“Transabdominal Cerclage in Australia”: Before Pregnancy, Success Rates and When It Fails
In this guide
If a vaginal stitch didn’t hold and you are wondering about a transabdominal cerclage, or TAC, this guide is for you. It explains what a TAC is, who it is for, how it differs from a vaginal stitch, what Australian and international research shows, what can go wrong, and the questions to ask. It also explains when not being told about a TAC may be part of a legal question.
Quick answer · updated November 2026
A TAC is a stitch placed higher, at the top of the cervix, through the abdomen, usually by keyhole surgery before pregnancy. In a randomised trial of women whose vaginal stitch had failed, birth before 32 weeks was 8% with a TAC and 33% with another low vaginal stitch. Birth is by caesarean. See the evidence.
The TAC path, stage by stage
- 1After a failed stitchA loss or very early birth despite a vaginal stitch.
- 2ReferralTo a surgeon who places TACs, ideally before your next pregnancy.
- 3The surgeryUsually keyhole, before pregnancy, often as a day case.
- 4PregnancyWatching, and a plan for what happens if something goes wrong.
- 5BirthA planned caesarean. The stitch usually stays for next time.
At any stage: you can ask, “Am I someone a TAC might help, and if not, why not?”
The second time, I knew what was happening before anyone told me. Nineteen weeks, a stitch in since thirteen, and that same dragging heaviness. They took the stitch out so it wouldn’t tear, and our son was born that night into a little knitted blanket the volunteers make.
Three weeks later I was awake at two in the morning, scrolling, and I typed TAC vs cervical cerclage because a woman in a support group had written those three letters like they were obvious. I read until it got light. A stitch placed higher, from above. Done before pregnancy. Studies with numbers that made me put the phone down and walk around the kitchen.
At my follow-up I asked about it. The obstetrician nodded and said, “Yes, that would be the next step for you.”
I said, “Was it the next step after the first one?”
He looked at the notes for a long time. “It could have been discussed,” he said.
I drove home past the paddocks with the radio off. I wasn’t angry yet. I was just very, very tired.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are here after a stitch didn’t hold, I am so sorry. The fact that you are reading about the next step, while you are still grieving the last one, says a lot about you. I hope this helps you walk into your next appointment with the right questions.
This article is part of a series on failed cerclage and second-trimester loss. It covers what a transabdominal cerclage is, who it is for, how it compares with a vaginal stitch, what the evidence shows, what can go wrong, practical questions about accessing one in Australia, and how the law looks at it when the option wasn’t raised.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, a great many of them about pregnancy and birth. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts here come from a randomised trial, Australian published research and hospital patient information, all listed at the end. Please talk to a specialist about your own situation.
Start with your question
- What is a transabdominal cerclage?
- TAC vs vaginal cerclage: what’s the difference?
- Who should be offered a TAC?
- What is the transabdominal cerclage success rate?
- Before pregnancy or during pregnancy?
- What happens if a TAC fails?
- How do I find a TAC surgeon in Australia?
What a transabdominal cerclage is
Definition
A transabdominal cerclage (TAC), sometimes called an abdominal cerclage, is a stitch or band placed around the top of the cervix, through the abdomen rather than the vagina. It can be placed by keyhole surgery (laparoscopy) or through a small open cut (laparotomy). Birth is by caesarean, and the stitch is usually left in for future pregnancies [1][2].
In plain terms: a stronger, higher stitch, put in from above, that stays there.
A London hospital explains that a TAC is placed “at the very top of your cervix, from above”, laparoscopically before pregnancy or through a small “bikini-line” cut during pregnancy, and that it is usually left in for further pregnancies, with a planned caesarean for birth [1]. The UK’s National Institute for Health and Care Excellence describes the keyhole procedure as working well for a weak cervix, with no serious concerns about its safety [2].
TAC vs vaginal cerclage
Vaginal stitch
- Where
- Lower on the cervix, placed from below
- When
- Usually between 12 and 23 weeks of pregnancy [3]
- How
- Through the vagina, under spinal or general anaesthetic [3]
- Removal
- At about 36 to 37 weeks, or straight away if labour starts [3]
- Birth
- Vaginal birth is usually possible
- Next pregnancy
- A new stitch each time
Transabdominal stitch (TAC)
In plain terms: a TAC trades a vaginal birth and a simpler operation for a stitch that sits higher and lasts.
