Re: Incompentent Cervix?
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Jun 26 12:14:05 2005
Richard:
Agree with others, as there clearly is no right answer. Of course,
involve the patient in discussion (after all, you must have a great
relationship through a tough 1st pregnancy and then the others) and see
what her "worry level" is. My guess is that the ease of a 13 week
cerclage, with such minimum downside, and her success--whether related
to the prophlyactic cerclages or not--will lean her dramatically towards
another.
My gut say cerclage here, although I BET she would be fine either way.
Garry
At Sun, 26 Jun 2005, Robert J. Carpenter, Jr. MD wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
