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Re: The case from Hell - should she have another cervical suture From: art fougner, md (evsono@pipeline.com) Wed Nov 1 08:16:45 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. Lynn Montgomery: "Re: Oral Cytotec" Previous message: Richard Chudacoff, MD: "Re: Fri: A fowl question" In reply to: Ron Jewell: "The case from Hell - should she have another cervical suture" Next in thread: Myer S. Bornstein, MD, CPE, FACOG: "Re: The case from Hell - should she have another cervical suture" how long is the closed portion of the cervix? art At Wed, 1 Nov 2000, Ron Jewell wrote: > >I have a very high risk obstetric case. Her first delivery was normal >and she then had a series of first trimester losses(about 6). She then >had a pregnancy loss at 18weeks with a history suggestive of cervical >incompetence. > >In 1999, she saw my partner and had a cervical suture placed at 14 weeks >gestation. I saw her at 28 weeks when she went into labour and >unfortunately had a stillbirth. She developed an ominous FHR pattern >and had an emergency C section, unfortunately classical as she had no >lower segment and was a breech. The baby died between starting the >operation(fetal heart heard) and delivery. Subsequent PM showed >chorioamnionitis, probably with mycoplasma. > >After the pregnancy, I performed multiple investigations and found that >she has prothrombin gene mutation and mild protein S deficiency. > >Much to my horror, she is pregnant again and is now 23weeks. >I put in another suture at 14 weeks(McDonald type)and she is on >Clexane(low molecular weight heparin) and aspirin. A scan at 18 weeks >showed the cervix to be closed and to be 29mm long. A small amount of >beaking was noted (5mm wide and 8mm depth) A scan today showed the >beaking has increased - now 7mm wide and 10mm deep. There is still over >1 cm between the suture and the beaking. > >My plan had been to observe rather than place another suture higher. I >would value other opinions. > >Thank you > >-- >Ron Jewell > -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: Dr. Lynn Montgomery: "Re: Oral Cytotec" Previous message: Richard Chudacoff, MD: "Re: Fri: A fowl question" In reply to: Ron Jewell: "The case from Hell - should she have another cervical suture" Next in thread: Myer S. Bornstein, MD, CPE, FACOG: "Re: The case from Hell - should she have another cervical suture"

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