Beginners Guide To The TAC!

A few people have asked me what a TAC is and why I have it. Here is a bit of a beginners guide to the TAC!

What is cervical incompetence?

Cervical Incompetence (also known as IC) in a nutshell is when, during pregnancy, the cervix begins to shorten and or dilate prematurely, usually in the second trimester. If IC is untreated, Pre-Term Labour (PTL) will likely occur. This condition occurs in approx 1-2% of all pregnancies.

Of course, I was one of the 1-2%. It was discovered in my last pregnancy, at my 18 week ultrasound, that my cervix had shortened dramatically. As a general rule, if a cervical length of 2.5cm or less is discovered, there is cause for concern. Mine had shortened to 1.1cm. I was rushed into surgery the next morning.

How do you treat cervical incompetence?

The most common form of treatment for IC is a Transvaginal Cerclage (TVC). This involves sewing the cervix closed from the outside, strengthening the cervix and preventing the amniotic sac from bulging out and subsequently, the baby coming out. The stitch is then removed at around 36 weeks, allowing for a natural delivery.

Unfortunately, while the TVC does work for some women, it doesn’t work for everyone. It didn’t work for me. I was told that I virtually had no external cervix, so it was extremely hard to place the TVC as there wasn’t enough cervix to sew shut. At the time of the surgery, my OB could already see Twin 1’s amniotic sac bulging through my cervix, so it really was only a matter of time. My TVC was placed at 18 weeks, and it only held for a week. At 19 weeks I started having contractions, and my water broke. My TVC had to be removed. I managed to stay pregnant for another week, but at 20 weeks the contractions became too severe, and after 29 hours of labour, I delivered our twins, L&T. Basically all the TVC did was buy us an extra 2 weeks. Sadly not enough time.

A less common form of treatment for IC is a Transabdominal Cerclage (TAC). This involves placing a synthetic band around the cervix, but much higher, through an incision in the abdomen (similar to a c-section incision). This can be placed before pregnancy, or during early pregnancy. Delivery is by c-section, through the same incision used to place the TAC. The TAC is permanent and stays in for future pregnancies. More than 95% of TAC pregnancies are successful.

Six weeks after L&T were born, at my follow up consultation with our OB, he told us about the TAC. I remember him mentioning it the day I delivered, but it sounded so scary and so major, that I didn’t pay much attention to it. When he mentioned it later though, and said that it really was our only option to carry a baby to term, I paid attention.

Of course, I spent the next couple of months researching the TAC. I found virtually nothing in Australia, but luckily a couple of websites in the US. One of those sites was Abbyloopers. Membership to this site is available to women who suffer from IC and either already have a TAC or are looking at getting a TAC. I found so much valuable information here and gained the knowledge to make my decision.

My IVF Doctor, in conjunction with my OB, found a surgeon here in Melbourne willing to place my TAC, and on 21 May 2009 I had my surgery!

We are confident in my TAC and things are looking great at this stage. Our next scan is in a few days (18 weeks) and we hope to hear that my 'super cervix' is still around the 4.2cm mark!

The plan is to deliver via c-section sometime in the 37th week. My personal goal is to make it to 34 weeks, and anything past that date will be a bonus!