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Re: Dr.Thomas Ind: Am interested in your departmental discussion on incomp.cervixFrom: William D. McIntosh, MD (anonymous@obgyn.net)Sun, 6 Sep 1998 16:39:10 -0500 (CDT)
At Sun, 6 Sep 1998, Jas wrote: > >Dr. Ind, First let me say I am not debating what you are saying about >cerclages, because I know the studies are out their debating their >effectiveness. I have always been frustrated by the studies that debate >this. > >As a woman who has lived a cervical incompetence nightmare for 5+ years >and have had 5 cerclages placed under all different conditions, I would >very much like to know what's to debate in their effectiveness. I guess >what really interests me is if there is anything to debate on cerclages >if you were to take 2 groups of women who have lost their pg in the >second trimester due to premature dilation and placed the preventative >cerclage in one group for their next pg and in another group skipped the >cerclage. Has a study been done that shows more babies going to term >with the preventative cerclage than to forego it and take the chance of >having a repeated loss? My personal feeling is there would be more >losses documented than infections due to performing the cerclage. From >my personal experience I have not had an infection from these although I >know the risk remains and as far as the cervix tearing from a cerclage >pulling out, I had the unfortunate situation that my cerclage did pull >out with dilation. It did not tear my cervix the stitch broke first >before that happened. I have also had cerclages fail and work as well. >Even having that experience I would never just sit back and chose the >option of doing nothing, but then again everyone needs to do their >reasearch and make that decision for themself. I guess you can tell >even if there was a study that was negative about cerclages I would do >it over a hundred times. To me the risk of something going wrong due to >cerclage is minimial compared to the pain and suffering of a second >trimester loss and having done nothing to try and help myself. I would >also be interested in your dept. discussion if these summarized points >were to be available. > >Thanks, Jenn > >At Sun, 6 Sep 1998, Naureen wrote: >> >>Dear Dr. Ind I read today that your dept. is discussing incomptent >>cervix. Would it be possible for you to briefly summarise the points >>discussed? I know you must be quote busy but the reason I am interested >>is that 10 months ago I lost my baby at 16 weeks due to incompetent >>cervix. Have been trying to get pregnant ever since and am reading up >>on the condition. Any thing you can tell me will be highly appreciated. >>Thank you very much for your time. I know that your remarks were directed to Dr. Ind, but I have made similar remarks about cerclages, so I thought I would respond. You are in that group of women who have truly incompetent cervices, and as such, a cerclage can be a miracle proceedure, and you are right, the risks FOR YOU are far outweighed by the almost certain 2nd trimester loss that you will have without it. However, the truly incompetent cervix is a rare thing, and it is a rare cause for pregnancy loss. If you take a woman without a rock solid case for incompetent cervix, and give her a cerclage just in case, you will kill more babies than you will save. In former days, the only way to make that kind of a diagnosis was by actually losing a pregnacy in the peculiar manner of the incompetent cervix. Nowadays, we routinely look for certain characteristics of the cervix at the routine 2nd trimester sonogram, and we find potential problems much earlier. The point is, like ALL of medicine, what will help one person, could seriously injure another. Cerclage is only useful in those who have a particular problem. Much of the confusion in the literature is the result of improper patient selection by the researchers. Some are too liberal, some too stingy.
-- William D. McIntosh, MD Clarksville, TN
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