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Author Topic: Cerclage removal during a C-section?  (Read 15784 times)

MommaToOlivia

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Cerclage removal during a C-section?
« on: June 21, 2011 at 05:49 PM »
Since I've heard so many horror stories about cerclage removal, has anyone had their cerclage removed during a scheduled C-section?  I'm trying to avoid unnecessary pain.  I have to have a C-section - no choice.  Why not get the cerclage removed while I'm numb, right?
Mom to Olivia, 26 Weeker now 6 years old
Mom to Hannah, 18 Weeker in Heaven
Mom to Baby #3 (another girl!), due 11/11/11

momofbabyblue

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Re: Cerclage removal during a C-section?
« Reply #1 on: June 21, 2011 at 07:41 PM »
Sounds like a good plan to me!! :)
due 8/1 - a girl
Mom to Blue, born 10/7/09 @ 37 weeks
Bedrest @ 22 weeks due to short cervix

AdamWolfbergMD

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Re: Cerclage removal during a C-section?
« Reply #2 on: June 22, 2011 at 09:03 AM »
This is really standard practice: the c-section is completed, then the cerclage is removed while the anesthesia (typically spinal) is still functional. In fact, I'd stay this is the standard of care for women with a cerclage who make it to their scheduled c-section without encountering preterm labor. Good luck. Adam Wolfberg, MD (@AdamWolfberg).

MommaToOlivia

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Re: Cerclage removal during a C-section?
« Reply #3 on: June 22, 2011 at 10:51 AM »
Yay, I hope so!  If this is true, then that's really good news for today!
Mom to Olivia, 26 Weeker now 6 years old
Mom to Hannah, 18 Weeker in Heaven
Mom to Baby #3 (another girl!), due 11/11/11

Bug

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Re: Cerclage removal during a C-section?
« Reply #4 on: June 22, 2011 at 12:03 PM »
I'm planning on having a VBAC...but my doc did tell me that if a c-section was necessary he would remove my cerclage right after delivering the baby. He said there is no reason to remove the cerclage prior to the c-section. Also, depending on the type of cerclage that was placed, if you plan on having all c-sections, some cerclages don't have to be removed until you are all done having babies. The only reason to remove it is to deliver a baby vaginally or if it is a rescue cerclage....that is what my doc told me. I would ask your doc. If you can leave it in you won't have to have another cerclage placed with your next pregnancy. Good luck!
EDD 7/14
Bed rest since 3/1 (20 wks 5 d)
Cerclage 3/2 due to premature dilation (2+) and effacement

Couchdiva

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Re: Cerclage removal during a C-section?
« Reply #5 on: June 22, 2011 at 01:26 PM »
I'm also having a c-section and my doc said he didn't see any reason to remove my cerclage until my little guy was born.  Thankful for that considering all the posts I've also read on how painful they are to remove.  I'm gonna let my spinal at my c-section be my savior for that!!  :)

It's also nice to have a doctor post on here too - it's nice to have another opinion on the matter.  Thanks Dr Wolfberg!
Mom of 2: Ella 5 yrs, Adeline 19 mos
Baby Boy due Aug 21, 11 (c-section scheduled for 8/15)
Bedrest since 20 wks, IC & cerclage @ 22 wks

MommaToOlivia

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Re: Cerclage removal during a C-section?
« Reply #6 on: June 23, 2011 at 01:33 PM »
Wait... how can you could get pregnant with a cerclage already placed?  I thought the point was that it keeps your cervix tightly shut.  Either way, I can feel mine pinching especially when the little one moves around or when I sit/lie down a certain way.  I don't know if I'd want to keep it there!  :) 
Mom to Olivia, 26 Weeker now 6 years old
Mom to Hannah, 18 Weeker in Heaven
Mom to Baby #3 (another girl!), due 11/11/11

AdamWolfbergMD

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Re: Cerclage removal during a C-section?
« Reply #7 on: June 23, 2011 at 02:15 PM »
Great posts everyone. Let me clarify a few things:

1. A cerclage placed vaginally ought to come out at delivery (or before). First of all, it forms 'wick' for infection since there's a non-disolvable stitch in the cervix with the ties hanging in the vagina (which is normally colonized by bacteria). Second, the cervix 'remodels' itself during pregnancy and labor, so a cerclage that is placed early in pregnancy may not be appropriately placed for another pregnancy.

