Re: GBS, cerclage, steroids: conflicting info

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Hi Patti,

Either lab error or many bacteria with GBS being unable to be delineated. If the former or the latter, just have it repeated. It's really not a problem.

>In
>order to know how to rescedule, is it inappropriate to take the culture
>after KY's been added to the vagina (I usually get TVUS, then see OB)?

Whoa, big mistake. Culture first, without KY. KY can mess up paps and cultures.

>Also, I'm getting confused because of mixed messages from the various
>OBs in my group and my perinatologists. I thought I'd try to get some
>opinions here, since I know that most of you rely on evidence over
>tradition.
>
>1) Some are telling me to minimize digital exams, and others are
>insistent on doing vigorous ones weekly.

Why vigorous? Gentle works just as well.

>The exams do appear to
>increase contractions

Not to be contrary, but it's irritability. :-)

>when the OB palpates the top of cervix rather than
>just checking for softening and external dilation. If the TVUS is
>showing no funnelling nor shortening, what's the benefit of palpating at
>the internal os? (And how might it change the plan of care?)

The TVUS can over or underestimate length by subtle pressure on the cervix during the exam. Vaginal exams help confirm the sonographic findings. I have a patient in the hospital with an incompetent cervix (singleton). Outside of cultures and the initial exam, I've stayed out.

>2) I asked the OB I saw today how our plan of care would change if he
>detected funnelling, and he indicated a cerclage would be in order. I
>was shocked, as it seems late for this procedure; in addition, his
>partners and my peris indicated that the risk far outweighed the
>benefit. Is a cerclage really a reasonable option this late?

The stats say NOT to do it at this stage. It rsiks do outweigh the benefits.

>3) Today's OB was very insistent on weekly steroid shots from now on,
>although this plan differed from that of his partners and my peris. On
>questioning about this difference, he said (I'm *sure* I heard this
>right) that the shots may be associated with an increased incidence of
>IVH. I thought the very opposite was true; has something changed?

The current info stats no difference between one steroid (actually 2 shots is one dose) dose and weekkly steroid doses. INcreasing number of doses have been recently associated with IVH. We and our perinatal dept. only do one dose (2 shots separated by 12-24 hours).

>Sorry for the length and number of questions. The setup takes so long
>that I thought it might be easiest to ask all at once.
>
>With warm regards,
>
>--
>Patti Tessler
>

Write anytime.

Harv

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York

**Note:  Opinions expressed here are for educational purposes only
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This information is not intended to supplant the need for you to
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• Next message: Christine: "Re: Identical or Fraternal?"
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• In reply to: Patti Tessler, FNP: "GBS, cerclage, steroids: conflicting info"