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Re: cervical scarringFrom: Betsy Hyde (elishyde@connix.com)Wed Apr 4 17:12:22 2001
At 11:16 PM 4/3/01, Marco A. Pelosi, III, MD wrote:
> Although our practice does follow our patients who have had conizations (and no subsequent full term pregnancy) with regular cervical length ultrasounds, Maggie's patient was 32 weeks on 2/1, and the case in point occurred last week. Since she made it to 39-40 weeks, she would not have benefitted by cervical surveillance or cerclage! She made it to term despite all our technologies! She made it to 39 weeks. She doesn't have cervical incompetence.
It is
>more often cerclage rather than conization which creates the scarring I don't think anyone suggested pushing forward with a stenotic os; however, having had many women w/ scarring due to cryos or cones, once the scar tissue is broken up (and I have only done this digitally), the cervix opens quite promptly to 3, 4, 5 cm as Dan has suggested. And then the dilatation progresses quite normally.
>Thank your obstetrician for having the wherewithall to eliminate I agree that persistence in labor in the face of a stenotic, scarred external os is not wise...regardless of prior c/s or not. One primip had a posterior sacculation of the uterus, with the fetus coming thru the posterior LUS because it was the "line of least resistance". This fetus was approximately +3 station and a paper thin LUS, the obstetrician was consulted and (eventually) believed me that this woman was closed, not completely dilated. But it took a spec exam since the uterus was so thin. C/S was uneventful. Another woman w/ previous c/s and cryo since last birth was admitted in labor w/ stenotic os which we could not break up digitally. Had c/s w/ a window. I thank those posters who gave suggestions for breaking up this scar tissue. I would certainly attempt this the next time I am faced w/ cervical stenosis. An automatic c/s without attempt at correcting the stenosis is *not* a benign procedure, and the techniques presented here would not cause any undue delay.
-- Betsy Hyde CNM Branford, CT
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