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Re: Pessary and preterm labor From: Braun, R. Daniel (rbraun@iupui.edu) Tue Mar 23 04:05:41 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "Re: Anesthesia for Emergency Cesarean" Previous message: Braun, R. Daniel: "Re: GDM screening" Maybe in reply to: Jane Helwig, MD: "Pessary and preterm labor" Next in thread: Tonya Von Brooks, CPM: "Re: Pessary and preterm labor" Try the references listed below. Dan Document # 3 of 200 from MEDLINE Relevance to Query: Maximum Relevance: Successful treatment with the Smith-Hodge pessary of cervical incompetence due to defective connective tissue in Ehlers-Danlos syndrome. Am J Perinatol 1992 Jan;9(1):25-7 (ISSN: 0735-1631) Leduc L; Wasserstrum N [Find other articles with these Authors] Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030. Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders with at least ten distinct types. We report a case of EDS complicated by cervical incompetence. Treatment was undertaken after confirmation that the patient's EDS was not type IV, hence not associated with potentially serious vascular complications. Because of concern about stretching or tearing of the hyperextensible connective tissue associated with EDS, cerclage was not performed. The cervical incompetence due to defective connective tissue was treated with a Smith-Hodge pessary. Major Subject Heading(s) Minor Subject Heading(s) Cervix Incompetence [therapy] Ehlers-Danlos Syndrome [complications] Intrauterine Devices Find other articles with similar Subjects. Adult Cervix Incompetence [etiology] Equipment Design Pregnancy Indexing Check Tags: Case Report; Female; Human Language: English Unique NLM Identifier: 92198510 MEDLINE Indexing Date: 199207 Publication Type: JOURNAL ARTICLE must-get-js-browser.html <must-get-js-browser.html> must-get-js-browser.html <must-get-js-browser.html> Document # 4 of 200 from MEDLINE Relevance to Query: Maximum Relevance: Treatment of the incompetent cervix with the Hodge pessary. Obstet Gynecol 1966 Aug;28(2):206-8 (ISSN: 0029-7844) Oster S; Javert CT [Find other articles with these Authors] Major Subject Heading(s) Minor Subject Heading(s) Abortion, Habitual [prevention & control] Cervix Diseases [therapy] Pessaries <search.c> Find other articles with similar Subjects. Pregnancy Indexing Check Tags: Female; Human Language: English Unique NLM Identifier: 66167489 MEDLINE Indexing Date: 196612 Publication Type: JOURNAL ARTICLE must-get-js-browser.html <must-get-js-browser.html> must-get-js-browser.html <must-get-js-browser.html> Document # 5 of 200 from MEDLINE Relevance to Query: Maximum Relevance: Pessary treatment of the incompetent cervical os. Obstet Gynecol 1968 May;31(5):732-3 (ISSN: 0029-7844) Vitsky M [Find other articles with this Author] Major Subject Heading(s) Minor Subject Heading(s) Abortion, Habitual [prevention & control] Cervix Diseases [therapy] Pessaries Pregnancy Complications [therapy] Find other articles with similar Subjects. Pregnancy Indexing Check Tags: Female; Human Language: English Unique NLM Identifier: 68199147 MEDLINE Indexing Date: 196807 Publication Type: JOURNAL ARTICLE must-get-js-browser.html <must-get-js-browser.html> must-get-js-browser.html <must-get-js-browser.html> Document # 6 of 200 from MEDLINE Relevance to Query: Maximum Relevance: Vaginal lever pessary in patients with multiple gestation, preterm labor and low fetal station. A report of three cases. J Reprod Med 1997 Nov;42(11):751-5 (ISSN: 0024-7758) Keys SL; Elliott JP [ <search.cgi?getcount 0&advanced=1&relevanceP&english_only=on&concept_map ping=on&earliestseg=UM667499&latestseg=UM999935&searchlogic=fuzzy&getchunk=2 0&wordvars=on&relevance_sort=on&searchstring=&journals=&authors=Keys%09SL%2> Find other articles with these Authors] Department of Obstetrics and Gynecology, Good Samaritan Regional Medical Center, Phoenix, Arizona 85006, USA. BACKGROUND: The vaginal pessary has been utilized previously in patients with cervical incompetence, resulting in improvement in pregnancy outcome. The mechanical advantages generated by the vaginal lever pessary could theoretically be applied to patients in preterm labor with low station of the presenting part to prevent cervical dilatation. CASES: One patient with twins and two with triplet pregnancies presented in preterm labor with advanced cervical dilatation and low fetal station. They were treated with tocolytic drugs, and a vaginal lever pessary was placed. The gestational age at delivery was delayed with the addition of the vaginal pessary. Based on previous experience with these difficult cases, it was judged that the use of the pessary achieved a delay in delivery that would not have occurred without the device. CONCLUSION: Vaginal pessaries can be used as mechanical adjuvants in the treatment of preterm labor. These devices work by altering the pressure dynamics on the cervix and lower uterine segment. They may also help limit cervical change by preventing engagement of the presenting part into the maternal pelvis. In these cases, a vaginal pessary appears to be beneficial in delaying delivery in multiple gestations presenting with advanced cervical dilatation and low station of the presenting part. Major Subject Heading(s) Minor Subject Heading(s) Intrauterine Devices Labor, Premature [therapy] Pregnancy, Multiple Find other articles with similar Subjects. Adult Cervix Incompetence [therapy] Gestational Age Pregnancy Outcome Pregnancy Indexing Check Tags: Case Report; Female; Human Language: English Unique NLM Identifier: 98073195 MEDLINE Indexing Date: 199803 Publication Type: JOURNAL ARTICLE must-get-js-browser.html <must-get-js-browser.html> must-get-js-browser.html <must-get-js-browser.html> Document # 4 of 5 from MEDLINE Relevance to Query: Maximum Relevance: Silicone-plastic cuff for the treatment of the incompetent cervix in pregnancy. Am J Obstet Gynecol 1972 May 15;113(2):233-8 (ISSN: 0002-9378) Yosowitz EE; Haufrect F; Kaufman RH; Goyette RE [Find other articles with these Authors] R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN -----Original Message----- From: dacker@bics.bwh.harvard.edu [SMTP:dacker@bics.bwh.harvard.edu] Sent: Monday, March 22, 1999 1:54 PM To: Multiple recipients of list Subject: Re: Pessary and preterm labor At Mon, 22 Mar 1999, Peter Wein wrote: > >>Has anyone had experience with using pessaries in preterm labor? I am >>not contemplating using one in my current patient, but would like to >>know more, if only to stay up to speed with my patient's family who now >>consider pessaries part of preterm labor care. >> >>Thanks for your input. >> >>Jane >> >>-- >>Jane Helwig, MD >>Private practice >>Nassawadox, VA >There is quite a lot of experience (not mine but colleagues) in pessaries >for cerviacl incompetence - not for preterm labour though. > >-- >Peter Wein > I think there is a great difference between "having experience with..." and "...having data to support the intervention..." I am unaware of any data to support the use of pessaries for either preterm labor or incompetent cervix. Next message: Braun, R. Daniel: "Re: Anesthesia for Emergency Cesarean" Previous message: Braun, R. Daniel: "Re: GDM screening" Maybe in reply to: Jane Helwig, MD: "Pessary and preterm labor" Next in thread: Tonya Von Brooks, CPM: "Re: Pessary and preterm labor"

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