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Re: Apparent Cerclage Failure From: DoctorJoe (DoctorJoe@aol.com) Thu May 7 11:32:45 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert Brenner: "Re: forceps or vaccum extractor & ADD or mental retardation" Previous message: DuBose, Terry: "Re: Apparent Cerclage Failure" Next in thread: art fougner, md: "Re: Apparent Cerclage Failure" Reply: art fougner, md: "Re: Apparent Cerclage Failure" In a message dated 5/7/1998 11:21:12 AM Central Daylight Time, DuboseTerryJ@exchange.uams.edu writes: << Since I do not do cerclage or deliveries, I am curious. How strong is the suture material used? What is the expected sequence of events? Will the cervix tear or will the suture break? Seems one or the other must occur if premature deliver is to occur. >> Nice image of cerclage with hour-glassing membranes, Terry (http://www.obgyn.net/US/_uploads/CERCFAIL.JPG). Couple of points: 1. If you put it too low or too loose, the cervix can "get away" from you. 2. Especially with thin suture in a McDonald type procedure, the suture can pull through the cervix at points and end up with the same effect as 1. above. I'm personally fond of a HIGH Shirodkar type procedure, with 5mm Mersilene tape. I don't do a "real" Shirodkar, and completely bury the suture. I leave the knot exposed posteriorly and take it out near term. I think this type of stitch holds the tissue better, is anatomically superior to the in-and-out pursestring type of stitch you use for a McDonald, and the higher you can get it, the better. If I remember, this modified Shirodkar is illustrated in Plauche's "Operative Obstetrics" by Saunders. Nice pictures taken by one of my techs of one of my former residents... Joe P. Next message: Robert Brenner: "Re: forceps or vaccum extractor & ADD or mental retardation" Previous message: DuBose, Terry: "Re: Apparent Cerclage Failure" Next in thread: art fougner, md: "Re: Apparent Cerclage Failure" Reply: art fougner, md: "Re: Apparent Cerclage Failure"

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