Preventive TVC

Getting a preventive TVC (Transvaginal Cerclage, either McDonald or Shrodikar) means that somewhere between 12-14 weeks, your doctor will place a transvaginal cerclage.  Whether it’s a McDonald or a Shrodikar is determined simply by how high up it is placed in the cervix.  No surgicial incision is required as this is placed via the vaginal canal.  This is temporary and will be removed prior to term delivery – usually between 36 and 38 weeks.  This allows you the possibility of a vaginal delivery.

I want to be very clear that I do NOT advocate a TVC.  While I have seen this work, I have seen it fail far too often for me to recommend as a sound option for your baby’s life.  Does the TVC work for some women?  Absolutely!  But here is what I’ve come to understand:

The success of the TVC depends not only on the stitch, but also on the cervix! And the cervix changes from one day to the next and one pregnancy to the next. Just because your doctor’s TVC worked in another patient does not mean it will work in you.  Just because your last pregnancy was sustained by a TVC does not mean that your next one will be. 

Considerations:

  • I feel the TVC gives women a false sense of confidence during their pregnancy.  They think that everything is fine and continue working, cruising the mall, picking up their toddlers, carrying in groceries, etc.  All of these things – and the baby in utero – put strain on the cervix.  Hopefully the stitch can hold it.  But maybe not.
  • Lifestyle changes: If you have a preventive TVC placed, you should be prepared to also change some things.  No baths, no sex, nothing in the vagina at all, no orgasm, no swimming, no heavy lifting.  I’d urge strict bedrest with even a preventive tvc, but that’s because of all the failures I’ve seen.  Most women will not do strict bedrest.  That works fine for many, but not for all.  And you won’t know until you know.
  • Frequent cervical montoring: To help combat that false sense of confidence a stitch gives, you should still see the doctor for frequent (weekly or bi-weekly) cervical monitoring.  I find a problem in this, though, because the most accurate cervical measurements come from a transvaginal ultrasound.  You do not want to introduce anything at all into the vagina.  So, I would only do an abdominal ultrasound.  Again, it’s not as accurate.
  • Frequent swabs: To help stay on top of any potential infection, I’d urge weekly or bi-weekly cultures run on vaginal swabs.  Preventive antibiotics is something to discuss with the doctor, though long-term antibiotic usage has problems, too.
  • As with an emergency placed cerclage, you need to familiarize yourself with stitch failure.

Clearly, I am not a fan of a tvc.  There are some cases where I’d advocate for it, but those are far and few between. Some of those instances might be:

  • Does not have access to a TAC surgeon (but I wouldn’t take this lightly.  One gal sold her car to travel from Australia to Dr. Davis.  That is the kind of effort having a tac placed is worthy of.)
  • The government won’t allow TAC placement (I see this in national health care systems; not in the U.S.  Even Medicaid will pay for a TAC as long as one finds an in-state surgeon or an in-state surgeon is not available and one must go to another state.)
  • Gestational age is past the time a TAC could safely be placed.  (Usually beyond 14 weeks, but I’d not just read this and assume that.  You should still contact Drs. Haney and Davis and Sumners to see if they’d be willing to try and discuss the pros/cons of TAC placement at a late gestation.)  Generally, if you’re past this time period, though, you are in the category of needing a rescue cerclage.
  • For some reason, multiple abdominal surgeries in a short time period would occur and be problematic.

In all of the above scenarios if TAC was denied, I’d urge somebody to try and pursue a TVCIC instead of a regular TVC.  If that wasn’t possible, I’d concede to a TVC with the adamant care plan of frequent cervical monitoring, weekly swabs for bacteria, P17 shots or progesterone pessaries, and strict bedrest.  I’d educate myself on steroid shots for baby, finding a true Level III or greater nicu, and becoming somewhat familiar with what to expect if I have a micropreemie.

Often I read of women who have a definite IC diagnosis and they still opt for a TVC just because that’s what their doctor says and that’s the easiest solution.   In sharing their decision to get a TVC, they say that they want to try it and if it doesn’t work, then next time, they would get a TAC.  Though I must tread lightly on those forums, I want to be clear here that I stand firmly against that reasoning.  I find it reprehensible.  To say a TVC doesn’t work means to say that there was some sort of compromise to baby (either fetal demise or prematurity).  Baby’s life – and quality of life – is worth the fight.  Always.  Always.  Always.

Please spend considerable time in prayer begging the Lord to show you the way He intends for you to go.  He may, in fact, call you to a TVC.  And choosing a TVC because of prayer is awesome.  I am for that.  I don’t understand it, but I am for God’s leading.  To be honest, that is the only free-and-clear recommendation I can give about pursuing a TVC.

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