If you have ever struggled with infertility or been plagued with “female problems”, as I have, you may have heard the term “transvaginal cerclage” before. However, you may not be as familiar with what an “abdominal cerclage” is. I have learned, from personal experience, that there is not as much information out there about abdominal cerclages. Take it from someone who has had one of each, here is what you need to know.
*I am not a doctor and am simply providing information based on my personal experiences. For more information, questions, or concerns, please contact your doctor.
What is a Transvaginal Cerclage?
A cerclage is a fancy word for a surgical stitch. You will also hear the term “cervical cerclage” or “cervical stitch”. Basically, your doctor will go through your vagina and use a surgical stitch to sew your cervix closed. Your cervix is located at the base of your uterus and is what helps keep the baby safely in your womb when pregnant.
Imagine your uterus is like a balloon and your cervix is like the opening of the balloon. Your doctor will go and tie that opening closed. Just like you would do to keep the air inside of a balloon. Your cervix is also what “dilates” when it is time to give birth and allows for safe passage of the baby.
Why Would You Need a Transvaginal Cerclage?
Your doctor may suggest you need a transvaginal cerclage for several different reasons. If you have ever had a history of an incompetent cervix or second-trimester miscarriages. In my case, I had cervical cancer.
I was diagnosed with cervical cancer after a routine annual exam. In fact, I had scheduled the appointment earlier than the one-year mark because I wanted to talk to my doctor (again) about trying to get pregnant. The cancer was already quite advanced. From the time of my diagnosis and the time of my surgery, a period of three weeks, the tumor quadrupled in size.
I had what is called a cone biopsy. The surgeon went in, planning to cut a cone shape wedge, out of my cervix. However, the tumor had grown so large that my oncologist had to remove far more than he was planning. He was concerned that he was not able to remove all of the abnormal cells, but he did! I am so unbelievably lucky, words cannot adequately express
I am so unbelievably lucky, words cannot adequately express my good fortune. The downside, however, is that I was left with the absolute tiniest bit of cervix. This itty bitty piece of tissue would not be adequate to support a pregnancy without medical intervention.
If like me, you have had any trouble with your cervix in the past, your doctor may recommend a transvaginal cerclage if you become pregnant. Your doctor will review your history and do a transvaginal ultrasound to check your cervix. Don’t be afraid to ask your doctor questions!
When is a Transvaginal Cerclage Performed?
A transvaginal cerclage is usually performed somewhere between weeks 12-14 of your pregnancy. I had my transvaginal cerclage at thirteen weeks. My doctor explained that this is an optimal time because your cervix will have thickened to just the right amount to be stitched. Gotta love those pregnancy hormones!
It is also possible to have a transvaginal cerclage performed late in your pregnancy if your cervix begins to open too soon. In either case, the cerclage is usually removed during Week 37 of pregnancy, when it is safe for the mother to go into labor.
What is Having a Transvaginal Cerclage Like?
You will be given guidelines by your doctor before, during, and after the cerclage. For example, you may have to abstain from heavy lifting and sexual intercourse. Or, you may be required to be placed on bed rest. It is a hospital procedure, so you will have to arrive early and plan to stay for several hours afterward or overnight.
You will be given an epidural before the procedure, but you will remain awake. Be sure to let the anesthesiologist know if you have any adverse reactions. I am the queen of adverse reactions to anesthesia. After my transvaginal cerclage, I ended up back in the ER with the mother of all headaches, which turned out to be a spinal leak. This reaction is extremely rare, but that’s how I roll when it comes to anesthesia. If you experience any side effects, just call your doctor.
After the cerclage, you might have light cramping and a little spotting that usually disappears in a few days. Your doctor will probably recommend that you just rest and take it easy for a few days. No problem, doc! Pregnancy is exhausting!
To have your cerclage removed, it is a simple office visit. No sedation required. It is described very similarly to a pap smear. I am, again, an exception, so I cannot speak to this. However, my mom friends say this part did not hurt and was very simple.
What is a Transabdominal Cerclage?
A transabdominal cerclage is not as widely performed as the transvaginal cerclage and thus, there is a lot less information out there about it. Again, I am not a doctor of any sort, but when my doctor began discussing the possibility of a transabdominal cerclage, I began doing my research.
