Transabdominal Cerclage

Transabdominal Cerclage (TAC): A Definitive Solution for a Secure Pregnancy

For women who have endured the heartbreak of late-term pregnancy loss due to an incompetent cervix, the path to building a family can feel filled with uncertainty and fear. When a traditional transvaginal cerclage (TVC) has failed or is not surgically possible, a Transabdominal Cerclage (TAC) offers a powerful and highly effective solution to carry a pregnancy to term safely.

At Happiher, Dr. Manou Kaur is an expert in performing this advanced, specialized procedure. We understand the emotional weight of your journey, and we are here to offer a definitive surgical solution that provides the strength, security, and hope you need for a successful pregnancy.

What is a Transabdominal Cerclage (TAC)?

A TAC is a stitch (suture) that is placed around the very top of the cervix, at the level where it joins the main body of the uterus. Think of it as a strong, internal support belt placed much higher and with greater strength than a traditional vaginal cerclage.

This high placement is the key to its success. It bypasses the lower part of the cervix, which may be weak, shortened, or damaged from previous procedures or births, providing a secure and unyielding closure that is not affected by pressure from the growing baby.

The procedure is performed laparoscopically (keyhole surgery), often with robotic assistance, ensuring maximum precision with minimal invasion.

Who is a Candidate for a TAC?

A TAC is a specialised procedure reserved for women for whom a vaginal cerclage is not a suitable or effective option. You may be a candidate if you have a history of:

  • A previously failed transvaginal cerclage (TVC) that resulted in a pregnancy loss.
  • A severely shortened, scarred, or surgically damaged cervix (e.g., from cone biopsies) that makes placing a vaginal stitch impossible.
  • Congenital anatomical abnormalities of the cervix.

A TAC is a proactive step, offering the highest level of cervical support available in modern medicine.

The Unparalleled Advantages of a TAC

  • Exceptional Success Rate: Transabdominal cerclage has a very high success rate, with studies showing a neonatal survival rate of over 95%. It is the most effective treatment available for preventing late-term pregnancy loss due to cervical insufficiency.
  • Unmatched Strength and Placement: Because the stitch is placed at the very top of the cervix (the cervico-isthmic junction), it provides superior structural support throughout the entire pregnancy.
  • A Permanent Solution: The TAC stitch is designed to be left in place permanently for all future pregnancies, offering lasting security without the need for repeat procedures.

The Procedure: Timing and Technique

A TAC can be placed at two different times, both performed using a minimally invasive keyhole approach.

  • Pre-Pregnancy (Interval) Placement: This is the ideal time to perform the procedure. It allows the stitch to be placed when the uterus is small and blood flow is normal, making the surgery simpler and allowing for complete healing before you conceive.
  • Early Pregnancy Placement: The procedure can also be performed safely in early pregnancy, typically before 14 weeks gestation.

Crucially, delivery for all pregnancies with a TAC in place is always by a planned Caesarean section. Attempting a vaginal delivery is not possible, as the unyielding stitch would prevent the cervix from dilating and could lead to uterine rupture.

Your Patient Journey: What to Expect

  1. Highly Specialised Consultation: Your journey begins with a detailed and sensitive review of your obstetric history. Dr. Kaur will confirm that a TAC is the most appropriate option for you and will discuss the timing of the surgery.
  2. The Minimally Invasive Procedure: Performed under general anaesthesia, the surgery is done laparoscopically, often with robotic assistance for enhanced precision. The suture is carefully passed around the top of the cervix and secured. This is typically a day-case or single-overnight-stay procedure.
  3. Recovery: Recovery is swift due to the keyhole approach. Most women can return to normal, non-strenuous activities within 1-2 weeks.
  4. Pregnancy and Delivery: Once pregnant, your pregnancy will be carefully monitored. Your delivery will be scheduled as a planned Caesarean section, usually around 37-39 weeks gestation.

Frequently Asked Questions (FAQ)

  1. Is a TAC really that much more effective than a vaginal cerclage?
    Yes. For the specific group of patients for whom it is indicated (e.g., failed TVC), the success rate is significantly higher because of its superior placement and strength.
  2. Can I have a vaginal birth with a TAC?
    No. This is an absolute contraindication. Because the stitch is permanent and positioned so high, labour would not be able to progress and would be dangerous. Delivery is always by C-section.
  3. Does the stitch need to be replaced for future pregnancies?
    No. The TAC is left in place and provides support for all subsequent pregnancies.
  4. What are the risks of the surgery?
    As with any laparoscopic surgery, there are small risks related to anaesthesia, bleeding, and potential injury to nearby organs like the bladder. However, when performed by a specialist surgeon, it is a very safe procedure with a low complication rate.

Secure Your Hope for a Successful Pregnancy

After the profound challenge of pregnancy loss, a Transabdominal Cerclage offers a powerful, evidence-based path toward bringing your baby home safely.

Picture of Dr. Manou Manpreet Kaur

Dr. Manou Manpreet Kaur

Dr. Manou Kaur is a consultant gynaecologist specializing in advanced minimally invasive surgery for complex conditions like endometriosis and fibroids. With a passion for patient education, she writes to empower women with clear, evidence-based knowledge about their health.

Learn more about Dr. Kaur's expertise
Picture of Dr. Manou Manpreet Kaur

Dr. Manou Manpreet Kaur

Dr. Manou Kaur is a consultant gynaecologist specializing in advanced minimally invasive surgery for complex conditions like endometriosis and fibroids. With a passion for patient education, she writes to empower women with clear, evidence-based knowledge about their health.

Learn more about Dr. Kaur's expertise