Who should be offered a TAC
A TAC isn’t for everyone at risk of early birth. It is generally considered for women in whom a vaginal stitch has already failed, or can’t be placed.
- A failed vaginal stitch. The randomised trial described below included women who had a second-trimester miscarriage or a birth before 28 weeks despite a low vaginal stitch [4].
- Not enough cervix for a vaginal stitch. For example, after extensive surgery to the cervix. The UK charity Tommy’s notes that women who have had extensive cervical surgery may be offered a TAC [5].
- Other situations a specialist judges to be high risk, after discussing the alternatives.
A US commentary on the randomised trial put it plainly: women with a prior failed vaginal stitch “can and should be counseled regarding the availability of TAC” and given the opportunity to weigh the risks and benefits [6]. That is a view, not an Australian guideline. But it frames the question many women ask afterwards: after the first stitch failed, was I told this existed?
What the research shows
The randomised trial: MAVRIC
The MAVRIC trial, published in 2020, randomly assigned women whose vaginal stitch had failed before to a transabdominal stitch, a high vaginal stitch, or a low vaginal stitch, placed before pregnancy or before 14 weeks [4]. Of the 111 women who conceived and were analysed:
Source: Shennan et al, MAVRIC, Am J Obstet Gynecol 2020 [4][7]. Low vaginal 11 of 33 women; transabdominal 3 of 39; high vaginal 15 of 39.
The trial also found fewer pregnancy losses with a TAC than with a low vaginal stitch (3% compared with 21%), and no serious operative complications in the 39 TAC cases [4][6]. The authors calculated that about four women would need a TAC to prevent one birth before 32 weeks, and concluded that a TAC is the treatment of choice after a failed vaginal stitch [4].
Australian results
Australia has some of the largest published experience of keyhole TAC. A Melbourne centre reported 121 pregnancies after a TAC placed before pregnancy: the average gestation at birth was 35.2 weeks, compared with 23.9 weeks in the same women’s earlier pregnancies, and perinatal survival was 98.5% [8]. A 2025 report on 512 keyhole TACs from the same Melbourne group found neonatal survival of 96.4%, with 85.7% of babies born after 34 weeks, and surgical complications in fewer than 0.5% of operations [9]. An earlier comparison found keyhole TAC appeared as effective as open surgery, with fewer complications [10].
These are encouraging numbers, but they need careful reading. They come from observational studies of selected women, largely from one surgical team, without a comparison group randomised to something else. The authors themselves note those limits [8]. MAVRIC is the stronger evidence on whether TAC works; the Australian series show what experienced keyhole surgery can achieve.
Before pregnancy or during pregnancy?
A TAC can be placed before pregnancy or in early pregnancy. In MAVRIC, stitches were placed before conception or before 14 weeks [4]. Before pregnancy, it can be done by keyhole surgery; during pregnancy, a London hospital explains it is placed through a small open cut [1]. In the Melbourne series, TACs were placed before pregnancy, and 86% of women went home the same day [8].
Placing it before pregnancy avoids surgery while pregnant, but it means planning ahead, which is hard when you are grieving and unsure whether you want to try again. There is no wrong timing for asking the question. The series article “Pregnant Again After a Second-Trimester Loss” covers the wider plan for a next pregnancy, including progesterone and scans.
Pregnancy with a TAC
A TAC changes some things about a pregnancy, and it’s worth knowing them in advance.
- Birth is by caesarean. Because the stitch sits high and stays in, labour can’t open the cervix [1][5].
- The stitch usually stays. It is left in for further pregnancies [1].
- A plan for early loss. If a pregnancy ends in the second trimester with a TAC in place, the stitch may need to be removed, for example by keyhole surgery, or the baby born by caesarean. A US commentary lists managing a fetal death beyond about 14 weeks among the particular complications of a TAC [6], and the Melbourne series describes a TAC being removed laparoscopically after the waters broke at 15 weeks [8]. Ask how this would be handled where you live.
- Watching still matters. A TAC isn’t a guarantee. Infection, the waters breaking, and labour can still happen. The signs to act on are in “How Do You Know If Your Cerclage Is Failing?” and “My Water Broke at 20 Weeks”.
