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Re: OB:Cervical CerclageFrom: John Robertson M.D. (john.robertson@obgyn.net)Thu Feb 26 21:03:12 1998
At Thu, 26 Feb 98, dagriff@pacbell.net wrote: > >Dear List members: > >Advice wanted: 26 y/o G2P1001 at 9 weeks gestation with a prior history >of cold knife conization and prophylactic cerclage performed during her >last pregnancy at 14 weeks because, per the patient, "Cerclage after >cervical conization was the protocol at this HMO." Patient had the >cerclage removed and delivered uneventfully and had to be induced. >Patient is now asking me, "Do I have to have a cerclage this pregnancy?" > >What is your criteria for prophylactic cerclage after conization? > >Do you measure the cervix transvaginally? > >What do you advise patients as the risk of incompetent cervix after cold >knife conization? > >Thanks in advance, > >Daniel R. Hersh, M.D. >Private Practice >Tracy, CA I think the answer depends on the amount of tissue taken at the time of conization. I certainly tell all my patients that conization may lead to premature dilation of the cervix. OTOH I have looked after patients with (predominantly laser) cones who had stenosis of the cervix and had a hard time dilating even after the cervix was 100% effaced. On several occasions I have had to dilate them digitally (which then lead to rapid progression to full dilation and delivery).
-- J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9 (604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
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