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Re: Prognosis of Ultrasonically Dx Cx IncompetanceFrom: DoctorJoe@aol.comMon Dec 18 08:02:18 1995
<<This seems way too meddlesome. Unfortunately, U/S seems to replace clinical findings. Assuming that both these women have had full term deliveries previously, why do anything?>> Let me make two comments on this: 1) There is a lot of sentiment (I've seen it; it exists) for NOT making the diagnosis of cervical incompetence unless the patient has lost a baby. I think this is quite inhumane, and probably unethical in the long run. If there is some prospective way (we don't have one yet - don't get me wrong) of identifying the problem, why not try to use it? U/S is considered benign - you don't get infected from it, you don't stir up prostaglandins, you don't even much get undressed. What's the problem? Probably money, but that has to be individualized. And if the patient is getting scanned for some other reason, why should you not image the cervix and lower uterine segment? There's NO reason not to. 2) Because something wasn't there before, doesn't mean it won't be there now. Otherwise, you wouldn't listen to someone's heart more than once in their life. The human patient is quite a dynamic thing, and women through their pregnancies are quite dynamic, each pregnancy being different than the last. In fact, the previous pregnancy, though it was at term, may in fact be the predisposing factor (e.g., big cervical laceration) to the incompetent cervix. I know this is a lot more than 2c, but here it is. ************************************************* doctorjoe@aol.com "All things are connected. Joseph Pastorek, MD Some things are just more Department of OB-GYN connected than others." LSU Medical Center - Dirk Gently New Orleans, LA U.S.A. *************************************************
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