

Hugs
Kristin


QUOTE=loulou13;4022205]Hi there
Im sorry for your loss. I to have suffered 2 lost baby girls. Bayley at 20 wks incompedent cervix even with stitch placed. and then Matilda at 23wks also with stitch. I also have endo. I had my tubes removed so my pregnancys have been IVF. I have know had an abdominal stitch placed and about to have our 5th round of IVF. I had my procedure done in Perth at the King Edward Memorial hospital, I think that i wass the first there to have the stitch placed thru keyhole surgery. My IVf team Put me in touch with Professor Hart who performed the surgery. I understand that the success rate is around 90 percent. So as u can imagine we are hoping that we will be welcoming a new addition into our family so time soon. I wish u all the luck.:)[/QUOTE]

[AngelMiasMum]

Hi ladies

To those of you who have followed my story, I would like to thank you for your support and encouraging emails!

3 weeks ago I had my abdominal cerclage (TAC) operation done in the US and I can honestly say it was the best decision we have ever made. I had really high expectations from reading about Dr Davis on a lot of different forums, and he certainly the most amazing doctor I have ever met. His knowledge of obstetrics and his experience dealing with cervical insufficiency really impressed us both. When examining me he found a long tear at the back of my cervix which no other Australian doctors had discovered, and he said the tear in addition to my incompetent cervix would have given me a very slim (if any) chance of success with a vaginal cerclage (TVC).

So yes, the operation went really well. The abdominal cerclage was placed perfectly, and according to Dr Davis I can now go on to have a normal pregnancy with no bed rest or risk of my cervix not holding. I spent 1 night in hospital and was sightseeing in New York City 4 days later.

I have a 10 cm scar along the hairline low on my tummy which will fade over time. My hubby loves my scar and I do too! Other than feeling a little sore now that I am back at work, I feel amazing. I was told I have to wait 6 weeks before I do housework which is the best part :)

Hopefully we'll fall pregnant by the end of the year, and we are discussing how many babies we want to make sure we get our moneys worth from this operation lol All up we spent about $10,000 incl hospital & doctor fees, hotels x 12 nigths, return flights x 2, rental car x 4 days, food etc etc. The best spent money ever! And we also had the best time over in the US, it really felt like a holiday and we enjoyed spending some quality time together.

From my many months of doing research about incompetent cervix I have so much information about the abdominal cerclage. If this can be of help to anyone else, please just send me an email. My whole cerclage placement story is on the ic forum: http://ic.hobh.org/forums/ (just look in the cerclage placement section)

There are also some photos from after the operation: http://www.facebook.com/album.php?aid=307920&id=848110354&l=1330a2c3be

Hugs
Kristin

[naebie]

Kristin, that is fantastic.
Sending you a tonne of baby dust so that you may conceive in the near future, and have a happy, healthy pregnancy!

[lulu177]

Hi LouLou,
So sorry to hear of your loss. I joined this forum after reading your post. I live in the uk, suffered PROM at 16 weeks with IVF twins, lost Gabriel at 17 weeks and Samantha at 20 weeks a week after a TVC. I cant emotionally cope with another miscarriage, and need to reduce as much risk as possible. How long after the laporascopic TAC were you able to try for IVF?
Im booked for another round of IVF July 21st 2010, and want a TAC before pregnancy. How long is the recovery? Did it effect the success of your IVF?
Your advice is appreciated.
Lou

[Iused2bewithit]

Hi Kristen
Firstly Im so sorry for the loss of your baby girl Mia. Whilst I havent personally experienced this, as a mother it is a parent worst nightmare.
I just wanted to wish you the best of luck and I hope you fall pregnant soon with your little bundle of joy. Sending you lots of baby dust and best wishes.
Sonya

[arall]

Hello,

I am currently recovering from a laproscopic abdominal cerclage which was placed 2 days ago. Although I have not had a loss due to IC I have had several surgeries on my cervix and have been told I would need one to carry a pregnancy to term as I do not have much of a cervix to place a vaginal stitch.

