If you are unsure whether or not you have IC, but you experienced pPROM, then you may want to look at the list of follow-up questions for an ob/mfm appointment.
TAC Consulting Questions – Consider asking these questions to a TAC surgeon in order to determine your understanding of TAC and the surgeon’s approach/philosophy on TAC. Please note that if you are speaking with your regular OB or MFM (NOT a TAC Surgeon), then your consultation will be much different. When you start asking your doctor about the cervix, IC, vaginal cerclages, and especially TAC, he is going to freak. Generally speaking, doctors are NOT open to diagnosing IC – particularly after “just” one loss. Doctors simply are uneducated about IC and sure are not comfortable with a TAC. Some doctors even bristle and are combative towards you expressing interest in cervical issues.
So, as you prepare your questions and get excited about the future – which you should be! – realise that your doctor is probably not on board with this line of thinking and don’t let him burst your bubble! Your husband is hesitant also because of the doctor’s hesitancy. (don’t worry, though, he will get on board)
1. Where did you learn about TAC?
2. Who is a candidate for TAC? Why or why not would you say I am a candidate?
3. What is your opinion of a TVC? Who should consider one? (In my personal opinion, a TVC ought never be recommended unless no other option is available. I think this question reveals a lot about the physician’s understanding of IC and TAC, so that is why I would ask it.)
4. At what point in pregnancy (or prior to) should a TAC be placed? Why?
- If during pregnancy, what are the risks to baby?
5. What is your preferred method of placing a TAC? Why? Please describe the surgical procedure.
- What would my anesthesia be? (General or spinal – why?)
- How is post-surgery pain managed? What are the risks of the actual TAC surgery?
- How long would I be in the hospital?
- Would I stay on a surgical floor or in L&D or where? (I recommend asking this because it is a shock to some women to be in the same ward as women who just gave birth if they are, in fact, placed for recovery in L&D)
- What is the recovery time and recovery limitations from TAC Surgery? Incision healing (how do you close the incision)? Bathing? Driving? Work?
6. How soon after my loss can I have a TAC placed?
7. How soon after TAC placement can I try to conceive?
8. What is the impact of TAC placement on baby during the pregnancy?
- Does it restrict fetal growth?
- Does it make infection less likely?
- Will funneling occur and, therefore, put baby at risk for pprom?
- Will I dilate through my TAC?
- Will my uterus rupture?
9. What long-term impact does a TAC placement have?
- Infertility difficulties?
- Could I still do an IUI or IVF?
- Need for hysterectomy?
- Adhesion from surgery?
- Bladder issues?
- Future contraceptive limitations (can I still use an IUD?)
10. What is your personal success rate with TAC? (For each placement method if various ones used)
11. Describe the losses your patients have had with one of your TACs. Why did that loss occur? What modifications have you made since then?
12. What modifications would I need to make during my TAC pregnancy compared to a non-TAC pregnancy? (Activity levels, intimacy, baths, more frequent monitoring, etc.)
13. What interventions would I need to support my TAC?
- P-17 shots?
- Additional occlusion suture?
14. What happens if I miscarry with a TAC in place? (Before and after 12 weeks?)
15. What happens if I go into labor early?
16. How is a C-section with a TAC different than a C-section without a TAC?
- What would I need to know to prepare for a C-section in an emergency situation with a doctor not familiar with TAC?
- Am I limited on the number of c-sections, and therefore pregnancies, that I could have with a TAC?
17. Are you willing to educate and consult my OB or MFM about my TAC at the beginning of my pregnancy?
18. Will insurance cover my TAC? Do you work with the insurance company to gain coverage or do I have to do this?
19. If you do not place my TAC, then who would you recommend me seeing?
20. Is there any other information I need to know?