As we consider expanding our family, here are some options as we see them. For us, doing nothing isn't an option, as we're terrified that our next baby will be born prematurely. Doctors have advised us that certainly it will and it isn't unlikely that it could happen even sooner next time.
My ob-gyn said that we could get pregnant and to call when we did to schedule a vaginal cerclage (cervical stitch to prolong pregnancy in times of cervical incompetence) procedure. (In Layman's terms: sewing the cervix closed!) However, being 2 engineers, my husband and I wanted more of a plan, more data, and more assurance than that.
We met with an amazing MFM (Maternal-Fetal Medicine) doctor. We saw our options as either:
1) Get a vaginal cerclage at the end of the first trimester - easy procedure, somewhat successful
2) Get an abdominal cerclage at the end of the first trimester - placed via C-section surgery - proven to be very successful
3) Get an abdominal cerclage before pregnancy - placed via laparoscopic surgery - experimental
There are lots of advantages and disadvantages to these. There is a weigh and balance of risk of procedure vs. possible outcome. For us, we wanted to pull out every trick possible to prevent extreme premature birth.
Traditional ways of thinking indicate that option #1 is suitable for a case such as mine. Being a more major sugery, often abdominal cerclages might not be used until multiple losses or premature births are experienced. But those options are not acceptable to us.
So - We opted for #3. A few weeks ago I had an transabdominal cerclage placed. I am not pregnant. And it was placed via the DaVinci robot (it looked like the bad guy from Spider man 2....awesome) This is an experimental surgery and was considered a success. It was considered outpatient, but I was kept in the hospital 1 night for observation. I was feeling totally normal within about 4 days. The worst issues I had were recovering from the anesthesia and back pain as my stomach muscles healed.
We felt option 3 was the best for us for a few reasons:
1) We wanted the abdominal cerclage because of it's somewhat better success rates (ie: pregnancies that go to term) than a vaginal cerclage (note I don't have this statistics)
2) I believe that the probability for bed rest or hospitalization is less with the abdominal cerclage. This is also really important for us because we have a toddler at home to take care of.
3) The obvious advantages of the laparoscopic surgery are that it can be done before pregnancy and has a faster recovery time. I'd read some negative info on the internet about this method, but my doctor is an expert in this field and so I trusted his advice for our particular situation.
We weighed the risks of the experimental, major surgery vs. the reward and felt that option 3 was the best for us.
Some other factors that entered into our decision:
-Success rates (of carrying baby to term)
-Risks to mother
-Risks to fetus
-Probability of being on bed rest, resuming "normal" life during pregnancy, including taking care of toddler at home
-What happens if you have a miscarriage with option #3
-With vaginal cerclages you would have to repeat the procedure with future pregnancies, abdominal cerclages are permanent
-Abdominal cerclages require c-section at delivery of baby
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