WOMENS-HEALTH Messages for September, 1998: Re: High Risk Pregnancy and Cerclage

Re: High Risk Pregnancy and Cerclage

From: Thomas (anonymous@obgyn.net)
Sun, 6 Sep 1998 05:01:26 -0500 (CDT)

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In reply to: Zerda: "High Risk Pregnancy and Cerclage"
Next in thread: William D. McIntosh, MD: "Re: High Risk Pregnancy and Cerclage"

As I am not American, I cannot tell you if there are any AMA recomendations. However, it is usual to tailor visits to the individual. In the UK where I come from, a doctor normally sees a woman at booking and at a week overdue. Sometimes a doctor also sees a woman at 36 weeks. Women are generally seen by midwives at 20 weeks, 4 weekly until 32 weeks, two weekly until 36 weeks and then weekly. In other parts of the world midwives don't take such an active role and the doctor sees the woman.

For normal healthy women, this is probably excessive and if a woman has other risk factors that necessitate more visits then the doctor sees her more frequently. There is no evidence in the medical literature as to how often a woman should be seen so practices vary immensely.

What makes a pregnancy high risk is also contraversial. There is quite a well known study which was conducted in the UK where a computer defined women as being of high or low risk. Factors such as the ones that you described as well as social factors such as smoking, body weight and others were all included. Regrettably the computer selected 97% of all the women as high risk (a bit like 90% of the population thinking they are better than average drivers!). Now-a-days doctors decide at the booking visit what women are at higher risk of and tend to arrange appointments or investigations appropriately. In some instances, even if a woman is at higher risk of developing a complication, no tests or visits can prevent it or predict it early so a woman has nothing different.

Cervical cerclage is contraversial. There is a well known study called the RCOG cerclage study that suggested than a cervical stitch is of no value. Furthermore, some doctors believe that there is no such thing as cervical incompetence. My department are debating this subject next week in our academic club. However, the RCOG study has come under a lot of criticism and has many faults.

The long and short of it is that if you are considering a cervical suture, then you should be part of the decision making. Like many things in medicine there a potential pros and potential cons. There is no reason why you couldn't be completely informed of these pros and cons and make a decision yourself. In summary, the potential benefits are that it may prevent a second trimester miscarriage or premature labour. The cons are that there is still no evidence that a stitch does this. Furthermore there are risks from the operation and infection around the stitch. The worst complication that can occur is if a woman goes into labour before the suture is removed and dilates before reaching the hospital. This can cause the stitch to tear through the cervix.

Hope this helps.

--
Dr Thomas Ind MB BS MD MRCOG
St George Hospital
Kogarah
Sydney
NSW 2217
AUSTRALIA

Next message: Thomas: "Re: CIN III, Diathermy unsuccessful, where to now?"
Previous message: Gerry: "CIN III, Diathermy unsuccessful, where to now?"
In reply to: Zerda: "High Risk Pregnancy and Cerclage"
Next in thread: William D. McIntosh, MD: "Re: High Risk Pregnancy and Cerclage"

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