Laparoscopic TAC: Treatment of recurrent miscarriages
Having a baby is most women’s dream, but a miscarriage can push a woman down into deep bouts of depression. One such lady, Sudha, who was 20 weeks pregnant and had had five miscarriages in the past (all around the fifth month of pregnancy) was referred by her gynaecologist to Sunrise Hospital, South Delhi, where hundreds of cases have been treated successfully. According to Dr Nikita Trehan, a gynaecologist and laparoscopic surgeon working at Sunrise Hospital, who took over the case, Sudha suffered from a condition called Cervical Incompetence. In this condition, the mouth of the womb opens before time, causing a miscarriage in some women and pre-term delivery in others.
The cervix, or mouth of the uterus, is about 3-4cm long, extending from its internal opening, the internal OS (leading to the uterus) to its external opening, the external OS (at the vaginal end). When the process of labour starts at the internal OS, the contractions begin, causing the womb to open. The last part to dilate or open is the external OS. “Even today, most gynaecologists put stitches to close the womb at the level of external OS, to prevent a late miscarriage or pre-term labour. But this stitch often fails, as the entire cervix is already dilated. At Sunrise Hospital, a tape is applied at the internal OS. As this part, cannot be reached from below the stitch with a strong tape is applied via laparoscopy (keyhole surgery) at this point. This is called a Trans Abdominal Cerclage (TAC) procedure,” says Dr Trehan.
There are several challenges during this procedure as operating under general anaesthesia on a large vascular uterus, with a foetus inside, is no child’s play. “Hence, expert surgeons and infrastructure such as 3D cameras, etc are needed. I have been practising for 17 years and have performed hundreds of such procedures at Sunrise Hospital. Many women, like Sudha, have been able to experience the joys of motherhood,” says Dr Trehan
Sunrise Hospital, Kalindi Colony, South Delhi has 24/7 emergency laparoscopic Encerclage services.