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AW: Rigid cervix, history of endometritisFrom: Pasqualetti Roberto KSSG_FRA (foa4@ms1.kssg.ch)Wed Aug 12 04:40:02 1998
>---------- >Von: jane@seasonedsystems.com[SMTP:jane@seasonedsystems.com] >Gesendet: Mittwoch, 12. August 1998 00:30 >An: Multiple recipients of list >Betreff: Rigid cervix, history of endometritis > >Would appreciate some quick input on this ongoing case: > >47yo G5P1S3 at 39 weeks, vaginal delivery of 9lb baby years ago with >retained placental fragment which delivered a week later, hospitalized >for several days with endometritis, taken to OR for drainage of pus. I >don't have these records, but patient is good historian. > >She began contracting every 2-3min at 4am yesterday (more than 36hr >ago), with some dark bloody show. On initial cervical exam, cervix was >very posterior, dilated to a fingertip, 3cm long, unusually rigid and >hard. She was sent home after reactive NST, returned to hospital a few >hours later with strong contractions every 2 minutes. These seem to be >of excellent quality, patient unable to talk through them. She was >given morphine early today for sleep because of exhaustion, and slept >about 3 hours before contractions returned strongly. > >She continues contracting every 2 minutes. Cervical exam now shows >tissue surrounding external os to be normally soft, but there remains a >ring of rigid tissue 1 cm thick surrounding the internal os. Dilation >is still fingertip. Cervix in mid position, vertex at -2. The fetal >size is well below the 9lb of her previous baby. > >She has never had a cone biopsy or cryo. No cervical laceration with >previous delivery that she is aware of. Membranes are intact. > >I hate to move to c/s for failure to progress in latent phase. However, >I have never encountered such a rigid cervix. > >Has anyone seen this kind of cervix after previous endometritis? I have >encountered scar tissue after LEEP in other patients, but it has never >failed to yield to digital breaking-up. > >My patient and I would appreciate your thoughts! Thanks. > >Jane > >-- >Jane Helwig, MD >Private practice >Nassawadox, VA I would try an epidural , afterwards, if necessary, start with oxytocin. If doesn't work, go for C/S. Roberto Pasqualetti MD Kantonsspital St. Gallen Switzerland
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