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Incompetent cervix
Correspondence
Incompetent cervix To the Editors:
I read the recent article by Dr. Allan C. Barnes entitled "Conization and Scarification as a Treatment for Cervical Incompetency" (AM. J. 0BsT. & GYNEC. 82: 920, 1961) in which he cited a reference to one of my previous papers. At the time that paper was written (1956), the method was just in the experimental stage. In a subsequent paper (Fertil. & Steril. 9: 436, 1958) I had treated 2 patients in that way and both went to term without any difficulties. Since that time I have treated 6 more out of whom 2 had 2 babies after the procedure. They all went to term; however, 2 of them presented true cervical dystocia during labor so that I almost was tempted to perform cesarean section. I stimulated labor in both patients with an intravenous oxytocin solution with the result that one of them finally was delivered spontaneously after the cervix dilated, whereas the other sustained a cervical tear and then also was delivered spontaneously. I do feel as does Dr. Barnes that the method is applicable only in certain cases, especially in those patients that do not come to the office in an already pregnant state but where the diagnosis had been previously made either by myself or by another gynecologist. But, like Dr. Barnes, I feel that patients on whom I did the procedure have been doing quite weii.
I should like to report a case of successful treatment of the incompetent cervix by scarification of the external os. The patient's first pregnancy terminated spontaneously at 37 weeks. At 23 weeks of the second pregnancy pelvic examination showed an incompetent cervix with bulging membranes. A Shirodkar operation was done, but two weeks later the membranes ruptured spontaneously and labor began, terminating with delivery of a fetus that did not survive. Following this pregnancy the external cervix and the cervical canal were scarified by the nasal tip cautery and bovie coagulating blade. A good external stenosis was obtained. The patient became pregnant and carried to 41 weeks. The lower segment was completely effaced and paper-thin. The external os was only a dimple. It was dilated with dilators and a cicatricic band incised with scissors. The membranes were ruptured, labor began and terminated spontaneously 7 hours later. Previous experience with other stenosed cervices and 3 cases oi conglutinatio has indicated that a stenosed external cervix will hold a pregnancy until manual rupture or surgical incision of the adhesive bands is accomplished. James C. Muir, M.D. 1198 Park Ave. San Jose, California Oct. 31, 1961
Werner Steinberg, M.D.
35 Gesner St. Linden, New Jersey Oct. 12, 1961
Hydrocortisone after pelvic operations To the Editors:
Regardless of the technique used in the management of the vaginal cuff, following total abdominal hysterectomy, the exuberant growth of granulation tissue will appear in some cases. The healing of the vaginal vault with the open cuff technique frequently employed in this area is
To the Editors:
Dr. All
Incompetent cervix To the Editors:
I read the recent article by Dr. Allan C. Barnes entitled "Conization and Scarification as a Treatment for Cervical Incompetency" (AM. J. 0BsT. & GYNEC. 82: 920, 1961) in which he cited a reference to one of my previous papers. At the time that paper was written (1956), the method was just in the experimental stage. In a subsequent paper (Fertil. & Steril. 9: 436, 1958) I had treated 2 patients in that way and both went to term without any difficulties. Since that time I have treated 6 more out of whom 2 had 2 babies after the procedure. They all went to term; however, 2 of them presented true cervical dystocia during labor so that I almost was tempted to perform cesarean section. I stimulated labor in both patients with an intravenous oxytocin solution with the result that one of them finally was delivered spontaneously after the cervix dilated, whereas the other sustained a cervical tear and then also was delivered spontaneously. I do feel as does Dr. Barnes that the method is applicable only in certain cases, especially in those patients that do not come to the office in an already pregnant state but where the diagnosis had been previously made either by myself or by another gynecologist. But, like Dr. Barnes, I feel that patients on whom I did the procedure have been doing quite weii.
I should like to report a case of successful treatment of the incompetent cervix by scarification of the external os. The patient's first pregnancy terminated spontaneously at 37 weeks. At 23 weeks of the second pregnancy pelvic examination showed an incompetent cervix with bulging membranes. A Shirodkar operation was done, but two weeks later the membranes ruptured spontaneously and labor began, terminating with delivery of a fetus that did not survive. Following this pregnancy the external cervix and the cervical canal were scarified by the nasal tip cautery and bovie coagulating blade. A good external stenosis was obtained. The patient became pregnant and carried to 41 weeks. The lower segment was completely effaced and paper-thin. The external os was only a dimple. It was dilated with dilators and a cicatricic band incised with scissors. The membranes were ruptured, labor began and terminated spontaneously 7 hours later. Previous experience with other stenosed cervices and 3 cases oi conglutinatio has indicated that a stenosed external cervix will hold a pregnancy until manual rupture or surgical incision of the adhesive bands is accomplished. James C. Muir, M.D. 1198 Park Ave. San Jose, California Oct. 31, 1961
Werner Steinberg, M.D.
35 Gesner St. Linden, New Jersey Oct. 12, 1961
Hydrocortisone after pelvic operations To the Editors:
Regardless of the technique used in the management of the vaginal cuff, following total abdominal hysterectomy, the exuberant growth of granulation tissue will appear in some cases. The healing of the vaginal vault with the open cuff technique frequently employed in this area is
To the Editors:
Dr. All