WOMENS-HEALTH Messages for December, 1998: Re: 2 different ob/gyn and 2 different opinions. What shall I do?

Re: 2 different ob/gyn and 2 different opinions. What shall I do?

From: William D. McIntosh, MD (anonymous@obgyn.net)
Mon, 28 Dec 1998 18:25:25 -0600 (CST)

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In reply to: Naureen: "2 different ob/gyn and 2 different opinions. What shall I do?"

At Sun, 27 Dec 1998, Naureen wrote: >
>Last year I had a miscarriage at 16 weks. This was my 2nd preg. The
>1st resulted in a girl born 4 years ago. The miscarriage was diagnosed
>as incompetent cervix (went into hospital when I noticed the amniotic
>sac bulging into the vagina. No pain. Was more than 4 cms dilated.
>Induced after the waters burst). The doc said he would give me a stitch
>at 13-14 weeks in the next pregnancy. We subsequently moved to a new
>area. I am now 12 weeks pregnant. The new doc doesn't want to give a
>stitch and says that the miscarriage may have been due to infection. He
>has put me on antibiotics and booked me for a scan at 13 weeks 2 days to
>check the lenght of the cervix. I have no history of cervical
>operations and during my first pregnancy had dilated fully before having
>an emergency CS due to deep transverse arrest. I 'm very confused now
>and would greatky appreciate any help/advice. Thanks a lot.

I would tend to agree with your second doctor, at least insofar as he/she wants some evidence of true cervical incompetence before running off to the OR. In patients such as yourself, with a history that is concerning for this condition, I scan for cervical length every 2 weeks until 24 weeks. If the cervix begins to shorten, then I place the cerclage. It it does not, then there is no need, and an unnecessary, and potentially dangerous, proceedure is avoided. I generally would not treat with antibiotics in the absence of positive cultures or DNA probes.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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