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cervical cerclageFrom: James E. Sumners (james@cpdx.com)Thu Nov 28 05:05:44 1996
Dr. van der Colf wrote a few more questions: 1. shirodkar or mcdonald stitch? does the patient's cx length make any difference (shorter cx or previous stitch - rather shirodkar). some thoughts: trans vaginal cerclage success is dependent on avoiding the stitch being thrown off the end of the cervix by the progressive effacement inevitable as pregnancy progresses. my understanding of the classic Shirodkar leads me to believe that success depends on the scarring down produced by advancement of the bladder and truly burying the stitch (or fascia lata). The McDonald approach (at least in my hands) depends on transfixing the uterosacrals (best done if you pass from posterior to anterior on each side from the six o'clock insertion) to keep the stitch high. stitches placed submucosally, unless they scar in well, will more easily be extruded off the end of the cervix. if your exam leads you to the conclusion that the cervix is too short to allow a placement as above or there has been a failure of a (prophylactically placed) transvaginal cerclage in a prior pregnancy, consider transabdominal approach. (i have wondered if the first cerclage description and popularization had been of the transabdominal approach, wouldn't we be using that as the primary approach and arguing about selection criteria for the tv approach)
-- James E. Sumners james@cpdx.com http://www.cpdx.com http://www.datadirect.net
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