The doctor who performed this procedure is Dr. Alex Ades in Melbourne at Royal Womens hospital for those of you in Australia looking for someone. I understand he is the only doc to do it laproscopically in Australia. Dr. Mark Umstad also in Melbourne and Dr Laurie Brunello in Brisbane, also do the procedure but as I understand the caesaearn style.

Anyway I am recovering well, was a bit sore yesterday but up and moving around today and will be back at work 7 days after the op.

Ideally the procedure Is done whilst not pregnant, but I am 7 weeks pregnant - so was petrified about going under the general, but doc said all went really well , another scan on Monday to check all Ok. Fingers crossed x

[Woody1982]

Arall how are you doing? I'm looking at having this done also at the same hospital :(

[arall]

Hi Woody,

I am doing great - currently 24 weeks pregnant. The recovery from the stitch surgery was fine although I have 2 lovely scars on my tummy ( a small price to pay). I have had to have scans every 4 weeks from the surgery time to check cervix length and my cervix has remained closed and a good length, so the stitch has been doing its job well ! Having the abdominal stitch has also taken the need for bedrest out of the pregnancy so I been able to stay fairly fit with regular exercise and my job involves been on my feet all day ( restaurant)and apart from regular pregnancy aches and pains, have had no problems.

I would recommend the surgery and no hesitation in recommending Dr. Ades, he was great and even answered my emails and questions I had after the surgery. I had been through 8 stimulated cycles of IVF to have this baby and was not going to take the risk of losing it from IC, and I am so glad I made that choice.

Good Luck and any more questions, Just post !

arall

[mummymofo]

Hi there,

Unfortunately we lost our first child this weekend at 19 weeks due to a weak cervix. The vaginal sucture I'd had placed didnt hold because there wasnt enough cervix to grab, and funnelling had already started at 15 weeks.

Obviously we're heartbroken but are also trying to look to the future and my only option for a successful pregnancy going forward is to have an abdominal cerclage which the doc thinks would be best to place laparoscopically before I get pregnant. However, he doesnt know of anyone in Sydney who has done many of these procedures.

They're looking into it but as far as we can ascertain, the most experienced specialists that have performed lots of these procedures are in Brisbane or Western Australia.

Does anyone know of a specialist who can do it in Sydney?

Ideally one with lots of experience - or would it be worth the risk of having it done by someone who has only done a few of them? If not, I'll have to go interstate.

[Woody1982]

Sorry to hear :( I lost my little man 2 and a half weeks ago. Yet to have appointment after all the tests but they suspect incompetent cervix. I was too far dilated so I couldn't get a stitch... Was yours preventative or emergent? If you are willing to travel there are some good drs at royal women's that specialise in this. I'm sorry for your loss :(

[arall]

Oh mummymofo, I am so sorry for your loss. Give yourself some time to grieve.
I travelled to Melbourne from Sydney to have the operation with DR. Alex Ades who works from Royal Womens hospital. ( just google there is some info on this procedure on his website). As far as I am aware no one does it in Sydney and he is quite experienced in doing the surgery laprocopically .The surgery is day procedure but Expect to spend a week in Melbourne, so he can check on you before you are allowed to return home. He was extremely helpful and answered all my questions I had by email, before I even got to Melbourne.

Good luck

[mummymofo]

Thanks for the info guys, will def contact Dr Abes.

Have any of you also heard of a doctor Stephen Lyons as his name was mentioned, along with Dr Robert Ford who could possibly place a transabdominal cerclage?

Obviously we're still in bits, especially as we got to meet our poor son who died during labour. His bag burst through the stitch and he was born still in the amniotic sac. Just heartbreaking. The docs and midwives were fantastic and are being so supportive.

