Transabdominal cervical cerclage (TAC) is a surgery performed to prevent pregnancy loss in patients with the most challenging cases of incompetent cervix (cervical insufficiency).
For decades, patients have traveled to the University of Chicago Medicine from both coasts and everywhere in between for this life-changing surgical procedure. Our experts perform more than 200 abdominal cerclages per year.
Transabdominal cerclage may be an option for you even if:
- You’ve had a cervical tear from a previous delivery
- You’ve had a failed transvaginal cerclage.
- You aren’t eligible for a transvaginal cerclage.
What is a transabdominal cerclage?
A transabdominal cerclage is a small, extremely strong, woven synthetic band stitched high on the cervix. This band supports the full length of the cervix and resists the pressure the growing fetus places on it. The band prevents the cervix from opening and losing the pregnancy.
As with any surgery, there are some risks to abdominal cerclage procedures. If you think you may be a candidate for TAC, discuss the potential risks and benefits with your doctor.
What are the benefits of transabdominal cerclage?
There are several advantages with a transabdominal cerclage, including:
- A high success rate for live birth
- A lower chance of preterm birth and NICU care compared to transvaginal cerclage
- No bed rest or activity modification required
- No need for TAC removal after delivery (The TAC can be used for future pregnancies.)
What is the success rate of transabdominal cerclage?
TAC surgery is effective in at least 95% to 98% of our patients. We use a range to acknowledge that many considerations can impact how success is defined. Specifically, we measure success of a TAC with those deliveries that occur at 36 weeks or later. However, it’s important to remember that every patient is unique and that their health and risk factors play a role in a TAC’s effectiveness.
Learn More About the TAC Procedure
The TAC band is placed through a 2-inch surgical incision along the bikini line — similar to a C-section incision but smaller. This approach allows our experts the level of control and precision they need to best determine the amount of tension around the cervix, providing the most secure TAC band placement.
TAC placement is usually an outpatient procedure, meaning you can go home the same day. However, some patients may choose one overnight hospital stay, depending on their insurance coverage.
Recovery time is minimal, usually about two weeks. And when it’s time, your baby can be delivered by C-section through the same surgical incision.
The best time for abdominal cerclage placement is before trying to conceive again. Most patients have a TAC band placed around 90 days after losing a pregnancy. This time frame allows doctors to place the band as high as possible around the cervix, providing the best support possible.
Although each case is unique, TAC placement is generally not recommended in patients who are already pregnant, due to the elevated risks involved during pregnancy. In the rare exception that you are already pregnant and your doctor determines that TAC placement would be safe for you, you would need a consult as soon as possible to have your TAC placed during the eighth or ninth week of pregnancy.
Patients usually return to work in two weeks, with some returning earlier. It is important to stay active after the TAC placement procedure. Your underlying muscles may feel sore, but bruising due to the surgery is normal. Using your muscles will help speed your recovery, and activities like walking can help reduce your risk of developing a blood clot.
You must not drive for at least one week after TAC placement. Talk with your doctor about how to know when you’re ready to drive again.
Q&A: Pregnancy, fertility and childbirth with TAC
Laura Douglass, MD, explains what patients can expect after TAC surgery.Read Dr. Douglass' TAC Q&A
With transabdominal cerclage, there is no requirement to be placed on bed rest or to avoid sexual intercourse during pregnancy.
However, patients with transabdominal cerclage must give birth by cesarean delivery (C-section). If your TAC was placed using the open technique, your baby’s delivery can be performed through the same bikini line incision.
There is no increased risk for preterm labor with transabdominal cerclage. Patients with incompetent cervix may be prone to experiencing Braxton-Hicks contractions — false labor pains, which are common and harmless — as early as the second trimester.
The material used in a transabdominal cerclage is safe, highly durable and compatible with human tissue. A TAC can remain in your body permanently. You can carry future pregnancies using the same band by leaving it in and using contraception until you’re ready to conceive again. Some patients may choose to have it removed. You may also have gynecologic surgery with the TAC in place.
Yes. If one or more fibroids make placement difficult, the fibroid tissue can be safely removed in patients who are not pregnant. Patients who have their fibroids surgically removed (a myomectomy) must have a C-section to give birth, but this is already a requirement when you have a TAC anyway.
Is TAC safe?
Yes, TAC is safe. TAC surgery carries less risk than a simple C-section, particularly since placement is often performed as an outpatient procedure. From our patients’ point of view, the benefits of safely carrying a full-term pregnancy and having a healthy baby far outweigh the risks of TAC surgery and a C-section.
Transabdominal cerclage is safe and effective, with few risks and side effects.
Patients with a TAC are not at an increased risk for common pregnancy complications, such as miscarriage or preterm delivery. If these complications occur, they are managed no differently from other patients.
Funneling is the term used to describe when the amniotic sac moves into the cervix prematurely, forcing the cervix to take on the shape of a funnel. The band used for a TAC is tied with enough tension to prevent funneling without compromising the blood flow of the cervix. A TAC, however, cannot fix a cervix that has already funneled. In rare circumstances, funneling below the TAC can occur if it could not be optimally placed due to a physical abnormality – such as a fibroid near the top of the cervix – or cervical tissue that has been damaged by a surgical procedure or a tear from a previous childbirth.
One misunderstanding surrounding TAC is that it increases the risk for miscarriage. This is entirely false based on decades of patient outcomes.
Pregnancy loss with TAC is rare; however, it is possible. TAC protects against loss by incompetent cervix, but not against a genetic miscarriage during the first trimester.
If a first trimester miscarriage occurs, the tissue can pass spontaneously because the TAC does not narrow the cervical canal. Otherwise, misoprostol may be used to help expulse the tissue, or a D&C can be performed without any impact on the effectiveness of the TAC in subsequent pregnancies.
Additionally, TAC does not prevent pregnancy loss due to:
Helpful Information about TAC and Insurance
Several health insurance companies cover the cost of a transabdominal cerclage as a primary treatment for incompetent cervix. However, if an insurance company has denied you coverage for TAC, you may attempt to appeal the decision. Make sure to contact your insurance company for details about your coverage.
If your insurance claim for a transabdominal cerclage placement has been rejected, it may help to ask your insurance provider whether the correct procedure code was used. To correctly describe a TAC placement, one of the following common procedural technology (CPT) codes should be used:
- CPT code 58999 (non-specific genital tract procedure): Currently, this code is used because there is no specific CPT code for pre-pregnancy TAC placement.
- CPT code 59325 (placement of a TAC during pregnancy): Again, this is extremely rare.