Types of Cerclages

Since the cervix will not stay closed in patients with IC (incompetent cervix), treatment is to close it via intervention.  This is referred to as a cerclage.  There are many types of cerclages, all varying by method and height of placement.  I am going to discuss only the two main ones here with a mention to a third one.  This is a picture drawn by Dr. Davis to illustrate the different levels of cerclages.  (Picture courtesy of Amy H., one of Dr. Davis’s TVCIC patients.  Thanks, Amy!)

Transvaginal Cerclage (TVC): a stitch (suture) which is placed through the vagina, within and around the cervix, much like a “purse string”.  This is placed at the bottom of the cervix or “as high up” as the doctor can get.  The method of placement is vaginal and the patient is given a spinal.  A TVC may be placed anytime from 12 weeks on.  Sometimes it is placed preventively before a problem seems to arise (aka a prophylactic cerclage).  Other times it is placed after the “wait-and-see” has demonstrated a problem with the cervix.   These are called a rescue or emergency cerclage.

A TVC requires pelvic rest, has an increased risk of infection as the stitch material itself can wick up vaginal bacteria, and is currently considered successful about 80% of the time.  Be sure you ask your doctor what the definition of success is!  Often times in discussing a TVC, their definition of success is a “live birth” regardless of prematurity.

The TVC is removed around 37 weeks to allow for a normal vaginal delivery.

See “The Wait-And-See Approach” and “Preventive TVC” for more information on this type of cerclage.

Transabdominal Cerclage (TAC):  a band is placed around the OUTSIDE of the cervix and tied in place to disallow dilation.  This is placed at the very top of the cervix/bottom of the uterus.  It is placed via abdominal incision or laparoscopically.  The TAC may be placed prior to pregnancy or during pregnancy (around 12 weeks).  The TAC does not make the cervix smaller, it simply allows it from dilating.  So, blood, sperm, catheters/fertility instruments can still enter and exit the uterus.

A TAC is considered the absolute medical solution for IC.  Once a patient has a TAC, she can cross IC off her list of potential problems.  No bed rest or pelvic rest is required due to IC with a TAC.  It has a success rate of greater than 95% for a TERM delivery.  (The success rate varies on the particular surgeon.  For example, Dr. Haney currently has a success rate of greater than 99% for a TERM delivery)

The TAC is permanent and requires delivery via c-section.

See “TAC” and “Exploring TAC” for more information on this solution.

Transvaginal cervico-isthmic cerclage (TVCIC): The TVCIC is placed above the cardinal ligaments but isn’t quite as high as the TAC. It closes the cervix about 1/2 cm below the internal os.  Dr. Michael Katz in San Francisco is doing a lot of these.  Dr. George Davis in New Jersey performs these as well.  More recently, Dr. James Sumners learned how to place a TVCIC.  It is NOT the same as the TAC.  It is placed vaginally and can be removed for vaginal delivery or left in place for future use if a c-section is required.

See “TVCIC” for more information.

Explore this journal article by Dr. Katz (It’s a .pdf):
http://ki.au.dk/fileadmin/www.ki.au.dk/forskning/forskningsenheder/gyn__kologisk-obstetrisk_afd__y/undervisning/obstetricia/tidligere_obstetricia/060105transvaginalcerclage.pdf

3 responses to “Types of Cerclages

  1. I had a TVCIC placed by Dr.Katz in 2010 at 14 weeks with my son opted for a c-section to leave it in and I am on pregnancy #2. I almost 20 weeks and have had no issues or changes at all and no bed rest. After two losses at 16 weeks and a failed McDoanld’s at almost 23 weeks it was nice to not have issues like before and feel less stressed. I was so glad when talking to Dr.Davis that me mentioned it to me I had never heard of it and was unable to get a TAC placed before the time frame was up. If it weren’t for him mentioning it and me finding Dr.Katz (who by the way is awesome!) my son probably wouldn’t be here. Dr.Davis and Dr.Katz do place them a little different but the outcomes are great. Dr.Katz told me he hasn’t had a loss and any early deliveries were due to other things not related to the cervix.

    Sarah

  2. I totally agree! I was the first one at the Perinatologist office that had one placed one of the Perinatologist (Dr.Gilbert) actually places the TAC but was on vacation which is why I couldn’t get it done. Now they actually are recommending (TVCIC) it to other women after seeing how well mine did, only thing is they have to travel 2 hours to get it placed if they live in Sacramento since Dr.Katz is in San Francisco. Dr.Katz has a great assistant Peggy she is very helpful and will talk to you and answer any questions you may have. I am also lucky I was seeing a doctor that Dr.Katz knew because it saved me from having to go there every month to see him I saw Dr.Gilbert (he went to school with Dr.Katz’s daughter) so it did make it a lot easier. I am glad you can actually find TVCIC mentioned on the internet now when I tried looking before I got mine placed I couldn’t find anything really. Thanks for putting the information out there for others, many have either never heard of it or if they have don’t really know much about it or it gets confused with other cerclages. To tell you the truth I called to see if Dr.Katz did the TAC Peggy said no they did this other one, I had stopped listening when she said no and kept on my search. Well what do you know I ended up calling back and talking to her and that is just what I got. Peggy had actually scheduled me for my procedure before doing my consultation with Dr.Katz he told us he got on to her for it and asked her why she did that, she told him look at the chart…He read it and said “good job Peggy, good job!”. I had my consultation and with my history he thought I was a excellent candidate for the TVCIC. He was one of the only doctors really that listened as well when I told him my Mother also had IC, he said they are starting to pay attention to that more and more when they hear that. Thank you for letting me share my experience on your site.

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