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Re: cervical scarringFrom: Marco A. Pelosi, III, MD (marcop@agoron.com)Tue Apr 3 23:13:34 2001
At Tue, 3 Apr 2001, maggiela@rochester.rr.com wrote: > >Had a clinic patient last week who presented to L &D with ROM and this >history: G2P1, previous C-sec for FTP. Exam:fingertip/100%/-2. Cervix >scarred from Letz procedure after first birth. Could not break up scar >with digital exam. My plan was to get pt and epidural and try again >once she was comfortable. Pt ended up with a repeat c-section as the >in-house attending did not seem to feel this was a valid management >option. Any suggestions on how to manage these patients-how to break up >that scar or how to know when to not try? What anesthesia would you >suggest- none, epidural, pudendal, paracervical? > >Interestingly enough, this patient had been on Depo for 2 years and had >switched to OCPs in August 00. She continued on OCPs until 2/01 when >she thought she felt something funny! She was about 32 weeks pregnant >and had taken OCPs faithfully every day throughout her pregnancy!! > Cervical conization by any method typically weakens the cervix and is a strong risk factor for cervical incompetence and preterm delivery. This patient would have benefitted from serial sonographic cervical length determinations & possibly second trimester prophylactic cerclage. It is more often cerclage rather than conization which creates the scarring which you describe. Nonetheless, faced with labor contractions, a previous cesarean, and a rigid yet effaced cervix, the question you should be asking yourself is not by what ridiculous means can we force the cervix open, but rather what is the point of least resistance - the cervix or the uterine scar? Thank your obstetrician for having the wherewithall to eliminate unnecessary danger to the patient by putting a prompt and appropriate end to this dangerous riddle.
-- M.A. Pelosi, III, MD
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