I'm going to be closely monitored at the high risk unit at Royal North Shore next time and must say, I'd highly recommend them, unlike Manly Hospital which has been shocking. The midwives are fab but the doctors less so .

I just wish I'd flown to Perth for an abdominal stitch at 14 weeks after speaking with a Dr Pennell who was willing to do it, but my Manly doc advised against it. Turned out she had no knowledge of the procedure.

She admitted my cervical stitch was a disaster as there wasn't enough to grab, so it was basically a case of winging it. We gambled and we lost. So regret not flying to Perth there and then.The guilt of my child dying is killing me :-(

So my advice to anyone with a high risk pregnancy on the northern beaches would be to bypass manly hospital and go straight to RNS, but do your research also. After all this I dont want an abdominal suture put in by someone inexperienced.

Out of interest, which procedure is best, laparoscopicaly or open surgery caeserian-style? X

[mummymofo]

So Saddened to hear about your loss too. Just awful.

My cervical stitch was a supposedly preventative one after my cervix had shortened from 25mm to just 13mm in a week or so. Then it started funneling at week 18 and was over the day before we'd have been 20 weeks.

I believe there's a place for vaginal cerclages but in my case, the cervix was already weakened du e to two cone biopsies, being misshapen and having hardly anything left to stitch,

It's a bloody unfair learning curve isn't it x

[Woody1982]

Were you all put on bedrest with the stitch? The TAC I think I read never requires bedrest, but from the forums I've read the women who were on bedrest lasted much longer. I've been told I won't be given the TAC until I've had a failed TVC (another loss!), but bedrest and a TVC means I'll probably have to sell my business as it has me on my feet all day. :(

[mummymofo]

Hi Woody,

I find that very heartless that they expect you to go through another one before even considering a TAC. Of course you could go on to have a successful pregnancy, but I can see how you would be hesitant.

Did you had any scans to measure the cervix length after 12 weeks, or have you had any previous procedures done on it? How far dilated were you?

I'd had a cone biopsy for pre cancerous cells and because they had to cut away a fair bit of cervix, it was left scarred, weak and very mishapen, so the TVC stitch I had placed at 14 weeks wasn't really strong enough to hold as it didn't have enough tissue to work with. I was already down to 11mm.

They said bedrest probably wouldn't make much difference so early on but I was to avoid anything strenuous, bending, lifting, sex and no straining on the toilet (TMI).

Unfortunately I feel the docs should have then referred me to the high risk unit to be monitored because when went there for my morphology scan at 18 weeks, I had already started funneling.

The specialist was worried and said to cut back on all activities, and that it could give way at any time so they'd monitor me weekly and if I funneled even just 1mm, they'd get me in on bed rest.

My bosses agreed to let me work from home but unfortunately the cervix gave way at the weekend so before my next appointment.

I was in a bit of pain over the weekend and started bleeding on Sunday night but as i was already 5cm dilated when i went to hospital, was nothing we could do but hope he could hold in and that infection wouldnt set in. Both long shots and sadly he was born.

Are you under the care of a high risk unit or obstetrician? because of my previous procedures, my doctors agree that the abdominal stitch is my only hope.

It may be worth you getting a second opinion as you have so much to lose, and I was told bed rest isn't advisable early on in the pregnancy as can cause its own problems?

Which state or city are you in?

[Woody1982]

I'm in Melbourne and in june 2nd I had some pain in my back in the morning, I then realized it was coming in waves, so I went to royal women's and they found me 4cm dilated, bulging membranes. They did a swab and found no sign of infection.They took me to l&d but I didn't realize they expected me to give birth... By the morning I still hadn't so they moved me to recovery, put my bed on incline and kept me there (19 weeks)... The ob hoped the membranes would retract so she could place a stitch, but my membranes ruptured before that happened. We agreed to keep me till I got an infection to induce me because I couldn't let go of the hope of a miracle. I lasted till the 11th when I got a fever and had to deliver my little man :(
I've never had anything to make me think Id be at risk, no procedures, abortions etc. I've checked my 13 week scan and my cervix was measured at 3.5cm. I'm still waiting for a follow up appointment and referral to one of the specialists at royal women's....

