Re: Incompentent Cervix?

From: Robert J. Carpenter, Jr. MD (zygote@icsi.net)
Sun Jun 26 11:04:34 2005

To me there is no truth. Given the first circumstance and placement of cerclage which modern (last 7 yrs) randomized US/Dutch studies clearly indicate that outcomes are the same but one suggests that preterm delivery may be later in sutured than in control provides no real answer to today. The suggestion for f/u is okay and so is placement of cerclage now. Given no truth I would choose the latter since several patients like this where later -"if the cervix" changed - demonstrated substantial change - I would go for cerclage now. Discuss the pros/cons and document well.

On 24 Jun 2005 at 21:24, DoctorJoe@aol.com wrote:

>
> 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.
>

--
Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
St. Luke's Medical Tower
Houston,TX 77030-2339
713-795-4600



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