On April 25th, I took my first step towards getting a transabdominal cerclage by contacting Dr. Haney via email.
Dear Dr. Haney,
I am writing to you in hopes that you can help my husband and I.
I am a healthy 34-year-old woman who resides in NYC. My husband and I have a healthy, beautiful 6 year old daughter, who was delivered at 40 weeks, 1 day. In October of last year, we decided to grow our family and we immediately became pregnant with our son in November. Unfortunately, during my 21 week anatomy scan on March 31, 2017, the doctors at Lenox Hill noted that my cervix was open and I was admitted immediately. Due to PPROM, they were unable to complete an emergency cerclage. I tried to keep my son as long as I could but delivered him after 5 days in the hospital. He was only 22 weeks, 3 days on April 5, 2017.
The doctors noted that I presented with no signs of infection. Historically, I have never had any procedures completed on my cervix. They noted that my incompetent cevix may have been caused by my emergency c-section 6 years ago with my daughter. They were puzzled since I carried my daughter to term which demonstrated that my body is able to physically carry a child.
While I am still in the state of mourning, I am very much relying on my faith, family and friends, acupuncture, yoga to ensure I can get strong physically, mentally spiritually and emotionally. Ever since my hospital stay, I’ve been reading literature on incompetent cervix, PPROM and cerclage. I would like to get a transabdominal cerclage before trying to conceive again.
Would you be available for a phone consult? Thank you for your time.
Within one day, I received the following response from him:
I am sorry to hear of your loss and am sure this was devastating for you and your entire family. There is no doubt you have an incompetent cervix (IC) as there is virtually no other way you could have funneling without symptoms detected at your 21 week anatomy scan except from IC. About 8% of women with IC have had a previous term delivery, typically encountering some difficulty in that delivery such as a prolonged labor, difficult forcepts delivery, C-section, etc. Once you have had an IC loss, without treatment you are likely to have a similar pattern of cervical change and loss in any subsequent pregnancy. You have two basic treatment options, a preventative transvaginal cerclage (TVC) or a transabdominal cerclage (TAC) and they are very different. The TVC is typically placed around 12 weeks, generally requires bed rest, allows you to have a vaginal delivery, results in living children approximately 75% of the time but with a high rate of preterm delivery often with a long and risky NICU stay. The TAC is easily placed prior to pregnancy as an outpatient, does not need bed rest, requires a C-section but virtually assures you a term delivery (> 36 weeks). Since you have already had a C-section, you would likely need one regardless so that is not an issue. Additionally, you simply leave the TAC in place at the time of the C-section and it will work just as well in any subsequent pregnancies. I am currently placing over 200 TACs per year in women with histories like yours. It is important that you have your TAC placed prior to pregnancy so please use contraception temporarily. I am happy to discuss your situation with you on the phone to answer all of your questions and make your options clear. You can arrange that by contacting my assistant and she can find a mutually convenient time. I look forward to speaking with you. Good luck.
I couldn’t help but smile when I read his response. He responded to me quickly and everything he noted was exactly what I had been reading across different sources. I immediately contacted his assistant to schedule a phone consult for the following week. She responded by providing me with common Questions and Answers, a demographic form, CPT codes for my insurance, and a HIPAA waiver. She requested for my insurance cards and the following information:
- Pregnancy history (i.e. how many pregnancies, how many losses, how many children etc…..)
- Abdominal history (i.e. LEEP Procedure, Cone Biopsy, TVC etc…..)
- Gynecologic history (i.e. Fibroids, Endometriosis, etc……)
I submitted my responses and photographed my insurance cards and sent them to her via email. From that moment until my phone consult, I read more about the TAC and wrote down multiple questions to prepare for my conversation with him. I came up with several questions that I thought would be good for our one hour consult. And then I waited anxiously until the following week.