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Re: cervical scarringFrom: kay (mrsrrobb@hotmail.com)Fri Apr 6 06:07:36 2001
At Wed, 4 Apr 2001, Braun, R. Daniel wrote: > >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 >being a midwife myself, it was the first time I had come across this situation re pinpoint cervix.... I was the patient! I can tell you in no uncertain terms that the procedure to break the scar is definitely not painless. My OB used an amnihook to stretch the pinhole to 3cm. 3 hours later stretched to 6-7cm digitally. A rim was still remaining 2 1/2hrs later requiring augmentation for infrequent contractions. Large baby via ventouse/forceps. My previous birth prior to Lletz loop was as normal as you could get. Could be that my reproductive years are nearing an end. I'm 39 G11P6 >-----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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