A transabdominal cerclage is like a transvaginal cerclage, only the stitch is placed higher. Imagine the transvaginal cerclage placed at the bottom of the cervix and the transabdominal placed at the top, closer to the uterus. I created my own visual diagram below, again it is not scientific, but I am a big fan of analogies!
How is a Transabdominal Cerclage Performed?
A transabdominal cerclage is performed laparoscopically. The surgeon makes several small incisions in your abdomen, one for a camera and the others for the surgical instruments. Again the surgeon ties the cervix with a surgical stitch, but this time it is done at the top of the cervix/base of the uterus.
You will need to be completely sedated for the procedure. Your doctor will probably tell you to make sure you do not eat or drink anything about twelve hours beforehand and you may be required to stay in the hospital overnight.
When is a Transabdominal Cerclage performed?
Here is the part that was a bit tricky for me. If your doctor thinks a transabdominal cerclage would be beneficial for you and your future pregnancy, he or she will most likely recommend that you have it done before you get pregnant. Your uterus is smaller and there are fewer blood vessels to worry about. And yes, you can still get pregnant if you have a transabdominal cerclage. Those little swimmers will still find their way in!
However, if like me, you seem to always buck the system, a transabdominal cerclage can be performed when you are already pregnant. As I described in my post, The Rare Surgery that Saved My Baby’s Life, this surgery is not as common. My transabdominal cerclage was performed robotically while I was pregnant. The camera and surgical instruments were all placed with robotic assistance. From what I understand, the surgeon was able to see exactly where to place the stitch through the use of the camera and ultrasound, which allowed him to be more precise.
At the time, I knew the surgery was risky. I did not know that if the surgeon was off by even a millimeter, I could have lost my miraculous pregnancy. However, I would make the decision to have the surgery again because it allowed me to carry my daughter to full-term with no complications. If you are considering this procedure, be sure to discuss the risks with your doctor before you undergo the procedure.
Why Would You Need a Transabdominal Cerclage?
You might be a good candidate for a transabdominal cerclage if you have a history of cervical incompetence or if you had a previous transvaginal cerclage that failed to preserve your pregnancy. A doctor might also look at whether you have had surgery on your cervix, like a cone biopsy. I check all of these boxes, but every case is different. Be sure to talk to your doctor about all of your options and which options best suit your needs.
What is Having a Transabdominal Cerclage Like?
I was nervous before the surgery, but my doctors kept me relaxed and calm. As I said, anesthesia and I are not friends. After the nausea subsided and let’s be honest, I was nauseous all of the time without anesthesia, the soreness set in. All of my incision sights were very sore. My doctor prescribed something for the pain, but with a bun in the oven, I decided to power through.
I was quite sore for a few days and there was a little mild cramping. My doctor instructed me to remain in the hospital overnight so that my baby and I could both be monitored. I was required to be on bedrest for my entire pregnancy, so I had plenty of time to rest after the surgery. If you are mandated to be on bed rest, check out my post on How to Survive Bed Rest (without losing your ever-loving mind).
If you are not required to be on bed rest, your doctor will give you instructions on when you can resume normal activities and return to work. Furthermore, if you do not undergo this procedure while pregnant, your doctor will let you know when it is safe to start trying to get pregnant.
The other factor of the transabdominal cerclage is that you will have to deliver via cesarean section. When your baby is delivered, the abdominal cerclage remains in place. This is different than with a transvaginal cerclage, where the cerclage is removed before delivery. However, since the abdominal cerclage remains in place, you are all set for future pregnancies!
The Bottom Line (Pun Intended)
After spending seven years trying to get pregnant, I thought the hard part was over. As it turns out, staying pregnant was equally challenging, if not more so. The best thing I did was talk to my doctors. I asked a million questions, but ultimately I trusted their advice.
Another important factor was maintaining a positive attitude. It was not always easy, truth be told. Somehow I mustered up all of hope and love and just kept it safe inside me. I prayed for and dreamed of the day that I would hold a healthy baby in my arms. It was a long and winding road to get there, but it was worth the journey.
Again, I am not an expert, but if you have any further questions about a transvaginal or transabdominal cerclage or if you just want someone to talk to about your struggles with infertility, please do not hesitate to contact me. I am sending you all my love, Mama!