Re: 23 week pPROM
From: Andrew Folley (agfolley@hotmail.com)
Wed Feb 21 06:30:46 2007
Linda
Was Sailing using "entire closure of the cervix" for very ealry prom as
well?? andy
>From: ljmidwife@aim.com
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: 23 week pPROM
>Date: Tue, 20 Feb 2007 21:15:05 -0600
>
> The cerclage with oversewn cervix is used to prevent PTL and pPROM in
>those women who have a history of such (2nd trimester miscarriages). Dr.
>Saling's first line is to prevent the change in vaginal flora, usually
>bacterial vaginosis, that is a forewarning of potentially more serious
>infections.
> By detecting the change in pH by having the woman self check her pH 2
>x/week and keeping a chart, she is the early warning system. The best
>preventive for the altered pH, and the first line treatment is the use of
>probiotics (lactobacillus acidophilis and bifidus) to strongly encourage
>the healthy bacteria that produce mild H2O2. I have looked at a few of the
>links from his site and the Mayo clinic lists some of the probiotics that
>work best (Gynoflor and several other brands). There are also some studies
>which use an instillation of half strength hydrogen peroxide to accomplish
>the same thing in the short term with continued coverage with the
>probiotics. The probiotics take up to 2 weeks to colonize the perineum and
>vagina.
> Oversewing the cervix prevents the ascending infections that get past the
>cerclage. It takes very little to reopen the cervix at 36-37 weeks and
>labor progresses normally.
>
> I have spoken with Dr. Saling's colleagues a time or two and they have
>been very helpful. My numbers are quite small, but the use of probiotics is
>something I strongly recommend to the women I care for who have a history
>of near term PTL. They all have gotten to term or been postdates by a few
>days. Obviously, someone with a history of short cervix or ACD would not be
>a candidate for OOH birth.
> Linda Johnson, CNM
> http://www.mothersownbirth.com
> Temperance, MI
> 1-866-920-8100
>
> "Not to know is bad. Not to want to know is worse.
> Not to hope is unthinkable. Not to care is unforgivable."
> --Nigerian saying
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