[mummymofo]

Sorry for the delay, we went away for a few days and I didn't have my laptop with me.

Am so sorry to hear what you have been through and hope they can offer some suggestions for you going forwards. It is horrific and I've already snapped at a few people who mean well but have really peed me off by saying things like, "oh it wasnt meant to be, but at least you know you're fertile and can have another." :no:

I've got a followup appointment with my gynaecologist next week so will let you know how it goes.

I'm hoping to get the referral for the abdominal stitch and whatever else I need from him to take to either Dr Ades, Dr Brunello or Dr Umstad as want to get things moving. There are no guarantees but my gynae, like me, believes this is our only option of going full term with future pregnancies.

Please let me know how you go also and good luck xx

[Woody1982]

My dr doesn't like my chances of seeing dr umstad because he's in such high demand... I sent him my referral but haven't heard back yet... Here's hoping, I've heard such good things about him.

I might have issues ttc this time, I have some cysts that werent on my ovaries before, i hope there was no damage from infection but the ultrasound report I have to take to my dr in 2 weeks doesn't look good. As if we don't have enough to deal with, I'm starting to think I wasn't meant to be a mother.

[naebie]

Hi Woody,
Massive hugs, if you feel you were meant to be a mother, then you are!
I had a TVC placed preventatively, and I was instructed to have moderate bedrest, though that essentially meant that I couldn't stand for more than 2 hours at a stretch. This only lasted a few weeks though from memory.
The other restrictions were no heavy lifting, no sex and no baths/showers to reduce risk of infection.
By 24 weeks I'd funelled to the stitch, the closed portion of my cervix was around 1.4cm?
I ended up going overdue with my dd, after having the stitch removed at 37 weeks, so it shows that anything is possible.

[mummymofo]

Hi Woody,

You are definitely meant to be a mother, don't give up. It sounds like you need to address the cysts first, but if you want to see Dr Umstad too, be pushy about it - follow up with Dr Umstad's secretary, and don't be scare to get a second opinion from a different doctor or gynaecologist. This is your body :-)

The doctor from my original maternity hospital tried to make us feel guilty about seeking a second opinion but I'm so glad I did as I ended up in the maternity fetal medicine unit for high risk pregnancies. Although it wasnt good news this time, they've been fabulous and will monitor me from the very beginning next time.

As Naebie proves, there are success stories with TVCs, so see everyone you can and only go with who and what you feel comfortable with. It looks like yo may need to address the cysts first and then TTC, but please make sure you are with supportive doctors and gynaes, whoever you need to help you on this journey. You can do this xx

[bluebear]

Does anyone know if a TAC is available through public health or do I need to go through private to have this done, if so does anyone know approx how much I need to save to have this procedure done?

[mummymofo]

Hi Blue Bear,

From my understanding, the doctors that perform these procedures in Australia work both publicly and privately.

If you have private health insurance, you'd need to check with your provider but I think most of it is covered so you receive the $ back.

I think that surgery, overnight hospital stays etc are covered, the only thing that arent are the actual doctors appointments, but you get a lot of that back on Medicare.

It's probably best to contact the doctors directly to check x

[mummymofo]

Hi Kristin,

I'm wondering if you can help me - in your quest to get the right surgery and seeing all the doctors, did any of them ever mention doing the procedure vaginally instead of abdominally?

There is a doctor who places the sucture at the same place, i.e. at the top of the cervix where it meets the uterus walls, but it's done with minimal invasion.

