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Re: Should I do an abdominal cerclage?From: DoctorJoe@aol.comFri Oct 25 10:31:24 2002
In a message dated 10/25/02 10:02:06, rbraun@iupui.edu writes:
> No, Shirodkar was in India and did not open the cul-de-sac and use the The "usual" interpretation of the different cerclages, as I learned them, was that MacDonald's uses a vaginal approach and uses a sort-of pursestring or in-and-out circumferential stitch with some "round" suture - usually a monofilament permanent suture. The knot is left out and the stitch removed later. A Shirodkar is done with 5mm tape, Mersilene or similar, and is buried - a bladder flap is advanced and the suture is placed on one side then the next, usually by using a doubly-armed needle set-up that is commercially available. The knot is tied posteriorly and can be buried. A common modification, allowing removal at onset of labor, is to leave the knot exposed posteriorly. The bladder flap is closed anteriorly anyway. The abdominal cervicoisthmic cerclage, written extensively on by Novy (? in Washington state?), is placed under bladder flap in an abdomincal approach and stitched just into the cervical isthmus (under the arteries, if you can figure it), piercing the uterosacrals posteriorly, leaving the knot posteriorly, in the cul-de-sac of Douglas. Most people I see do that as a permanent stitch, but it COULD be taken out through a colpotomy if you wanted... I've always used doubly-armed 5mm tape for that one myself. I don't know if that's universal or not. Joe P.
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