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!

16 Weeks

First things first. Here is an updated belly pic taken on Wednesday evening:


We made the decision, in consultation with my OB, to finish work in my 16th week. I had planned to finish a few weeks later, but when we found out we were expecting twins, we thought it would be wiser to finish now.

I guess you could say the next few weeks are considered my 'danger period'. During our last pregnancy, my cervix shortened from 2.9cm at 14 weeks to 1.1cm at 18 weeks. At 18 weeks I was rushed into hospital for an emergency cervical stitch (TVC), at 19 weeks my water broke, and at 20 weeks I delivered L&T. So this is the time I need to rest. Yes there is a huge difference this time, I have my TAC in place, but we still want to be cautious and do everything in our power to bring these boys home in December.

So, that said, yesterday was my last day at work! I am officially on leave now until September 2011. Wow that seems so far away. I had a lovely farewell lunch with about 20 or so of my work friends and was given some beautiful gifts and cards. I honestly will miss going to work...mainly for the social aspect...definitely not the 6am starts or the actual working part! As long as that nasty pre-term labour doesn't rear it's ugly head, I will certainly pop in (or should I say 'waddle in') and say hello a few times before the boys arrive.

One of the pics from my farewell lunch:


Here is a peek in utero this week:

15 Weeks

So today was our 15 week 1 day scan.

Things looked great with our little guys...yup that's right...2 boys! I was pretty surprised to say the least, I was totally convinced there were 2 little girls in there! I guess the 'sparkle fingers' I thought I saw last week was actually Twin 2 trying to get my attention and saying "Hey, stop calling me a girl...I'm a boy!!". That'll teach me to believe the gender prediction quizzes on the internet and my iPhone...who would have thought they'd be unreliable??!! At least I wasn't alone, it seems most people (other than my Husband, Parents-In-Law, and a couple of friends) were on Team Pink too!

So I guess I should be changing the blog colour to blue then!

The boys have more than double their weight since the 12 week scan! Twin 1 is 136g and Twin 2 is 135g.

Here are a quick couple of pics from today's scan. We got 14 photos in total, so for now 2 is all I can be bothered scanning!

Twin 2 just chilling out:



Twin 2 was being a bit of a bully and kept kicking his Brother!

A side view of Twin 1 trying to escape Twin 2's little butt:

It's All About The Colour!

Okay, so you've probably noticed that I've changed the blog colours to a 'gender-neutral' colour temporarily.

The next time you see this blog, it will either be pink or blue!

Not long to wait now...

Team Pink Or Team Blue?!

Forget Team Edward or Team Jacob...which team are you on...Team Pink or Team Blue?

As we have tried unsuccessfully to see the gender of the twins on two occasions now, your guess is as good as mine at this stage!

I'm interested to know though...what gender do you think they are?

2 Girls?


2 Boys?

14 Weeks

I know I could have gotten out of my trackpants and into something a little nicer for the photo, but I was exhausted and thanks to my dear friend Morning Sickness I'd been throwing up all morning! And by the way, whatever genius decided to name it 'Morning Sickness'...a male I'm sure...needs a stern talking to! Speaking of morning sickness, not only are my hormone levels double with twins, so is the morning sickness. So much for a blissful second trimester...and it's showing no signs of going away any time soon!

We had our second Obstetrician appointment with Dr Y this week and things are progressing as they should. He did a quick scan in his office and my cervix looks fine and the twins are still little dancers! Twin 2 was even doing sparkle fingers, Bring It On style!!

The Cat’s Out Of The Bag!

Finally!

We travelled interstate to Queensland on 19 June to tell my family about the twins. I wanted to tell them in person, and then once they knew, we could announce it publicly.

Such a weight lifted off our shoulders! It was getting near impossible for me to hide (as you could see in the last post!) and as such, I was feeling pressure to tell people. But...I stood my ground (as ridiculous as I may have looked!) and didn't say anything until I was 13 weeks along and we were home from Queensland.

Now I can breathe again :)

12 Weeks

This is me this week. Can you believe I'm still hiding this belly? To be honest I'm not sure it's much of a secret, as it's pretty obvious!!



We also had another scan this week. I love getting a glimpse into their cosy little world! Things are looking great and the twins are doing everything they're supposed to be doing. Well apart from revealing their gender that is!! At this stage in 2008 we knew the gender of L&T. It was just so obvious. This time not so much.



