Re: Should I do an abdominal cerclage?
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Oct 23 22:32:07 2002
I haven't done abdominal cerclages - but if in your hands you feel
"comfortable" doing it - well - go for it -
>At Wed, 23 Oct 2002, jafar6 wrote:
>
>40 year g3p1011 now 19 weeks, 1 week ago for pelvic pressure, no
>contractions. Cervix was open 2 cm, membranes bulged slightly past cervical
>os. Cervix was short with very little cervix posteriorly. No signs of labor
>or infection. Fetus appeared normal on ultrasound. Patient declined genetic
>amniocentesis or serum screening.
>
>An emergency cerclage was done on day of admission. Four days later patient
>was urging physicians to discharge her. She was examined in anticipation of
>possible discharge, and cervix was found to be open 2 cm, the membranes
>prolapsed into the vagina, approximately 4 cm past cervical external os (by
>ultrasound measurement). By palpation, the opening was posterior to the
>cerclage, with the suture not attached to the center of the posterior lip of
>the cervix. There was no palpable cervix posteriorly between 5 and 7
>o'clock, as high as I could feel.
>
>When this was initially presented to me, after the cerclage had failed, my
>initial impression was not to attempt another cerclage. I also recommended
>that the cerclage should be removed and induction of labor (cytotec) should
>be strongly considered for the safety of the mother and because of the
>probably inevitable loss of the fetus. The patient declined removing the
>cerclage, and still remained at hospital bed rest, hoping that the fetus
>would remain until viability.
>
>Three days later, the exam is unchanged. The membranes are not tense and
>could probably be reduced, if I could close the cervix. I ran the thought of
>an abdominal cerclage past my partners. I thought it would be the only way
>to grasp some tissue to keep the membranes in the uterus. I thought it would
>be a reasonable option to present to the patient. I realise there are
>significant risks to the patient. The chance of success is probably not
>high. I told her that I would not consider an abdominal cerclage without
>first an amniocentesis to rule out infection, since the infection risk would
>be high. The patient is all for it and ready. She wants everything done to
>save the baby.
>
>Opinions from colleagues are lukewarm, regarding offering the patient this
>option. Any opinions or suggestions?
>
>Gary Kleinman, MD
>Bridgeport Hospital
>MFM, genetics
--
"Life is neither the notes nor the silence between the notes, but the music that
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