Holy acronym Batman! Overwhelming, I know! I have no idea where to go from here in my journey to become a mother to children on earth. I know I want to be able to hold a child for more than a couple of minutes, and while the baby is still alive. Unfortunately, I have had the horrible experience of holding my dead children in my arms. I wish that on no mother. It is heartbreaking, and nightmarish. You do everything in your power willing that lifeless body back to life. You feel their skin growing cold against you. I personally wouldn’t let go of Hazel. I sat and rocked her for nearly an hour. Doctors and nurses walked in to talk to us, and I wouldn’t set her down, I rocked her to try and sooth her transition to Heaven. Mommy was there, no need to be scared.
I realized last night I need to make a decision. Why last night? When I was cooking dinner my fluffy cat Isis came into the kitchen crying for me. She then proceeded to stretch up on her hind legs and try to reach my waist, wanting me to hold her. So what did I do? I picked her up and placed her on my hip. She wrapped her front paws around my neck leaned in and head butted me, then placed them over my shoulder, while nuzzling in her head under my chin purring. I then began to bounce her slightly and held her while I cooked dinner. That’s right, I treated her just like anyone would with their toddler wanting to be held. I began instantly bawling when I realized I would never get to do that with Willow and Hazel, or that I may NEVER get to do that with a child. I decided then, that I need to at least come up with a plan if I ever decided I wanted to try again. I work well with flow charts, I do research as a Chemist so it is familiar to me. So here is that, plan: Sorry this is so crappy. I originally did it in MS Word, but all of the nice indentations and so forth do not translate to wordpress and I don’t feel like dusting off my programing from ‘way back when.’ If you would like an nice, easy to follow copy… don’t hesitate to ask me for it.
Do I ‘wait and see’ or do I get a cerclage?
1. Wait and see
i. Do nothing, get emergency TVC if needed
i. Decide between a TVC, TVCIC, TAC, RoboTAC
Do I want an ‘Open’ surgery or not?
i. TAC – If you are here, you have made your decision! YAY!
2. No open surgery
i. TVC, TVCIC, RoboTAC
Do I want this done pre-pregnancy or during pregnancy?
i. TVCIC, RoboTAC
2. During pregnancy
i. TVC, TVCIC
TVCIC vs RoboTAC
1. Can be permanent or can be placed so as to be taken out for a VBAC
(for me anyway)
2. Some doctors can place them just as high as a TAC, some can only
place them close to where the TAC is
3. Can be done laparoscopically
4. Done during pregnancy
1. Done laparoscpically
2. Must be done pre-pregnancy
3. Permanent, requires all deliveries to be c-section
4. Virtually the same as a TAC
5. Has slightly lower success than a traditional TAC
6. Not many has been performed
7. WAY better than just a laparoscopic TAC
TVC vs. TVCIC
1. See above
1. Done laparoscopically
2. Done during pregnancy
3. Can be done in an emergency situation
4. Stitch is very low, may not hold
5. Much lower success rates with IC
6. Can deliver vaginally
7. Usually covered by insurance because it becomes a needed
i. An out of pocket TAC with Dr. Davis is New Jersey would cost
about $5000 + airfare + food & Lodging
ii. Is there any situation in which it would be covered? ie. After
ii. Figure out co-pays etc.
1. Need to call and ask about coverage, terms, and coditions
Do I want an ‘open’ surgery or not?
1. Do I want to be ‘opened up’ 3 times in such a little time?
Concerns with getting a TAC, RoboTAC, TVCIC
1. Do I want to have a c-section with every pregnancy I will ever be
- If I am ok with that, what are the risks associated with so many c-sections? I already have one
a. c-section scar from my two twin angels (Willow &
2. Uterine Rupture
i. If you go into labor early (especially with a TAC, TVCIC, RoboTAC
and it is not stopped or quickly proceeded with a c-section, the
uterus could potentially rupture
*sidenote* With a TVC, you can tear the cervix opening
i. Harder for embryos to stick to scars, so this could hinder a
ii. Placental abruptioni.
a. The placenta can’t attach properly after 20 weeks and
can pull away. Leading to bleeding and possible pPROM
iii. Placenta accreta
b. The placenta attaches abnormally deep through the
endometrium and into the myometrium (the middle layer
of the uterine wall)
c. Caused by attachment to scar tissue
d. Risks are
– Hemorrhage during removal
– Can lead to hysterectomy
– Can be fatal
iv. Placenta previa
a. The placenta grows in the lowest part of the uterus,
and covers all or part of the opening of the cervix
b. Can be caused by a previous c-section scar
c. Can cause severe bleeding
– Is this occurs, it can be fatal to mother and
– May result in the delivery of child as a
4. Embryo Embedding
i. If the embryo embeds in the scar, it can result in a CSP
(caesarean scar pregnancy).