The stats are:

Twin 1 - Weight is 69 grams. Heartbeat of 152 beats per minute. Risk of Down Syndrome is 1 in 12800.

Twin 2 - Weight is 64 grams. Heartbeat of 150 beats per minute. Risk of Down Syndrome is 1 in 10000.

Cervix - 4.1cm (The longest it's ever been! At this stage in 2008 it was 2.9cm)

So overall a very successful scan! We have our next scan at 15 weeks, so stay tuned!

This is what the twins look like in utero this week:

Hi Mum & Dad!

7 weeks 1 day...our first scan!

We were both so excited to meet our little baby, who we'd been calling 'Emmy-Lou the Embryo'! I was, however, wondering if it was going to be a little strange only seeing one baby on the screen. We'd been so used to seeing two babies up until now.

The sonographer showed us the baby and it was so tiny...looked nothing like a baby at all at this stage! She pointed out the various parts (baby, placenta, etc) although I don't think either of us knew quite what was what!

After checking on my ovaries and cervix, she asked how many embryos we had transferred. "Just one...why?!". "Well there's your baby...and there's the other one!"

Identical twins! Emmy-Lou AND Emmy-Two!

I think both of our hearts stopped beating for just a second!! We were both ecstatic. We both thought we had caught a glimpse of another baby earlier, but just put it down to probably being the placenta or something. I told you we had no idea what was what!!



This week was also very exciting as the twins have a brand new cousin! Baby Kahlia was born on 16 May, so she will be just over 6 months older than the twins. We hope they'll all be great friends!

What Waistline?

There comes a time when you've just got to accept the fact that you need maternity jeans.

Only it doesn't usually occur when you're only 7 weeks pregnant!

A Hint Of Things To Come

The pregnancy test on 21 April revealed high hormone levels...a sign of a strong pregnancy...and perhaps a hint of things to come!

The HCG level (Human Chorionic Gonadotrophin - the pregnancy hormone) was 507. Average levels at this stage are between 50 and 320. Interesting.

The HCG level one week later (5 weeks 1 day) had increased to 8900. Average levels at this stage are between 900 and 4900. Very interesting.

The HCG level another week later (6 weeks 1 day) was through the roof at 45600. Average levels at this stage are between 4800 and 28550.

It was then I asked Corinne the question "Could this indicate twins?". She said yes, but then again I could just have very high hormone levels. Hmmm. She said it's rare for an embryo to split, but it's not impossible. Hmmm.

A Pregnancy Test...Or Three!

On the morning of Monday 19 April (9 days after transfer), I decided to sneak in a home pregnancy test (HPT). They advise you not to do HPTs in case you get a false positive due to the IVF medication that may still be in your system, but as it was a frozen embryo transfer (and therefore no drugs), I thought "What the heck"!

Two strong lines appeared within a few seconds!!!



Of course I did another HPT the next morning, and again the morning after that...just to be sure!!



I had my official blood test on Wed 21 April at 8am.

That afternoon, I got an excited phone call from our IVF nurse Corinne congratulating us on being 4 weeks 1 day pregnant!

Ice Ice Baby!

We trekked to our IVF clinic on the morning of April 10. As we'd had embryos that hadn't survived the thawing process in the past, we were both nervous and anxious to know whether we'd be having an embryo transfer that day. This time we had 4 embyros on ice, so we'd hoped at least one would thaw successfully. Our embryo transfer was scheduled for 11.30am, but we had to arrive 45 minutes early at 10.45am to get checked in. After the usual paperwork, we were taken in by Julie, a lovely nurse we'd had several times. She remarked that this was our 7th cycle and decided that today was the day we were going to get pregnant. We even shook on it!

At 11.30am I was in the transfer room, up on the chair with the oh-so-appealing stirrups. I'd had the recommended 2 glasses of water one hour prior to transfer and by this stage I was busting at the seams! Of course, the nurse came in to let us know that the Doctor who would be doing our transfer was called into an emergency and would be a little late. I decided to go to the bathroom then, as I wouldn't have made it another 15 minutes. Luckily I did, as the Doctor was delayed by 30 minutes! I'd had another glass of water in that time, so we were good to go! This transfer was probably the quickest and least painful transfer I've had so far.

This is a pic of our embryo being transferred that I took on my iPhone. The white dot next to the arrow is our little embryo!


Close up: