Thursday, May 18, 2017

What causes PPROM? And what is a TAC?

I mentioned that I got a TAC a few weeks ago, so here is the post where I explain it.

There are a few theories as to why I lost Miriam, and we decided to do everything possible to prevent either one of these possible things from happening again.

1. Underlying infection
My MFM actually thinks this is the reason that I had PPROM (water breaking way too early) last time. There was never any infection found in my bloodwork, Miriam's placenta, or anything else, but this is what he thinks. This is not a crazy thought though as it's a common theory for undiagnosed PPROM. This is the scariest option to me since there's not much doctors can do to prevent this, since they never identified an infection last time, even after my water broke. The only thing I can really do is pay attention to any signs in my body. BUT, we also have a "natural guy" that does electro-dermal screening and detects infections WAY better than doctors can. It's a little on the "woo woo" side, but hey, we are up for trying anything to detect infections. I'm currently seeing him once a week to be on the lookout for any infection, and so far so good. Whew!

2. Pre-Term Labor
This is not highly suggested by most doctors because it's not usually considered 'pre-term labor' unless it happens after 24 weeks, and my water broke at 19w5d. BUT, we are still doing the only thing they know to do by giving me weekly progesterone injections. If I started having contractions or cramping, there are other medications I could be given to prevent labor. But, I seriously hope and pray that doesn't happen this time, at least not until at least 24 weeks! (Doctors are more likely to treat pre-term labor then, as opposed to earlier when baby wouldn't survive outside the womb anyway). 


3. Cervical Polyp Removal
At 18 weeks last time (which I'm very close to now... yikes) I started having spotting, which obviously scared me. After a healthy ultrasound, a cervical polyp was found by my midwife, and she said it was nothing to be concerned about, but that I would continue to have heavy spotting unless it was removed. So, she referred me to an OB who removed it several days later. 6 days after removal, my water broke. All the doctors say this was not related at all, but it's hard to not wonder. We also found a couple of studies online that showed that removing cervical polyps makes you more likely to lose a pregnancy, but apparently they are not widely accepted.

To help prevent any polyps in this pregnancy I had a hysteroscopy done by my RE in November. This is where they send a tiny camera up through the vagina, cervix and uterus to make sure everything looks good. When this was done they found a couple of budding polyps and removed them. So, hopefully none pop up in this pregnancy! But, of course if one does there is zero chance we will remove it. So, please pray I don't get any spotting or a polyp as this would freak me 100% the heck out. 


3. Incompetent Cervix
If you have undiagnosed incompetent cervix you will just keep losing babies. This is the most common reason for multiple PPROM losses. It's also believed by some doctors to be the primary reason for 2nd trimester losses. The usual treatment for this is a cerclage. Typical cerclage placement happens after first trimester (so they know you won't have a miscarriage due to genetic issues), and they stitch your cervix closed (or as close to it as they can) through the vagina. These cerclages have a 70% success rate for healthy babies coming home (although some are still born prematurely).

I heard about the abdominal cerclage through online support groups for women who experienced PPROM. It was also recommended to me by my RE and he suggested I not transfer any more embryos until I had the TAC (trans-abdominal cerclage). This cerclage is placed at the very top of the cervix, and provides a 95% success rate instead of 70%. However, because it's so high it has to be placed surgically. Instead of a stitch, it's a permanent band up there. Usually before recommending a TAC doctors want you to have TWO second trimester losses and/or a failed vaginal cerclage. However, there was zero chance we were going to just "see what happens" to see if I had another second trimester loss!  Pregnancies with vaginal cerclages also often involve bedrest, and we really wanted to avoid that. You can see in the picture below how much higher TACs are than other cerclages. 




So, in December, we drove to Indianapolis to get a TAC laparoscopically placed by one of the top 2 successful TAC surgeons in the country. It was my first ever surgery (besides my wisdom teeth taken out and that hardly counts). The surgery and recovery weren't too bad and I just have 4 tiny scars on my belly. Because there's a pretty permanent band at the top of my cervix I will have to have a c-section. Pretty ironic for the lady that chose to get her pre-natal care at a birthing center last pregnancy, right? However, after losing Miriam my "ideals" for birth went out the window and my priority now is just living child. One would think those are low expectations, but for me they seem rather high.

Anyway, so that's what a TAC is and why I got it. There's certainly a chance that I don't even have an incompetent cervix and didn't "need" it placed. But, which is worse? Having it and not needing it? OR needing it and not having it and losing another baby? I would certainly take the former!

As you can see we are being very proactive about preventing PPROM this time around, but of course, I'm still a nervous wreck knowing that any day anything can go wrong. Last pregnancy I truly believed pregnancy was durable, but this time my head couldn't be further from that truth. Please continue to pray for us and this little baby girl. We would love for her to be a full term baby!

3 comments:

  1. Praying for you and this sweet baby!

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  2. I have never heard of this before but it definitely sounds like the better route with 95% success rate.

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  3. Thanks for sharing and processing with us! We are praying and hoping for a full term baby girl with you!!

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