Trans-abdominal cerclage

[Jolie, BSN]

Did anyone see tonight's episode of "Maternity Ward" on TLC? They profiled a patient who had experienced numerous fetal loses despite the placement of a cervical cerclage with each past pregnancy. She sought out the care of a perinatologist who performed a trans-abdominal cerclage early in her current pregnancy and she was able to carry a baby to term.

The doc explained that it was more effective than a cervical cerclage because the "stitch" was taken at a higher point on her cervix, much closer to the body of the uterus. Does that prevent the cervix from effacing as well as dilating? Other than requiring a C-Section at delivery, what are the risks? What happens if the mother has preterm labor with this type of cerclage in place? Is there a risk of tearing the cervix?

Has anyone worked with patients who've had this procedure done? What have their outcomes been? Does anyone know if this is relatively common, or is it done only at certain high-risk centers?

Thanks for the info.

[shay]

I've never had a pt. with one or even heard of one until now.

It seems logical. In my cerclage pts. who've had multiple losses despite the cerclage in place, the problem was usually that the cervix had become very weak and torn from being stitched so much. It would make sense to me that if the stitch were closer to the 'neck' of the cervix that it would be stronger and there would be less incidence of tearing of the cervical tissue.

Why would a c-s be mandatory? Tell me what you find out about this....interesting.

[Jolie, BSN]

Shay,

According to the program, the stitch is too high to be accessed lady partslly. In order to be removed, an abdominal incision is required, and therefore a C-Section.

As one with a history of premature cervical dilation (but also pre-term labor), I'm curious whether I could benefit from this.

Thanks for your input.

[MickeymomRN]

I also saw the episode and that was the first time I've ever heard of the transabdominal cerclage. I've only worked with the cervical kind. I've seen them work and I've seen them dilate through it, tearing their cervix. I thought the TA cerclage was a great idea! Anyone out there who works with a doc who does this? and where at?

[mom22]

Houston Perinatal Associates in Houston, Tx does it on occasion. We see a few, but it is not a common proceedure by any means.

[luv l&d]

we do them in denver, probably 5-8 per year. considered kind of a "last resort" as it does require a c/s to deliver. have seen it sucessful, when other options have failed.

[mother/babyRN, RN]

This is the first I have heard of this sort of cerclage but it does sound as though it would be more effective. To luv land d in Denver, about 4 years ago my sister in law from Ft. Collins went ino pt labor at 23 weeks, went to some hospital in Denver, was found to be GBS positive in one sac, that baby was delivered, she was circlaged and then on tocolytics and ended up delivering a healthy surviving twin at 37 weeks. If you or the staff were in any way involved THANKYOU! We are not technically a high risk unit ( though we do receive and keep high risk people at times). I am amazed and awed at all you special people do. Thanks again!

[ejoann]

Please contact Dr. Haney at the University of Chicago. The Transabdominal cerclage is 95% effective with incompetent cervix, so many babies have been saved by this procedure. The skill of the surgeon is very important.

[klone, MSN, RN]

I've "seen" (not seen directly, but read the operative report) one here in Denver. We all thought it was pretty cool.