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Re: Apparent Cerclage Failure From: art fougner, md (evsono@pipeline.com) Thu May 7 12:00:08 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure" Previous message: Robert Brenner: "Re: forceps or vaccum extractor & ADD or mental retardation" In reply to: DoctorJoe: "Re: Apparent Cerclage Failure" Next in thread: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure" Reply: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure" At Thu, 7 May 1998, DoctorJoe wrote: > >In a message dated 5/7/1998 11:21:12 AM Central Daylight Time, >DuboseTerryJ@exchange.uams.edu writes: > SNIP-------------------- Thanks! what i'm asking for actually is any suggestions for THIS SNIP-------------------- situation, now that plan A is apparently unsuccessful. SNIP-------------------- any help would be greatly appreciated. Art >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. -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure" Previous message: Robert Brenner: "Re: forceps or vaccum extractor & ADD or mental retardation" In reply to: DoctorJoe: "Re: Apparent Cerclage Failure" Next in thread: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure" Reply: Luis Sanchez-Ramos: "Re: Apparent Cerclage Failure"

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