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Re: Checking cervices at termFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Mon Feb 27 21:19:59 2006
At Mon, 27 Feb 2006, Garry E. Siegel, M.D. wrote: > >I check because: > >1. Many patients want me to/are used to it. If they don't want me to, >I don't unless overdue. >2. Nice to know that they're vertex, although this is not perfect, and >yes, midwives, the cervical exam is done in concert with Leopold's. >3. Nice to know what their "baseline" is when the primigravida calls >after hours with few contractions. The one who was 3/90% might go to L >and D; the long/closed one would be encouraged to wait longer. > >I am AMAZED at home many people kind so many reasons NOT to check a >cervix. For instance, one of our CNMs saw someone with "a few >Braxton-Hicks) at 30 weeks, who had been bleeding intermittently from a >polyp. She also had a retroplacental bleed at 15 weeks. Long story >short, she delivered a week later. Now, who knows if a cervical exam >might have detected anything, but I submit that it MIGHT have helped, >and would have been unlikely to have hurt her situation. Again, when in >doubt, take a history, review the chart, and do the examination! > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > Leopold's are usually of no help in mom's weighing greater than 250lbs. Personally I would feel negligent if I did not do at least one exam at 36+ weeks, its often the first clue I get of a transverse lie or unengaged head, when I find that I tell mom's to report to the D.R. with minimal delay upon rupture of membranes. Someone with braxton-hicks at 30 wks found to be 3cm 70% is sent to the d.r. for celestone based on the cervical exam. Vaginal probe u/s is all the rage for predicting incompetent cervix/ premature labor, it may give you an idea of cervical length put tells you nothing of cervical consistancy.
--
Take care, John
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