Here's a link to the procedure... https://mail-attachment.googleusercontent.com/attachment?ui=2&ik=02c60f5ddb&view=att&th=13126ec180069d04&attid=0.1&disp=inline&realattid=f_gq36x6xp0&safe=1&zw&saduie=AG9B_P-TDpvJWysKEijxorqasSqo&sadet=1310619689206&sads=ZAaobAwSTIXxL7HXIooQu3TwR_c&sadssc=1

I need to have a stitch placed high up due to the fact my cervical cerclage failed and am torn between which procedure to have.

If I had this treatment it could be done in my home town of Sydney, if not, it means having it going interstate to have it performed laparoscopically or by open surgery.

If anyone else can also please spread any light on this I'd be very grateful, especially if you have first hand knowledge of the procedures and any of the doctors :-)

[speckled]

I am terribly sorry ladies, I can only imagine what some of went through. I was lucky.

At my morphology scan it was discovered that my cervix had funnelled, 9mm left, started to dilate, not yet 1 cm, and bulging membranes. It was a complete coincidence that it was discovered I had had no cramps, pain or tightenings.

My Ob had seen Dr Craig Pennell's technique in placing these stitches and sent me to him at the Womens hospy. He places the stitch as far up the cervix as possible, it's done vaginally and blind, the stitch is wrapped around the cervix and pulled tight to pull the cervix closed. It is now 27mm long! And holding. I was tipped on my head in theatre so my membranes could fall back so they could get it that high.

I've been on bed rest since, I'm now allowed up for a max of 1-2 hrs a day, accumulative, but have a irritable uterus and my cervix is still funelled down to the stitch. So at risk of early labour but am now 26 weeks! Not bad considering he thought it was due to infection, in which case he wouldn't have been able to stop the labour regardless of the stitch. He now thinks that it was due to the fact that my placenta isn't working well, and my twins are very small so my body decided the pregnancy wasn't viable. It might not happen again but he would put one in electively.

He did say that if put in electively it is less complicated, more successful and bed rest shouldn't be necessary.

I'll try and find out what the proceedure is called, it's far more successful putting it higher, but most Obs cant do it as it is technically difficult and they can't see what they're doing, it's done by touch.

I hope I haven't made the OP feel any worse, you made the best decision you could at the time. But i'm trying to give optimism.

[speckled]

Modified shirodkar. (I think)

[mummymofo]

Hi Speckled,

That's great news that it's still holding out so strong, though the thought of them tipping you on your head is slightly alarming!!

Is it called the TVCIC? Did they place the cerclage right at the os where your uterus meets the top of the cervix? I take it from the posting that you're in WA?

Am very heartened to hear how well you're doing with it and wish you all the best for your imminent arrivals. Is the stitch to be kept in or will they take it out? x

[Woody1982]

Hi girls,

Just wondering how everyone's doing?

I thought I was going to have trouble getting pregnant again because of the cysts... But um, two faint bfp's today and yesterday, seems all I have to do is open my legs and I'm utd...

Now the worry commences.

I have my follow up app next week at the royal womens after losing my baby at 19.5 weeks in June. They told me to wait 3 mths so I expect a slap on the wrist but I also want to go knowing the course I want to take. I know the head ob wants to monitor me and do a stitch if necessary, but I'd rather a preventative stitch. Tvcic is possible. I think.

Any advice would be great. Hope you are all doing great xox

[mummymofo]

That's GREAT news Woody, huge congratulations!

Who would you be having the TVCIC with? Professor Michael Bennett in Sydney is fantastic and will do the TVCIC if you're pregnant.

You could also look at the TAC but Prof Bennett is the one who pioneered the TVCIC in Australia and from the research I've done, is highly respected and recommended by everyone in that field.

As we don't have time on our side, he told me to wait until I've had one period and then we could try again, and he has done the procedure on lots of pregnant women with great results.

It may be worth you contacting Dr Alex Ades too who is in Melbourne?

Am delighted for you. Definitely see as many people as you can now in order to make an informed decision, and go with your gut.

Because of what happened last time, make sure you're happy with the doctors you see and will be getting monitored as high risk from the start.

Please let me know how you get on xx