2. The only cerclage that sometimes is left between pregnancies is the abdominal cerclage, placed high up on the cervix/lower-uterine segment through a surgical incision in the abdomen (or sometimes laparoscopically). This is a rare cerclage, and is only placed when a woman fails cerclages placed vaginally. This cerclage does not enter the vagina, so isn't a nidus for infection, and is so high up on the cervix/uterus, that it may not be subject to the same remodeling as the cervical stroma that descends into the vagina. Obviously, if it's going to be left in place, a cesarean will be required.

3. That said, it is possible to become pregnant through any cerclage that is left in place, because we don't tie the cervix "closed." To do so would risk strangling the cervical tissue. Rather, we tie it firmly but with a little give to it so it supports the structure of the cervix but doesn't strangle the tissue. As a consequence, sperm, bacteria, amniotic fluid, and anything else benign or not can pass through the cervical canal.

Hope this helps.

Adam Wolfberg, MD

MommaToOlivia

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Re: Cerclage removal during a C-section?
« Reply #8 on: June 23, 2011 at 03:05 PM »
Wow, that was incredible helpful!  THANK YOU SO MUCH!   :)
Mom to Olivia, 26 Weeker now 6 years old
Mom to Hannah, 18 Weeker in Heaven
Mom to Baby #3 (another girl!), due 11/11/11

momofbabyblue

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Re: Cerclage removal during a C-section?
« Reply #9 on: June 24, 2011 at 08:00 PM »
Dr. Wolfberg - I'm curious as to what constitutes a failed vaginal cerclage? Any delivery before term? Or is there more to it than that?

At my last appointment w/ my high risk docs they talked about my options for future pregnancies (if we decide to have more children) and they definitely mentioned an abdominal cerclage as an option. So I'm just curious.
due 8/1 - a girl
Mom to Blue, born 10/7/09 @ 37 weeks
Bedrest @ 22 weeks due to short cervix

AdamWolfbergMD

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Re: Cerclage removal during a C-section?
« Reply #10 on: June 26, 2011 at 12:15 PM »
A cerclage placed vaginally - the two types are the McDonald and the Shirodkar - can be called a failure when the cervix shortens and dilates in spite of the cerclage.

But there are lots of caveats - for example, maybe there was an abruption that caused preterm labor that had nothing to do with the cerclage failing. So it really takes some interpretation by someone experienced.

Hope this helps.

Adam Wolfberg, MD


thebrg

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Re: Cerclage removal during a C-section?
« Reply #11 on: June 26, 2011 at 08:52 PM »
I have a TAC (trans-abdominal cerclage) due to failed TVCs (trans-vaginal cerclages)

My first pregnancy was a triplet pregnancy (mono twins with a fraternal triplet). I had a rescue TVC placed at 22 weeks which through me into full blown labor. My triplets were born at 23w6d and all passed away within 3 months of their births.

Second pregnancy was a singleton. My cervix was measured in the first trimester and was long and closed. I had a preventative cerclage placed at 14 weeks. By 15 weeks my cervix had shortened significally. By 16.5 weeks I had dilated around/through it. I went in immediately for a second TVC. I then spent 5 months in t-berg bed rest at home. She was born by a scheduled c-section.

This go around I had a pre-pregnancy TAC placed last year. I went in for a US at 12.5 weeks and my cervix was already down to 2.2 cm. I have been on bed rest since. Amazed and discouraged that not even a TAC can hold my cervix together :(
Mom to ^triplet angels^ and my rainbow Kenzingtonn Rae
pregnant with rainbow #2
On bed rest since 6/17/11. Due 12/24/11

MommaToOlivia

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Re: Cerclage removal during a C-section?
« Reply #12 on: June 27, 2011 at 05:52 PM »
thebrg:  Wow, I'm so sorry about your difficult pregnancies and your babies!  How far along are you with this one?
Mom to Olivia, 26 Weeker now 6 years old
Mom to Hannah, 18 Weeker in Heaven
Mom to Baby #3 (another girl!), due 11/11/11