Indications for Cerclage vs Progesterone for Preterm Labor скачать в хорошем качестве

Indications for Cerclage vs Progesterone for Preterm Labor

Intended for medical students and resident doctors. Please talk to your primary doctor regarding progesterone or cerclage use. There is several gray areas for this topic and doctors might manage patients slightly different. Here is a video that I made to elucidate the differences for when you would start a patient on Progesterones (either vaginal in intramuscular [IM]). Also talk about the different indications for cerclages. Ultrasound, History, Physical Exam, and..... unindicated. Cerclage is a surgical procedure in which a stitch is placed around the cervix to help hold it closed and prevent premature dilation. This procedure is typically recommended for women who have a history of cervical incompetence, or a weak cervix that may open prematurely during pregnancy. Cerclage is usually performed between 12-14 weeks of pregnancy and is removed at around 36 weeks of pregnancy to allow for natural labor and delivery. The procedure may also be used in certain cases where a woman's cervix is short or funneling, which may indicate an increased risk of preterm delivery. Progesterone, on the other hand, is a hormone that is naturally produced by the body during pregnancy. It plays a role in maintaining pregnancy and preventing premature labor by relaxing the uterus and reducing contractions. Progesterone may be given to women who have a history of preterm delivery, or who are at high risk for preterm delivery due to factors such as multiple gestation, a shortened cervix, or a previous preterm delivery. Progesterone may be given in the form of injections, vaginal suppositories, or a gel, and is typically started between 16-20 weeks of pregnancy and continued until around 36-37 weeks of pregnancy. McDonald cerclage: This is the most common type of cerclage and involves the placement of a single stitch around the cervix to help hold it closed. The procedure is usually performed between 12-16 weeks of pregnancy and is removed at around 36 weeks of pregnancy. Shirodkar cerclage: This procedure involves the placement of a stitch around the cervix, but it is done in a way that allows the stitch to be tightened, which may provide additional support for the cervix. This type of cerclage is usually performed between 12-14 weeks of pregnancy and is removed at around 36 weeks of pregnancy. Transabdominal cerclage: This procedure involves placing a stitch around the cervix through the abdomen, rather than through the vagina. This type of cerclage may be recommended for women who have had multiple failed vaginal cerclages or who have certain anatomical abnormalities of the cervix. The procedure is usually performed before pregnancy or in the first trimester. Rescue cerclage: This type of cerclage may be performed in cases where a woman's cervix begins to dilate prematurely, even after an initial cerclage procedure has been performed. This procedure may involve the placement of an additional stitch to help hold the cervix closed. Data is taken from ACOG bulletin, sMFM bulletin, uptodate, and from my amazing attendings and fellows at my institution. This video does not go into the research behind why we check cervical lengths or the risk reduction with vaginal or IM progesterone. This can be an easy video in the future. This video is just a conveyor belt of information so that you are able to be a boss on the floors. Good luck and hopefully you will see me soon in a different video. Hessami, et al., (2022): https://pubmed.ncbi.nlm.nih.gov/33926... #cerclage #