When a TAC fails
People search “transabdominal cerclage failure stories” because they need to know the worst before they choose. TAC failures do happen. In the Melbourne series, two pregnancies had cerclage failure: one with labour and ruptured membranes at 24 weeks, and one with the waters breaking at 15 weeks [8]. In MAVRIC, 3 of 39 women with a TAC still gave birth before 32 weeks [4].
The ways a TAC can fail are mostly the same as for a vaginal stitch: infection, the waters breaking, or labour. What differs is what happens next, because the stitch is high and the birth surgical. If you are planning a TAC, it is reasonable to ask what the team would do in each of those situations, at each stage of pregnancy, and to have that written in your notes.
Birth with a TAC
Birth is by planned caesarean [1]. Ask when it will be planned, where, and what would happen if labour started before that date. Because the stitch usually stays in, your surgeon should tell you whether it will be left in place and record that clearly for any future pregnancy, and for any future doctor.
The TAC was a Thursday. Keyhole, a day case. I was home by tea time with three tiny plasters on my stomach and a sore shoulder from the gas, eating toast on the couch.
Before that, I’d asked for my notes from the first two pregnancies. In the letter after the first loss, under “Plan for next pregnancy”, it said: “Early cervical cerclage at 12–14 weeks.” That was all. No mention of anything else. No mention of the option I found myself at two in the morning.
When I asked the surgeon about it, she was careful not to criticise anyone. She said practice had changed, that MAVRIC had been published, and that she would always want a woman with a failed vaginal stitch to at least hear about a TAC. “You should have had the conversation,” she said. “What you chose would have been up to you.”
That was the thing, in the end. Not that someone had done something wrong to my body. That someone had decided, without me, which options I would get to know about.
I’m twenty-eight weeks now. I check my scan dates on the calendar like other people check the footy.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
Questions to ask, and finding a TAC surgeon
TACs are done by a relatively small number of surgeons in Australia, often in private practice, and access may mean travelling. Ask your obstetrician or GP for a referral, and ask about public and private options, Medicare rebates and out-of-pocket costs before you book.
Questions to ask a TAC surgeon
- Am I someone a TAC is likely to help, given my history?
- Keyhole or open, and before or during pregnancy?
- How many TACs have you done, and what are your outcomes?
- What are the risks of the operation for me?
- What happens if my waters break or I miscarry with the TAC in?
- Where and when would my caesarean be, and what if labour starts first?
- Will the stitch stay in, and how will that be recorded?
- What will it cost, and is there a public option?
In plain terms: you are allowed to interview your surgeon.
What to look for in the records
| Record | Why it matters |
|---|---|
| Operation note for the earlier vaginal stitch | Shows the type, height and timing of the stitch, and the cervical findings. |
| Birth and stitch removal notes from the loss | Shows how and when the stitch failed, which helps decide whether a TAC is the right next step. |
| Discharge letter and follow-up notes | Shows the “plan for next pregnancy”, and whether a TAC was discussed. |
| Placental pathology | Shows whether infection was involved, which affects what a TAC can and can’t prevent. |
| Referral letters | Shows whether you were referred to a TAC surgeon, and when. |
| TAC consent form and operation note | Shows the risks explained, the technique, and whether the stitch will stay in. |
| Antenatal plan with a TAC | Shows the plan for scans, early loss, labour and caesarean. |
My guide to getting and reading your birth records explains how to request them.
How the law looks at it
A failed vaginal stitch isn’t, by itself, negligence. And neither is a failed TAC. The legal questions most often arise around what you were told, and what was offered.
Consent and information. Under Rogers v Whitaker [1992] HCA 58, you are entitled to be told about material risks and reasonable options [11]. After a failed vaginal stitch, an expert may be asked whether a TAC was a reasonable option that should have been raised, given what was known at the time. That depends on the date: MAVRIC was published in 2020, and practice has changed since.
Standard of care. Under section 5O of the Civil Liability Act 2002 (NSW), care isn’t negligent if it was widely accepted in Australia by peer professional opinion as competent practice [12]. Research and commentary are evidence of competent practice, not the law itself, and RANZCOG’s cervical length statement doesn’t address TAC [13].
