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Re: Incompentent Cervix? From: DoctorJoe@aol.com Fri Jun 24 21:23:29 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Peter Wein: "Re: Incompentent Cervix?" Previous message: DoctorJoe@aol.com: "Re: Oligohydramnios, dolicocephaly and elevated AFP" Maybe in reply to: Richard D. Kaplan: "Incompentent Cervix?" Next in thread: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?" Reply: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?" In a message dated 6/24/05 4:23:06 PM, rkaplan@triad.rr.com writes: > I have a patient who has had 4 full term deliveries.  In her 1st pregnancy > she had some mild cramping at 25 weeks and an exam revealed a 2cm dilated > cervix, 90%effaced with membranes firmly against the os.  I performed a rescue > cerclage, put her on oral terbutalene (for whatever good that does) and she > delivered at 38 weeks, one week after I removed the cerclage. >     In her subsequent pregancies I placed prophylactic cerclages early in > the 2nd trimester and she carried all these pregnancies to term and usually > several weeks after the cerclages were removed. >     She is pregnant again and asked me if I really felt that cerclage was > necessary.  I gave her my opinion but told her I would ask my colleges on the > internet.  Thanks in advance for your imput. > Interesting question. It raises a few questions: 1) Do you think the "rescue cerclage" done in the first pregnancy "worked?" In other words, if you had NOT done the cerclage, but merely put her at bedrest with the terbutaline, would she still have made it to 38 weeks? 2) After one cerclage, is there a place for the theory that cervical scarring may act in lieu of a second cerclage? In other words, after all the cerclages you've done, do you think her cervix has scarred down to be "competent" now? 3) Considering the history you've had with cerclages generally, and also your experience specifically with this patient, what do you consider the risk and travail and cost of a cerclage which might be worthless (although, maybe not)? Joe P. Next message: Peter Wein: "Re: Incompentent Cervix?" Previous message: DoctorJoe@aol.com: "Re: Oligohydramnios, dolicocephaly and elevated AFP" Maybe in reply to: Richard D. Kaplan: "Incompentent Cervix?" Next in thread: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?" Reply: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?"

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