After four pregnancy losses, transabdominal cerclage procedure helps one central Pennsylvania mother welcome healthy baby
Gertrude Augustin, 32, always wanted to be a mother. The Mechanicsburg resident and her husband began trying to grow their family several years ago and immediately found out there would be bumps in the road. She has polycystic ovary syndrome, which can make it harder to become pregnant and maintain a healthy pregnancy.
She was referred to Penn State Health, where she began fertility treatments, including two unsuccessful rounds of intrauterine insemination. In 2022, Augustin became pregnant for the first time on her own. But after four months, she lost the pregnancy. Two more pregnancies ended in similar heartbreak, with each loss happening around the fifth month.
Augustin’s struggles were due to cervical insufficiency, a condition where the cervix opens too early in the pregnancy. During her second pregnancy, she received a vaginal cerclage, or a small suture designed to keep the cervix closed long enough to allow the baby to develop fully. But the pregnancy still wasn’t successful.
Dr. Kristin Riley, obstetrician-gynecologist and chief of minimally invasive gynecologic surgery at Penn State Health, recommended a different approach – a transabdominal cerclage, known as a TAC. The minimally invasive procedure is recommended for patients who have experienced recurrent pregnancy loss in the second trimester despite a vaginal cerclage.
“The idea is to place that suture up higher, laparoscopically,” Riley says. “There’s good data indicating that abdominal cerclage has better outcomes than vaginal cerclage for preventing preterm birth.”
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A Different Option for Women with Cervical Insufficiency
Both vaginal cerclage and transabdominal cerclage aim to accomplish the same result – a longer pregnancy and healthy birth – but the TAC procedure offers more protection against preterm birth, with success rates between 85% to 99% according to the National Institutes of Health.
The difference is where the cerclage is placed. During TAC, a strong band is positioned higher on the cervix than can be reached through the vagina. The procedure is performed using minimally invasive robotic laparoscopic surgery. The band stays in place throughout the pregnancy, and all TAC births are by Caesarean section.
A TAC can be placed early in a pregnancy, but Riley says having the procedure before conception is ideal.
“When a patient is already pregnant, the uterus is growing, and blood vessels grow with it. It’s more challenging to place but possible,” she says. “Ideally, the TAC is placed before conception, and it can stay in for multiple pregnancies.”
Because TACs are placed laparoscopically, patients generally have minimal recovery time and less pain than with traditional abdominal surgery. Most patients don’t need bed rest or activity limits afterward.
Learn more about Penn State Health’s high-risk pregnancy care.
A Long-Awaited New Beginning
Although transabdominal cerclage surgery has been used in the United States for decades, Augustin is the first patient in central Pennsylvania to have a cerclage placed robotically. The result was the healthy birth she had been waiting for. Her daughter was born in July 2026, at 34 weeks.
For Augustin, there were other benefits as well, including lower stress levels after years of hope and loss.
“I had peace of mind, knowing that I have the cerclage in place, and there’s no way my cervix will open,” Augustin says. “Until now, I was scared of getting pregnant again, but now I don’t have to worry about losing another pregnancy.”
With a 3-month-old at home, Augustin isn’t thinking about having another child at the moment, but she hasn’t ruled out giving her daughter a sibling someday. For now, she’s focused on enjoying motherhood and watching her baby grow.
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