Re: twins with progressive cervical change.
From: art fougner, md (evsono@pipeline.com)
Fri Mar 9 08:43:05 2001
have occasionally performed amniocentesis in conjunction with cerclage
in situations with bulging membranes. also favor general anesthesia vs
regional.
good luck.
art
At Fri, 9 Mar 2001, John Robertson MD wrote:
>
>FWIW I feel much like your perinatologist that the cerclage is
>reasonable to offer because there is little else. I am not one to
>stitch everything, and as a matter of fact recently declined stitching
>someone who had stitches in her previous pregnancies because of a cone.
>(I am monitoring her and at 33 & 1/2 weeks she is still doing fine). I
>would recommend a couple more days of indocid to intentionally decrease
>the amniotic fluid and then possibly stitch around a 30 cc foley which
>can act as a retractor during the case - then remove it once you are
>done. John.
>
>At Thu, 8 Mar 2001, Kleinman, Dr. Gary E. wrote:
>snip
>
>Today, cervix is open , by palpation, 1-2 cm with
>>amniotic sac funneling to cervical os. Cervix feels 50% effaced.
>>
>>Patient placed on magnesium sulfate and indocin continued. Called
>>Southwestern Multiple Gestation Mecca for advice. Their perinatologist, said
>>that a cerclage would be reasonable because there was little else to offer,
>>however he was unsure of the benefit of this.
>>
>>I am in a quandry. I fear patient delivering 2 previable infants or
>>delivering at a gestational age where one or more might survive with severe
>>handicaps. I can't see the pregnancy progressing past that point without a
>>cerclage, but that procedure (if complicated) might cause the patient to
>>deliver at the worst time. The patient is 35 with a laparoscopy and medical
>>treatment for endometriosis, a myomectomy and years of infertility.
>>
>> I feel ready to stitch. I wonder if our community agrees.
>>
>>Thank you, in advance for your opinions,
>>
>>Gary Kleinman, MD
>>MFM, Genetics,
>>Bridgeport Hospital, Bridgeport, CT
>
>--
>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>(604) 793-9988 e-mail john.robertson@obgyn.net
>Who is wise and understanding among you? Let him show it by his good life,
>by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
