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Re: ruptured membranes and ShirodkarFrom: DoctorJoe@aol.comSun Nov 30 11:16:59 1997
In a message dated 11/30/97 12:47:25 AM, you wrote: <<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?>> In my experience, the chance of infection is overblown. If the patient spikes a fever, pull the cerclage and they deliver fast. And of course, there are antibiotics... I am more inclined to be agressive and wait it out... I wonder where the bleeding is coming from... labor? <<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?>> THere are a number of emergency cerclage papers in the literature. They get worse results, obviously, than elective cerclages. Still, the results are pretty good, and as far as I can see, the complications for the mother are fairly benign, i.e., manageable. Joe P.
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