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

Re: High Risk Pregnancy and Cerclage

From: William D. McIntosh, MD (anonymous@obgyn.net)
Sun, 6 Sep 1998 16:21:10 -0500 (CDT)

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In reply to: Zerda: "High Risk Pregnancy and Cerclage"

At Sun, 6 Sep 1998, Zerda wrote: >
>I am new to this forum and, after searching previous postings for
>answers, decided to pose the following questions:
>
>1. When it is determined that an individual is a high risk pregnancy
>patient due to age, hypertension, diabetes, prior surgical procedures,
>etc., what is the AMA standard for frequency of office visits such as
>first appointment and subsequent appointments or is it the same as a
>normal
>pregnancy?
>
>2. Who is at risk or a prime candidate for cerclage, abdominal or
>vaginal and what is the success rate or is the procedure very
>controversial in the medical community. Any suggestions on case study
>material or sites with research data on this?

I would confirm what Dr. Ind has written, but I might add the usual protocol in the US for prenatal visits. The average patient will see her caregiver every 4 weeks through the first 2 trimesters, in other words, 28 weeks. She will then be seen every 2 weeks until 36 weeks, and weekly till delivery. The first visit should be as soon as possible after the discovery of the pregnancy, usually between 6-8 weeks. Better yet would be a preconceptual visit. You should know that there is some controversy about this standard plan. In the interest of cutting costs, some argue that this number of visits is excessive. This standard plan is adjusted for high risk pregancies to reflect the nature of the risk. Many so-called high risk pregnancies are really potential problems that have not, and may not, surface. This might include such risks as advanced maternal age, or previous C/S, or a maternal history of genital herpes for example. While there are very serious problems that might arise in such patients, until the risks begin to manifest themselves, there is no need to see the patient more often than the average patient. Most of the time these remain potential, rather than actual problems. Other high risk factors, such as diabetes, may require the patient to be seen weekly or even more from the beginning of the pregnancy, as the problems are already being manifested. The point is, prenatal care must be individualized to the patient, not vice versa. A quick note on cerclage. This is NOT a benign proceedure. If you truly need one, get it. If you don't, skip it. True incompetent cervices are rare.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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