Transabdominal cerclage (TAC) is generally offered to those with the following:

prior failed transvaginal cerclage

short cervix with history of cervical incompetence

extreme cervical shortening (<1 cm.) without prior cervical incompetence

deep cervical laceration (cut or tear) to the level of the internal os (opening of the uterus).

Recently, some patients with multifetal pregnancies (triplets or more) have been offered transvaginal or transabdominal cerclage, with attention to the possible increased efficacy of transabdominal cerclage and the potential increased risks of the procedure. Patients at risk for cervical incompetence are evaluated with transabdominal and transvaginal ultrasound measurement of cervical length in addition to careful history, clinical cervical exam and fetal ultrasonography.

All procedures are performed with the type of abdominal incision decided based upon the size of the uterus and maternal body habitus. The uterus is usually pulled out of the mother's body and maintained moist with warmed saline. The procedure requires removing the bladder from the cervical area while tunnels are created near the uterine artery on each side. A mersilene band (a polyester suture) is placed around the upper portion of the cervix and tied in a square knot tightly enclosing the cervix which is not removed after the pregnancy. Becaue many fragile uterine veins are in this area, the most common complication is bleeding. Methods of stabilizing this bleeding depend on the situation and anatomy, while avoiding compromise of the supply of blood to the uterus. In recent years, perioperative treatment with indomethacin has been used for a total of 48 hours, as a uterine relaxant. Indomethacin is a drug that belongs to the family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin reduces pain, fever, swelling, and redness.

Prenatal care following the procedure would also include cervical exams every two weeks, careful attention to signs and symptoms of preterm labor (with aggressive use of tocolysis if labor persists) and planned delivery by cesarean as soon after 37 weeks as fetal lung maturity can be documented. Because of the latter intervention tactic, 37 week delivery is considered “term” for the purpose of our follow-up information.