Q&A: Pregnancy, fertility and childbirth with transabdominal cerclage (TAC)

Transabdominal cerclage (TAC) is a highly effective surgical treatment for incompetent cervix. With this condition, the cervix is too weak to carry a full-term pregnancy, often leading to miscarriage in the second trimester. However, TAC surgery has helped thousands of patients across the globe experience what once may have seemed impossible — safe, healthy pregnancies and deliveries.

If you’ve been diagnosed with incompetent cervix (cervical insufficiency), you may be familiar with the benefits of the TAC procedure. But, how much do you know about what it’s really like to get pregnant, be pregnant and give birth with TAC?

At the University of Chicago Medicine, not only are we building on a legacy of international leadership in TAC expertise, but we are also committed to empowering patients to fully understand their options and make informed health decisions. If you’re considering TAC surgery, it’s important to know how it may impact your fertility, pregnancy and childbirth experiences.

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Fertility and Pregnancy with TAC

How does having a TAC affect fertility?

A TAC has no impact on the time it takes to conceive. It will not affect your menstrual cycle or make it difficult for sperm to pass through the cervix to reach the uterus. A TAC doesn’t narrow the cervical canal in any way.

How does TAC affect infertility treatment?

If you require infertility treatment before having a TAC placed, you’ll still need those treatments afterward. Success rates for infertility treatment are the same with or without a TAC.

For patients undergoing IVF treatment, transferring embryos is possible with TAC. You may even have more than one TAC band placed to provide stronger support in case of multiple gestations (i.e., twins, triplets, etc.), which are more common with fertility treatments.

How long should I wait before trying to conceive now that I have a TAC?

You can start immediately. Some patients may experience a delay in ovulation due to stress, but this usually lasts no more than a month.

Can I have sex after TAC placement? Is it okay to have an orgasm?

It’s safe for patients with a TAC — including patients who have a shortened cervix due to a LEEP or conization (CKC) — to have intercourse and to orgasm. With a TAC, the cervix remains its normal length and maintains the protective cervical mucus that prevents infection from vaginal bacteria. Also, there is no reliable scientific evidence that links orgasm to preterm labor.

Is bed rest necessary with a TAC?

No. The support provided by the TAC band is substantially greater than the weight of your fetus(es). However, if you are trying a TAC after an unsuccessful transvaginal cerclage, lightening your activities based on your past experiences may help put your mind at ease.

How will I know how well the TAC is supporting my cervix?

Your doctor should measure your cervical length using ultrasound every two weeks, from 12 weeks to 20 weeks or past your previous loss point. (Manual exams cannot accurately assess length or early cervical changes.) Cervical length measurements can vary somewhat due to the fullness of your bladder, the angle of the scan and the ultrasound technician providing the measurement. However, your doctor will still be able to assess whether the TAC is preventing funneling and whether your baby and membranes remain in the correct position.

How does a TAC work in patients who conceive twins or multiples?

A TAC is extremely strong and able to support the weight of more than one fetus. In some cases, patients have more than one TAC band placed for additional support in case they have multiples.

With the help of ultrasound imaging, your doctor will carefully monitor all of your babies’ growth to ensure each fetus is developing appropriately and getting enough oxygen and nutrients, which is of particular concern during the third trimester. If one of your baby’s growth rate slows, your doctor will discuss how that will impact your delivery timeline.

Labor and Delivery with TAC

How many centimeters can I safely dilate if I have a TAC in place?

Your cervix will not be able to dilate with a properly placed TAC band. Also, dilation will not be necessary, because your baby will be delivered by C-section.

Do I have to have a C-section with TAC?

Yes. The small incision made during your TAC placement procedure can be extended to deliver your baby by C-section.

At what week of gestation should I have the C-section?

The timing of labor varies from patient to patient, but most patients undergo a C-section during the 38th or 39th week. This timeline ensures the full development of your baby’s lungs. Your obstetrician may recommend a non-stress test at 38 weeks before scheduling your C-section. The rate of pre-term labor is low in patients with TACs, and it’s important to distinguish true labor (regular, persistent contractions) from episodic Braxton-Hicks contractions that you may experience.

How is preterm labor handled in a patient with a TAC?

Preterm labor is managed with standard treatments, including intravenous hydration, tocolytics such as terbutaline, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium sulfate and nifedipine. Although progesterone has received renewed interest for prolonging pregnancy, there is no research supporting its effectiveness in patients with a history of second trimester loss due to an incompetent cervix, nor should it be used as an alternative to cerclage.

Sometimes, certain signs may be mistaken for preterm labor, including contractions with a shortened cervical mucus column (but no discomfort) in the second trimester and non-harmful Braxton-Hicks contractions. Although these can cause patients a great deal of anxiety, your doctor will be able to distinguish them from actual preterm labor.