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NAVIGATION

Frequently Asked Questions

The University Of Chicago's FAQ on Cervical Insufficiency.

http://www.uchospitals.edu/specialties/obgyn/cerclage/faq.html

What is Cervical Insufficiency?

During pregnancy, as the baby grows and gets heavier sometime around the second trimester, it presses on the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born. This condition is called Cervical Insufficiency or weakened cervix, and it may lead to a miscarriage or premature delivery.

How often does Cervical Insufficiency occur?

An Cervical Insufficiency happens in only about 1-2% of 100 pregnancies. Almost 25% of babies miscarried in the second trimester are due to Cervical Insufficiency.

What Causes Cervical Insufficiency?

Previous surgery on the cervix
Damage during a previous difficult birth
Previous trauma due to D&C from a termination or a miscarriage
Congenital malformed cervix or uterus
DES (Diethylstilbestrol) exposure

What is the treatment for a weakened cervix?

A procedure which sews the cervix closed to reinforce the weak cervix in an attempt to keep the baby in the womb. This procedure is called a “cerclage” and usually performed sometime after the first trimester. The most common type of cerclage is called a “Transvaginal Cerclage” which is a suture which is placed through the vagina, within and around the cervix, much like a “purse string”.

Why Transabdominal Cerclage (TAC)?

In general a vaginal cerclage can only be placed so highly on the cervix due to the nature of it's placement. The higher the placement of the suture or stitch, the more cervical length is preserved. This is important because the length of the cervix is what protects the baby and the amniotic sac from infection and opening prematurely, causing miscarriage.

The TAC is placed via an incision in the lower abdomen (much like a c-section or bikini incision) and is approached from the upper portion of the lower uterine segment as opposed to via vaginal route. This allows for the cerclage to be put as highly as possible (at the uterine/cervical junction), and reducing the chances for "funneling" or opening of the cervix from the inside. Additionally, due to the nature of the placement, intra-abdominally, there is less risk of infection as there is no suture material exposed in the vagina at all, which helps to prevent "wicking" of potentially harmful bacteria.

Transabdominal Cerclage is usually reserved for:

1) women do not have enough cervical tissue with which to do the standard Transvaginal Cerclage and/or

2) women who have had the Transvaginal Cerclage fail in spite of having it placed prophylactically (prior to any cervical changes).

Transvaginal Cerclages generally hold a 70-80% rate of success VS. Transabdominal Cerclage which holds a much higher rate of success, 90+%. Consider the fact that this high rate of success is among patients who have true Cervical Insufficiency and that 90% success rate becomes even more impressive.

Not every physician performs TAC, yet there are doctors who are specially trained in the procedure and their patients have extremely positive outcomes, due to the fact that they were in the hands of skilled and knowlegable practitioners. Not every patient may need a TAC, but if you fall into one or both of the categories listed above, then a TAC is highly indicated.