preterm labour

G2P1L0 previous preterm IUD at 7 months . H/O PIH in previous pregnancy ... now pt has no complaint regarding her present pregnancy ... but the USG is worrisome... what should be done for cervical opening.... should we go for circlage or conservative approach

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3 cm cervix and 8 mm internal os. You can apply cerclage. You also explain the complications following cerclage 1) Infection. 2) Bleeding. 3) preterm uterine contractions. 4) preterm premature rupture of membranes. 5) Miscarriage/ spontaneous preterm labour. I have seen cases where a patient came with severe pain abdomen following cerclage done elsewhere. She aborted and the fetus didn't come through cervix. It was aborted through a tear behind the cervix and cerclage was intact. I suture that rent under G/ A. Here, you do a pelvic examination to assess length of cervix and width of internal os. If you feel cervix is incompetent , you go ahead with cerclage either under General or spinal anasthesia. You can use prolene for cerclage.give duvadilan drip 4 ampoules in 5 % dextrose immediately after cerclage. Send her home next day with tab DUPHASTON 20 MG BD. I personally avoid cerclage unless absolutely indicated. I continue pregnancy only with DUPHASTON 10 MG BD till delivery along with rest and abstinence.

Take proper informed consent before cerclage.
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- Cervical Cerclage indicated - Though already cervical opening ( funneling) started , even in absence of such cervical opening, abdominal pressure test during TVS examination , funneling at the level of internal OS indicate OS tightening.

Under iv antibiotics coverage, go for cervical cerclage, high vaginal Swab should be send for C nST .High progesterone support with dydrgesterone, inj duvadilone, cap glumark (contain melatonin )prophylactic treatment for pih should be given.

Encirclage

Definitely need circlage

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