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Re: Incidental finding of funneFrom: DoctorJoe@aol.comTue Dec 19 12:14:24 1995
<<>Rule 10. If you don't take a temperature, you can't find a fever. I believe that before House of God commandment #10 quoted above is another: The essence of good medical care is to do as little as possible.>> Actually, you're referring to Rule 13 - "The delivery of medical care is to do as much nothing as possible." This would, of course, cover NOT doing a cerclage. <<I worry about the complications of cerclage, including pregnancy loss, in patients without history & incidentally noted funnelling.>> I would always consider the possible consequences of the procedure. This can NEVER be minimized. But we need to be a bit realistic about the whole thing... In a private setting, the risk of cerclage (at least those I have seen) is quite low. I would hazard a guess that the risk of anesthesia is higher than of the procedure itself. Even in our public (charity) service of late, I haven't seen very much in the way of significant complications of cerclage. On the other hand, the risk of NOT doing the cerclage is often certain death (for the baby, of course). So the "balance", as it were, is between two differently sized problems -- "complications" vs death. It's perhaps analogous to jumping out of a burning airplane with a parachute that you don't know is packed right -- you can take your chance with the parachute, or you can just die. Anyway, I didn't want to make a federal case out of this. The scientific argument, "Is funneling of the cervix, in the absence of any other finding or historic fact, significant enough to warrant cerclage?", is certainly something to be looked at prospectively and either verified or discarded. I would agree that TODAY, isolated funneling is NOT an indication by itself for cerclage. Practically speaking, a patient coming to me with a shortening cervix, feeling of bladder pressure, and funneling WOULD probably be a candidate for cerclage, all things being equal. This includes nulligravidas -- I wouldn't need the history of a "classic" pregnancy loss in midtrimester. Joe P. (Not born in the House of God, but a former nurses' aide none-the-less.) ************************************************* 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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