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Advanced dilitation and previable tripletsFrom: fuf@gulf.netMon Apr 29 01:15:04 1996
It is 1 am. I just got out of a tough case. A 26 y/o g1 infertility patient with triplets at 21 week's gestation presented with vaginal bleeding 12 hr prior to admission. On arrival in labor and delivery she was having intermittent back pains and the cervix was dilated to 7 cm with a protruding bag of waters and a head, deep in the pelvis. The temperature was 99.4 F, WBC count 11K with 13 bands. Amniocentesis of the presenting triplet was negative for infection. Mild contractions abated with magnesium sulfate and indocin. IV antibiotics and metronidazole gel were also administered. About 12 hrs later, a McDonald cerclage was placed (by my partner and I)with great difficulty. The cervix was vey thin and shredded easily. After the procedure, a perineal scan showed a cervical length of 3 cm. The patient is currently on Mag. indocin and antibiotics. Questions: 1. Has anyone had success with heroic cerclages and triplets? 2. Any suggestions for management to improve odds of success in this patient? 3. Are there any published articles adressing this? Thanks in advance, Gary Gary E. Kleinman, MD Perinatologist/Geneticist University of FL/Pensacola 5045 Carpenter Creek Drive Pensacola, FL 32503 904 484-9400
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