The phone appointment with dr. Haney went fabulously. I thought he was very intelligent and the things he said made perfect sense. Essentially I am lacking the internal sphincter provided by the top of the cervix at the level of the internal os. Therefore it needs to be replaced. Hence the TAC. The TVC only provides a barrier beyond which the membranes should not funnel, hence leaving enough column of mucus in the cervix to stop bacteria from ascending, but there is not a proper barrier like it is in the case of the TAC. I might dedicate an entire post at some point to writing the things that he said, because they are worth reading by anybody who has had PPROM, PTL, and IC. Essentially he thinks they are all effects of the same cause, which is loss of integrity of the internal sphincter and hence the column of mucus gets shortened in each case, and bacteria ascend. The progesterone that we all get given is meant to thicken that mucus.
My problem, however, is that the TAC has eroded through the wall of the uterus and has been removed. He said that he has only heard of two other cases like me in the world, none of them his. (Insert exclamation mark here!!!!!!!). WTF? Do I REALLY have to have the rarest of rarest things happen to me? I mean this guy is seeing the majority of TACs performed in the world and even he is at a loss of what to counsel me? This after having another two exceedingly rare things happen before, which are not even related (one was the delayed pneumomediastinum after the laparoscopy, the other one the heavy bleeding two weeks after delivery due to SIPS). Both of these things are super rare. I mean super duper rare. Only one other case of pneumomediastinum reported in the literature, and only 1% of post partum hemorrhages are so delayed, who knows how many are due to SIPS).
I should be in the Guiness book of records under "worst luck in obstetrical endeavours".
Anyway, he counselled that I get an ultrasound every week of my next pregnancy to make sure that the new TAC which he wants to insert is staying on the outside of the uterine walls, and that later on the scar from the previous erosion is not bulging out and about to give (i.e. ahem, rupture and kill the baby and perhaps me as well).
Should I go to India instead? Equal amounts of money, two surgeries less, and two trips to a country that I would in any case like to visit in my lifetime.
Today I am seeing my current OB who probably does not know how to get out of this mess in a polite way.