cerclage Flashcards

1
Q

what are the indications for cerclage?

A

History indication

  • 1 or more 2nd trimester pregnancy losses
  • 1 or more pregnancies in which cerclage was placed for ACD

Ultrasound indicated

  • history of PTB < 34 weeks
  • singletone pregnancy
  • CVL < 25 mm before 24 weeks

Exam indicated/rescue
- ACD in any pregnancy

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2
Q

what the surgical differences in two types of transvaginal cerclage?

A
  • McDonald - non-resorbable suture at cervicovaginal junction
  • Shirodkar - non-resorbable suture at internal os

Neither better than the other

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3
Q

When is a hx indicated cerclage best placed?

A

12-14 weeks

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4
Q

When would you consider at transabdominal cerclage/cervicoisthmic cerclage?

A
  • anatomic limitations (i.e. hx trachelectomy)

- prior failed transvaginal cerclage

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5
Q

what is benefit of hx indicated cerclage?

A
  • fewer deliveries before 33 weeks (17 vs 13%)
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6
Q

what is benefit of us indicated cerclage/cervical length monitoring?

A
  • reduces need for cerclage compared to hx indicated by 50%
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7
Q

what is benefit of exam indicated cerclage?

A

mean prolongation of pregnancy 33 weeks, neonatal survival improves (71 vs 43%)

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8
Q

do you remove cerclage for PPROM?

A
  • no clear data

- if evidence of PTL or abruption or IAI, yes

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9
Q

do you remove cerclage for PTL?

A

depends– if looks like truly progressing into PTL then yes

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10
Q

what is US monitoring to detect CVL shortening?

A

start 16 weeks, q2 weeks until 24 weeks

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11
Q

when do you schedule to remove cerclage?

A

generally 36-37 weeks. if mcdonald, can do in the office.

if scheduled CD, can do it at time of CD

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