Re: ruptured membranes and Shirodkar
From: John G. M. Robertson (jgmr@unixg.ubc.ca)
Sat Nov 29 23:02:45 1997
Should have mentioned in my previous post that if you do put a suture in
it could go sour easily - infection, ruptured membranes miscarriage, the
works. We are getting in to desparation time with this. Not to be a
pessimist, but with these patients, regardless of what you do, outcomes are
often bad.
J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
(604) 793-9988 e-mail jgmr@unixg.ubc.ca
The best we can do for one another is to exchange our thoughts freely;
and that, after all, is about all. James A. Froude (1818-1894)
-----Original Message-----
From: John G. M. Robertson <jgmr@unixg.ubc.ca>
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Date: Saturday, November 29, 1997 8:57 PM
Subject: Re: ruptured membranes and Shirodkar
>Patient #1
> Is she in labour - if so take it out (and if you feel so inclined
pray).
>If she is not you are "damned if you do and damned if you don't". I would
>monitor for signs of infection (both maternal and foetal), and remove at
the
>first sign of same.
>
>Patient #2
> Why are there bulging membranes - is this truely an incompitent cervix
>or is this premature labour. If this is an incompitent cervix a cerclage
>MAY be appropriate. ***Warning - Incomming anecdote*** When I was in
>residency we had a lady with twins who was having colposcopy for an
abnormal
>pap smear and was found to have bulging membranes (actually I diagnosed the
>twins after she was sent in from the colposcopist - but that is another
>story). We put her on bed rest for a week in trendellenburg, and gave her
>indocid (to decrease the amniotic fluid) then put in a suture and she
>carried to 38 weeks (suture placed at 22 weeks). Not sure if any of the
>treatment was previously confirmed by RTCs but it appeared to work for her.
>John
>
>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>(604) 793-9988 e-mail jgmr@unixg.ubc.ca
>The best we can do for one another is to exchange our thoughts freely;
>and that, after all, is about all. James A. Froude (1818-1894)
>
>-----Original Message-----
>From: shiraz suleman <suleman@sk.sympatico.ca>
>To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
>Date: Saturday, November 29, 1997 8:44 PM
>Subject: ruptured membranes and Shirodkar
>
>>I have just seen a patient in ER who is 22 weeks pregnant.She has been
>>bleeding for the past 2 hours[spontaneous and no pain].She had 3
>>previous miscarriages[fully investigated] .A shirodkar was insereted
>>at 13 weeks.On examination she was well.Apyrexial.Draining blood stained
>>lichor vaginally.U/S-normal baby and lichor.
>>The question is would you remove the stitch.If not is she not at risk of
>>getting infection with the stich insitu?
>>
>>A second patient at 18 weeks who had been spotting from early on in
>>pregnancy.She presents with bulging membranes.The cervix is 3 cm dilated
>>and almost fully effaced.Who does emergancy cerclages and how good are
>>your results?Busy night!
>>
>>--
>>Dr Shiraz Suleman
>>Consultant OB
>>Prince ALbert
>>Canada
>>suleman@sk.sympatico.ca
>>
>
