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Re: cervical scarringFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Apr 4 10:15:24 2001
The time that one knows that "Conglutination" (scarring ) has occurred is when the patient is 100% effaced and then remains FT or less dilated for a period of time. When this has occurred, one can then place a clamp throught the pinpoint cervix and open the clamp. Usually quite painless and the patient will go to 4-5 cm dilated just like that. Dan -----Original Message----- From: maggiela@rochester.rr.com [mailto:maggiela@rochester.rr.com] Sent: Tuesday, April 03, 2001 8:40 PM To: Multiple recipients of list OB-GYN-L Subject: cervical scarring 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!!
-- Maggie, CNM
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