Women's motivations for and experiences with transabdominal cerclage: A qualitative study

INTRODUCTION: Transabdominal cerclage (TAC) is used to prevent pregnancy loss and preterm birth in women with previous failed transvaginal cerclage or insufficient cervical tissue. TAC requires laparoscopic or open abdominal surgery, cesarean birth, and the potential long-term effect are currently unknown. While the procedural aspects, indications, and pregnancy outcomes associated with TAC are subject to ongoing research, little is known about how women experience the decision to undergo a TAC and the pregnancy that follows. MATERIAL AND METHODS: We conducted a qualitative interview study with 12 Danish women who had undergone laparoscopic TAC. Participants were recruited through a national online support group. Interviews lasted 58-90 min. Data were analyzed thematically using Braun and Clarke's approach. RESULTS: Two overarching themes were identified. The first theme, What it takes, describes how the decision to undergo TAC was often considered self-evident and necessary in light of previous pregnancy losses. Thus, the decision-making was shaped by prior trauma and urgent hope, but also grounded in careful assessment of risks, benefits, and prior experiences. The women downplayed the potential drawbacks of TAC (cesarean birth, long-term complications) in favor of the chance to carry a healthy baby to term. The second theme, Feeling safe(-r), describes how the TAC offered reassurance and allowed the woman to be more active during pregnancy compared to previous pregnancy experiences. However, anxiety and emotional vulnerability persisted, rooted in prior losses. Trusting relationships with healthcare providers were described as essential to navigate worry and uncertainty during pregnancy. All women with a TAC pregnancy achieved a live birth. CONCLUSIONS: For the women who underwent TAC, the intervention represented hope, and the downsides were perceived to be outweighed by an increased probability of having a healthy baby. The findings highlight the importance of continuity in care and patient-centered counseling that addresses the clinical and emotional dimensions of TAC. Future research should explore long-term physical and psychological outcomes and develop supportive interventions to improve care for this high-risk population.