Name of the Procedure:

Cerclage of cervix, during pregnancy; abdominal
Common name(s): Abdominal Cervical Cerclage, Transabdominal Cerclage (TAC)

Summary

An abdominal cervical cerclage is a surgical procedure performed during pregnancy to place a stitch around the cervix to help prevent preterm birth or miscarriage. This method involves accessing the cervix through the abdomen rather than the vagina.

Purpose

The procedure aims to treat cervical insufficiency (a condition where the cervix begins to dilate and efface prematurely). The goal is to reinforce the cervix, reducing the risk of preterm delivery and increasing the chances of carrying the pregnancy to term.

Indications

• History of second-trimester pregnancy losses due to cervical insufficiency.
• Previous failed cervical cerclage performed via the vaginal route.
• Anatomical abnormalities of the lower uterus or cervix.
• Short cervix diagnosed via ultrasound during pregnancy with a history of preterm birth.

Preparation

• Pre-procedure fasting (usually 8 hours before surgery).
• Adjustment or discontinuation of certain medications as advised by the physician.
• Routine blood tests and imaging (e.g., ultrasound) to assess the cervix and pregnancy status.
• Meeting with the anesthesiologist to discuss anesthesia options and medical history.

Procedure Description

1. Anesthesia: The patient is given general anesthesia or regional anesthesia (such as spinal or epidural) to ensure they are comfortable and pain-free during the procedure.
2. Incision: A small incision is made in the abdominal wall, typically above the pubic hairline.
3. Accessing the Cervix: Through this incision, the surgeon carefully reaches the cervix.
4. Stitch Placement: A strong suture material, typically a non-absorbable tape, is placed around the cervix and tied to keep it closed.
5. Closing Incision: The abdominal incision is then closed with sutures or staples.
6. Monitoring: The patient is monitored in the recovery room until fully awake and stable.

Duration

The procedure typically takes about 1 to 1.5 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Obstetrician-Gynecologist specialized in high-risk pregnancies and surgical procedures
• Surgical nurses
• Anesthesiologist
• Surgical assistant

Risks and Complications

• Common: Infection, bleeding, discomfort at the incision site.
• Rare: Injury to adjacent organs (e.g., bladder, intestines), complications from anesthesia, preterm labor, rupture of membranes.
• Management: Antibiotics for infection, careful monitoring, and prompt medical intervention if complications arise.

Benefits

• Significantly reduces the risk of preterm labor and second-trimester pregnancy loss in women with cervical insufficiency.
• Increased chance of carrying the pregnancy to term.
• Benefits usually realized immediately as the cervix is effectively reinforced.

Recovery

• Hospital stay: 1-2 days post-surgery.
• Pain management: Pain relief medication prescribed as needed.
• Activity restrictions: Avoid heavy lifting and strenuous activity for several weeks.
• Follow-up: Regular prenatal visits to monitor the cervix and the health of the pregnancy.
• Full recovery: Generally within a few weeks, but patient should avoid certain activities as advised by their physician through the remainder of the pregnancy.

Alternatives

• Vaginal cervical cerclage (less invasive, but may not be suitable for all patients).
• Progesterone supplementation (for less severe cases but may be less effective than cerclage).

• Bed rest and close monitoring.

  Pros and cons: Vaginal cerclage is less invasive but may be less effective in certain cases. Progesterone supplementation is non-surgical but might not provide sufficient support for severe cervical insufficiency.

Patient Experience

• During procedure: Under anesthesia, the patient will not feel pain.
• After procedure: Discomfort at the incision site, some cramping or spotting. Pain management will be provided.

• Initial recovery: May feel tired and need rest, pain relief as necessary.

  Pain management measures include prescribed painkillers and advice on how to manage post-operative discomfort.