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Re: Arrest of Dilatation/VBAC/post LEEPFrom: Braun, R. Daniel (rbraun@iupui.edu)Sat Mar 16 12:54:48 2002
Probably from scarring secondary to all the unnecessary (TIC) cerclages. Dan -----Original Message----- From: garrys@mindspring.com To: Multiple recipients of list OB-GYN-L Sent: 3/16/2002 2:32 PM Subject: OB: Arrest of Dilatation/VBAC/post LEEP I've had a few people post LEEP or other procedures who had stenotic cervices that needed manual (or occasionally instrumental) forceful opening in order to labor, and I believe that we've kicked this around before. However, I just had someone fail a VBAC that just shouldn't have failed. Here's the story, comments please. 38 YO P2002, now at 35 weeks with PROM 1st preg--SVD, uneventful, 7.5 pounds --then, central LEEP/peripheral laser for moderate dysplasia. The laser was necessary due to the geography. Her cervix was almost flush once healed fully. 2nd preg--flush cervix, short ultrasonographically, and prophylactic cerclage placed at 13 weeks (MFM consultation done prior to placement). Arrest of dil/febrile/distress at 5-ish cm, primary LTC/S for 8+ child. The patient is petite, and we both kind of thought that the problem was a bigger baby. Read on. . . This preg: Cerclage at 13 weeks, and on MFM scan in follow up around 21 weeks, the cervix was shorter and rescue cerclage entertained. However, she was put on "for real" bedrest until 35w0d. PROM at 35w1d, cervix 1 cm/70, and cerclage removed under epidural, and induction begun. Arrest dil (IUPC with adequate labor) at 5 cm/80/-2 for 4 hours--repeat LTC/S-TL of a 5 pound 8 ounce baby. I sectioned her as I didn't want to push a scarred uterus with a cervix that apparently wouldn't dilate despite very adequate labor for hours, and, specifically 4 hours of no change. Any comments? Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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