Causation. The law asks whether, if you had been told, you would probably have chosen a TAC, and whether it would probably have changed the outcome. A lost chance alone isn’t enough: Tabet v Gett [2010] HCA 12 [14]. TAC reduces risk; it doesn’t remove it, so this needs independent obstetric opinion.
Who can claim and when. The mother may claim for her own injury; the family if a baby was born alive and died; or the child, if a baby survived with lasting injury. If your child was born early, their time limits don’t always wait until they turn 18, so please ask early. The series article “Can I Sue the Hospital for My Miscarriage or Stillbirth?”, my page on pregnancy loss and stillbirth claims and my guide to time limits in NSW explain more.
In my practice
The TAC question usually appears in a file after the second loss, not the first. The pattern is quiet: a first stitch fails; the discharge letter says “early cerclage next pregnancy”; the woman is never referred or told that a different kind of stitch exists; the second vaginal stitch fails the same way. Each step looks like reasonable, standard care, and in the moment it may have been. The gap is in the conversation that didn’t happen. Often, the woman found the option herself, on a forum, at night. I don’t see these files as stories about bad surgeons. They are stories about information that didn’t reach the person whose body and family it concerned.
Both can be true
Your obstetrician may have given you careful, kind care through two pregnancies, and still not told you about an option you had a right to hear about. A TAC may be the right next step for you, and you may still grieve that it wasn’t offered sooner. You can be hopeful and angry in the same week. Both are allowed.
The bigger picture
Abdominal cerclage has been described for decades, but strong evidence is recent: MAVRIC in 2020 was the first adequately powered randomised trial comparing TAC with vaginal stitches [6]. Australian surgeons have since reported some of the largest keyhole TAC series in the world [9]. The 2024 BJOG review of cerclage summarises how the evidence has evolved [15]. Australian guidance has yet to catch up in a single place: RANZCOG’s cervical length statement covers screening and short cervix, not TAC [13]. In NSW, the Select Committee on Birth Trauma reported on 29 May 2024, with 43 recommendations [16].
Support
These services are free.
- Red Nose Grief and Loss, 24/7 support after pregnancy loss, stillbirth or the death of a baby: 1300 308 307 [17]
- Bears of Hope, pregnancy and infant loss support: 1300 11 4673 [18]
- PANDA, the National Perinatal Mental Health Helpline, including anxiety in pregnancy after loss: 1300 726 306 [19]
- Gidget Foundation Australia, perinatal mental health support: 1300 851 758
- Pregnancy, Birth and Baby, a free call with a maternal child health nurse: 1800 882 436
- Lifeline, if you are in crisis: 13 11 14
My guide to finding support after birth trauma in Australia has more.
The woman in the stories still keeps the first discharge letter in a folder, with the plan that didn’t mention a TAC. She’s added a page of her own now, in her handwriting: every question she asked, and every answer.
With care,
Rosemary
Frequently asked questions
What is the transabdominal cerclage success rate?
In the MAVRIC trial, after a failed vaginal stitch, 8% of women with a TAC gave birth before 32 weeks, compared with 33% with a low vaginal stitch. Australian series report survival above 96%, though from selected women.
TAC vs cervical cerclage: what’s the difference?
A TAC sits higher, at the top of the cervix, is placed through the abdomen, usually before pregnancy, stays in, and means a caesarean birth. A vaginal stitch is placed from below during pregnancy and removed before birth.
Can you get a transabdominal cerclage while pregnant?
Yes, usually early in pregnancy, through a small cut on the tummy. Before pregnancy it can be done by keyhole surgery, often as a day case.
What are the side effects and risks of a TAC?
Risks include those of any abdominal surgery, such as bleeding, infection and bladder injury, plus the need for a caesarean and a plan if the pregnancy ends early. Australian series report surgical complications in fewer than 1 in 50 cases.
Can a transabdominal cerclage fail?
Yes. Infection, the waters breaking or labour can still happen, though less often than with a vaginal stitch after a previous failure.
Should I have been told about a TAC after my first stitch failed?
It depends on your history and when it happened. You are entitled to be told about reasonable options, and many specialists now raise a TAC after a failed vaginal stitch.
Questions about the options you were given?
When you’re ready, and not before, I can go through what happened and your records with you, and tell you honestly whether there are questions worth asking.