It carries a high risk of uterine rupture
ii. Other possible complications (Mayo Clinic, 2012):
– post-surgery infection or fever
– too much blood loss
– injury to organs
– emergency hysterectomy
– blood clot
– reaction to medication or anesthesia
– emotional difficulties
– scar tissue and difficulty with future deliveries
– death of the mother
– harm to the baby
Boston Women’s Health Book Collective answered: In rare instances, the placenta implants abnormally, often in a scar from a previous cesarean section or other surgery on the uterus.The placenta can then grow into this scar and occasionally even through the wall of the uterus into other organs, such as the bladder. These abnormalities in attachment of the placenta are called placenta accreta, placenta increta, and placenta percreta, depending on the depth of invasion of the uterine wall. Placenta accreta, the most common of these serious complications, is becoming more common and now is discovered in about one in every twenty-five hundred births. The increase is thought to be related to the increase in the rate of cesarean sections.Abnormal attachments of the placenta are also seen more commonly with placenta previa.
The diagnosis of these conditions can now often be made by ultrasound or magnetic resonance imaging (MRI) during pregnancy. The abnormal attachment makes the placenta very adherent to the uterine wall so that it is difficult to remove after birth. If implantation problems are not diagnosed before birth, severe hemorrhaging can occur during and after birth. Your provider will attempt to stop the bleeding with a variety of interventions such as blood transfusions and exploratory surgery with the goal of avoiding a hysterectomy.
If I do not have IC and that is NOT what caused my pRPOM, then none of the above mentioned methods will prevent a subsequent pRPOM. You can still experience rupturing of the membranes with all the above mention cerclages, IF the cause it not due to IC. I have mailed three of the leading doctors in IC. I have received emails back from Dr, Haney, and Dr. Sumners. I am still waiting on Dr. Davis’ reply, but from what I hear, he doesn’t tend to email you back. You have to call him. I do not like this approach. I have hearing loss and talking on the phone is very difficult for me. I usually have to pass the phone off to James.
Dr. Haney, believes that ALL second trimester pPROM is due to IC, “there is virtually no other way you could rupture your membranes at 20 weeks without funneling from an IC.” The only problem I see here is that there as a very quick judgment and diagnosis of IC. Being a Chemist working in research, that bothers me, as does being told it will more than likely happen again, without proper examination of me and my medical history. But, he could just be trying to use a safer, more cautious approach meaning, if I have IC and I get the TAC, good, it will prevent this, if I don’t have IC and I get the TAC, it won’t hurt anything.
Dr. Sumners does not suspect that I have IC due to my history and the information given to him. He did suggest I work closely with my OB for my next pregnancy, be proactive about my treatment, and watch my cervix closely.
Dr. Davis – no answer via email.
You can read my OB and RE’s thoughts here: https://mommyoftwinangels.wordpress.com/2013/02/02/failed-body-or-fluke/
So where does this all leave me? Confused. It leaves me utterly confused. I am being made to feel that if I don’t go ahead and get the TAC, then if I do have PTL or pPROM again… it will have been entirely my fault and I could have prevented the death of my children. It will all be on my shoulders, unlike the loss of Willow and Hazel, where there was the “I couldn’t have known.” I really trust my OB and RE. I love them both. They did everything they could for me. Right now, it looks as if I am leaning toward the RoboTAC, TVCIC, or TVC… more so toward the TVC being placed. Then if needed possibly an emergency TVCIC. If I do have another failed pregnancy (please God no!) then I will go with a TAC or RoboTAC. But, honestly, I don’t know and I still haven’t made up my mind. Sorry for all who are reading this. I just needed to write out my thoughts and get them out there. Maybe it will help!