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Re: Chorioamnionitis: Question In response to Dr. Richard Chudacoff

From: Richard M. Chudacoff, MD (anonymous@obgyn.net)
Tue, 3 Nov 1998 10:25:34 -0600 (CST)

At Tue, 3 Nov 1998, Melissa wrote: >
>I read your discussion on incompetent cervix and the possibility of
>chorioamnionitis. I am 19 weeks into my 3rd pregnancy. I delivered at
>32 weeks due to premature rupture of membranes and I am wondering if
>this infection could have caused this to happen and if I should request
>that pelvic exams be performed at each Dr's visit to watch for cervical
>dialation in this pregnancy. This also leads to my 2nd question: Do
>cervical checks sometimes lead to premature labor? Please advise.
>Thanks!

It has been suggested that pregnant women be checked at each visit for BV (bacterial vaginosis). Although not a common practice at this point (I'll admit I am not fully set up to do this, and need to read some more studies to fully convince me) one suggestion is that the patient check the vaginal pH herself with Nitrazine paper at the same time they donate a urine sample. A pH greater than 4.5 suggests an infection and can be further investigated and treated. A pH less than 4.2 is highly suggestive of normal vaginal flora.

I happen to believe that more exams can lead to infection, but I do not have any randomized controlled studies to prove this. It was impressed upon me during my training. Simple dogma. This is just my opinion, training and practice. But if I have a patient at high risk for pre-term labor or cervical incompetence, the exams are much less risky than a missed diagnosis, and I would exam the cervix for dilation and the vaginal for BV at each visit. 

--
Richard Chudacoff, MD
Baylor College of Medicine
BaylorMedCare
Houston/Sugar Land, TX


Advisory Board-OBGYN.net
http://www.obgyn.net/board/chudacoff.htm


*Note:  Opinions expressed here are for educational purpose only.
This information is not intended to supplant the need for you to
consult with your physician prior to choosing therapeutic options.



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