When the Stitch Doesn’t Hold: the series
- “What Happens If a Cerclage Fails?” Failed Cerclage and Losing a Baby in the Second Trimester
- “Can I Sue the Hospital for My Miscarriage or Stillbirth?” Time Limits and Compensation After a Second-Trimester Loss
- “Do They Check Your Cervix at the 20-Week Scan?” Short Cervix, Funnelling and Missed Risk Factors
- “How Do You Know If Your Cerclage Is Failing?” Signs of a Failing Stitch or an Incompetent Cervix, and When They’re Brushed Off
- “Emergency Cerclage at 20 Weeks”: Rescue Stitches, Bulging Membranes, Risks and Success Rates
- “My Water Broke at 20 Weeks”: PPROM, Infection After Cerclage and What Happens Next
- “Baby Born at 22 Weeks”: Survival Rates, NICU and Comfort Care
- “Is 20 Weeks a Miscarriage or a Stillbirth?” Giving Birth, Funerals, Certificates, Leave and Payments
- “Why Am I So Angry After My Miscarriage?” Anger, Blame and “Is It My Fault?” After a Second-Trimester Loss
- “Transabdominal Cerclage in Australia”: Before Pregnancy, Success Rates and When It Fails (you are here)
- “Pregnant Again After a Second-Trimester Loss”: How Long to Wait, a Preventative Stitch and Progesterone
More: Pregnancy loss and stillbirth claims · Birth trauma and obstetric negligence · Pregnancy after a traumatic caesarean · Asking for a birth debrief · Complaining to a hospital
References
- University College London Hospitals NHS Foundation Trust, Cervical cerclage: patient information.
- National Institute for Health and Care Excellence, Laparoscopic cerclage: information for the public (IPG639).
- Women and Newborn Health Service (King Edward Memorial Hospital, WA), Cervical cerclage: patient information, 2025.
- Shennan A et al, MAVRIC: a multicentre randomised controlled trial of transabdominal versus transvaginal cervical cerclage, Am J Obstet Gynecol 2020;222(3):261.e1–261.e9.
- Tommy’s, Weak cervix (cervical incompetence).
- Owen J, A multicenter RCT makes a case for transabdominal cerclage, OBG Management 2020;32(5).
- ISRCTN registry, MAVRIC trial record (ISRCTN33404560).
- Ades A, Parghi S, Aref-Adib M, Laparoscopic transabdominal cerclage: outcomes of 121 pregnancies, Aust N Z J Obstet Gynaecol (doi 10.1111/ajo.12774).
- Pregnancy outcomes of 512 laparoscopic transabdominal cerclages: the Australian cohort, J Minim Invasive Gynecol 2025;32(10):935–940.
- Dobromilsky K, Ades A, Cheung K, Umstad M, Transabdominal cervical cerclage: laparoscopy versus laparotomy, J Minim Invasive Gynecol 2015.
- Rogers v Whitaker [1992] HCA 58.
- Civil Liability Act 2002 (NSW), s 5O.
- RANZCOG, Measurement of cervical length for prediction of preterm birth (C-Obs 27), current November 2021.
- Tabet v Gett [2010] HCA 12.
- Story L, Shennan A, Cervical cerclage: an evolving evidence base, BJOG 2024;131(12):1579–1586.
- NSW Legislative Council Select Committee on Birth Trauma, Birth trauma, Report 1, May 2024.
- Red Nose, Grief and Loss Support Services.
- Bears of Hope Pregnancy & Infant Loss Support, bearsofhope.org.au.
- PANDA, National Perinatal Mental Health Helpline.
The stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
About the author
Dr Rosemary Listing, PhD (Law), specialises in medical negligence, has been in practice since 2013, and is Of Counsel at Peter Evans & Associates in Newcastle, NSW. Her doctorate looked at patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified; clinical information in this article is checked against the sources listed.
Last updated: November 2026 · First published: November 2026 · Next review: May 2027
Cite this article: Rosemary Listing, ‘“Transabdominal Cerclage in Australia”: Before Pregnancy, Success Rates and When It Fails’ (Reframe Legal, November 2026) <https://reframelegal.com/transabdominal-cerclage/>.
This article is general information, not legal or medical advice. Every situation is different; please get advice about your own circumstances. If you or your baby need urgent help, call 000. If you are in crisis, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
