Re: 23 week pPROM
From: D. Ashley Hill (dahmd@cfl.rr.com)
Wed Feb 21 09:12:43 2007
While there is a reasonable theoretic possibility that the interventions
below would work, does Dr. Sailing (or anyone else) have objective
evidence that these interventions are both safe and effective? Remember,
obstetric history is full of "great ideas" that later were found to
cause harm.
Ashley
t Tue, 20 Feb 2007, ljmidwife@aim.com wrote:
>
> The cerclage with oversewn cervix is used to prevent PTL and pPROM in those women who have a history of such (2nd trimester miscarriages). Dr. Saling's first line is to prevent the change in vaginal flora, usually bacterial vaginosis, that is a forewarning of potentially more serious infections.
> By detecting the change in pH by having the woman self check her pH 2 x/week and keeping a chart, she is the early warning system. The best preventive for the altered pH, and the first line treatment is the use of probiotics (lactobacillus acidophilis and bifidus) to strongly encourage the healthy bacteria that produce mild H2O2. I have looked at a few of the links from his site and the Mayo clinic lists some of the probiotics that work best (Gynoflor and several other brands). There are also some studies which use an instillation of half strength hydrogen peroxide to accomplish the same thing in the short term with continued coverage with the probiotics. The probiotics take up to 2 weeks to colonize the perineum and vagina.
> Oversewing the cervix prevents the ascending infections that get past the cerclage. It takes very little to reopen the cervix at 36-37 weeks and labor progresses normally.
>
> I have spoken with Dr. Saling's colleagues a time or two and they have been very helpful. My numbers are quite small, but the use of probiotics is something I strongly recommend to the women I care for who have a history of near term PTL. They all have gotten to term or been postdates by a few days. Obviously, someone with a history of short cervix or ACD would not be a candidate for OOH birth.
> Linda Johnson, CNM
> http://www.mothersownbirth.com
> Temperance, MI
> 1-866-920-8100
>
> "Not to know is bad. Not to want to know is worse.
> Not to hope is unthinkable. Not to care is unforgivable."
> --Nigerian saying
>________________________________________________________________________
>Check Out the new free AIM(R) Mail -- 2 GB of storage and industry-leading spam and email virus protection.
>________________________________________________________________________
>________________________________________________________________________
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
|
|
