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cingulate_gyrus2006Send an Instant Message to cingulate_gyrus2006  




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Quick Scroll AIIMS NOV 2007 Gynaecology suture used in 2nd TM 11.05.07 (10 months ago) #1
A women presentedd in 24 wks of geatational age with abdominal pain usg showed signs of effacement ..She had history of abortion in past..The line of management ?

A. Fothergills suture.
B. B. Mc Donald suture.
C. ??? Sirodker.
D. ....Help...
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arterySend an Instant Message to artery  




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Quick Scroll 11.05.07 (10 months ago) #2
options were....

a.dinoprostone gel wit bed rest
b.misoprostol gel with bed rest
c.fothergills
d.mc donalds stitch


i think ans is..d
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Quick Scroll 11.06.07 (10 months ago) #3
artery wrote:
options were....

a.dinoprostone gel wit bed rest
b.misoprostol gel with bed rest
c.fothergills
d.mc donalds stitch


i think ans is..d
yes the answer is mcdonalds stitch. history of painless rupture of membranes followed by expulson of the fetus is s/o cervical incompetence.
either a mcdonalds suture using silk or mersilene tape can be done or shirodkars stitch can be taken.
shirodkars is technically more complex, involves upward mobilisation of bladder & is permanent .delivery is by lscs.
in contrast mcdonalds can either be removed @ 37 completed weeks or at the onset of labour & vaginal delivery allowed
fothergills stitch is taken in cervical amputation
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Quick Scroll 11.06.07 (10 months ago) #4
bt mcdonalds given in 14 week never after funnling
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Quick Scroll 11.07.07 (10 months ago) #5
pm wrote:
bt mcdonalds given in 14 week never after funnling
hmm, if it is done at 14 wks it is prophylactic. it should be done atlest 2 weeks before the time of previouspregnancy loss.
it can be done even after funnelling though the success rates are somewhat less.infact it can be done even with the os open and membranes prolapsed.
put the patient in lithotomy position, push the membranes with a gauze on a stick and put the suture.
though the standard books say that success rates are not good after 22 weeks this is the best amongst the given options
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Quick Scroll 11.07.07 (10 months ago) #6
Thank u gynguru for that point....
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Quick Scroll 11.07.07 (10 months ago) #7
thanku
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Quick Scroll 11.08.07 (10 months ago) #8
well as an afterthought & to complete this topic can anybody name an abdominal procedure for cervical incompetence??
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Quick Scroll 06.06.08 (3 months ago) #9
In cervical incompetence
either a mcdonalds suture using silk or mersilene tape can be used or shirodkars stitch can also be used.
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arunarali144Send an Instant Message to arunarali144  




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Quick Scroll 06.09.08 (2 months ago) #10
Was vaginal bleeding mentioned in the question? I believe it was mentioned.
If that is the case then the answer is prostaglandins and rest because any surgical procedure in cervical incompetence is contraindicated if there is history of vaginal bleeding with other signs of onset of labour.

if not then the answer is Donald's stitch as suggested by gynguru.

anyways, the options aren't clear to me. not totally sure about vaginal bleeding being in the question.
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