The cervix is a tough, fibrous segment of your lower uterus that provides passage for your baby from the womb to the vaginal canal during birth. With a normal pregnancy, your cervix remains rigid and essentially closed, which helps hold your baby in position. Once labor starts, the cervix naturally shortens, softens, and opens (dilates), becoming part of the birth canal during a vaginal delivery.
Cervical insufficiency causes your cervix to open prematurely and leads to a second-trimester pregnancy loss. This cervical malfunction typically happens somewhere between the 16th and 24th week of pregnancy, but most often during the 18th through the 22nd week.
Thankfully rare, cervical insufficiency and the resulting preterm delivery or miscarriage are understandably devastating. Fortunately, there are ways to combat this condition – namely, a surgical procedure that provides support (a cerclage) at the cervical opening to help keep the cervix closed throughout your pregnancy.
Dr. Tajzoy is an expert and well-respected for his skill in all cerclage procedures. He often prefers the most advanced method – robotic-assisted transabdominal cerclage – because of its success rate and minimally invasive nature.
A cervical cerclage is a rather straightforward surgical procedure, during which we place a band of synthetic material around your cervix to support it and keep it closed during pregnancy. The difference is in the approach.
We can perform the procedure through your vagina (transvaginal), but a transabdominal cerclage (TAC) often provides the best opportunity to place the cerclage high on the cervix where it is most supportive. During a TAC, we access your cervix via an incision in the lower abdomen.
We sometimes spot cervical insufficiency on an ultrasound before you become pregnant. When that happens, we can perform a cerclage as a preventive measure. It may also be noted on an ultrasound early in your pregnancy. In that case, we can use cervical cerclage during the first trimester to help you experience a full-term pregnancy and delivery.
Most often, however, cervical insufficiency is discovered after the loss of an otherwise normal pregnancy during your second trimester. Different than preterm labor and delivery, a pregnancy loss due to cervical insufficiency typically involves painless cervical dilation that’s not related to uterine contractions or placental abruption (when your water breaks).
A history of unexpected pregnancy loss due to cervical insufficiency increases your likelihood of experiencing the same during future pregnancies. Many women choose to have a cervical cerclage before attempting another pregnancy.
Very rarely, certain procedures, such as a dilation and curettage (D & C) or LEEP (loop electrosurgical excision procedure) for an abnormal Pap test, can weaken your cervix.
It’s very critical that you share accurate details of your medical history with your OB/GYN specialist, ideally before you become pregnant, so that we’re alerted to the potential of cervical insufficiency disrupting your pregnancy.
Robotic-assisted TAC is a laparoscopic procedure. This requires very small, buttonhole-sized incisions through which we insert a tiny camera and the surgical instruments and materials we use to perform the cerclage. You’re typically left with a couple of incisions that require only a stitch or two to close.
Conversely, a traditional or open TAC requires a long incision at your bikini line. Compared to the traditional approach, the laparoscopic method decreases trauma to the surrounding tissue and structures. This means less risk of infection or abnormal bleeding and allows quicker healing afterward.
Robotic-assisted TAC does not mean a robot controls your surgery. However, the advanced technology provided by the robotic system enhances the maneuverability and precision of the surgical instruments we use during the procedure. This often translates to better outcomes when compared to a standard laparoscopic TAC.
If you’re concerned about cervical insufficiency, schedule an appointment today with Dr. Tajzoy to discuss your options. Give our office in Dallas a call or use our online service to book your visit.