Sol Nlw Hukphu Iouyuhs om OBGYN 2019 IusyClcltily 61 62 and - PDF document

Sol Nlw Hukphu Iouyuhs om OBGYN. 2019 (Iusy-Clcltily); 6(1) 62 and inflated RitO Rarm saline solutionO After tOe memNranes Rere pusOed inside tOe uterine cavity modified McGonald’s suture Ras placed in a case of ST Reeks tRin gestation reported Ny Tsapanos et alO5 ROere tOe prolongation of pregnancy Ras RT Reeks and tOe gestational age at tOe time of delivery SY Reeks Ras notedO Conclusion Cervical cerclage sOould Ne considered in patients RitO advanced cervical dilatation and Nulging memNranes in tOe second trimesterO Gespite overall poor prognosis in sucO cases successful outcomes may Ne oNtained in selected casesO TOe COOattisgarO Nalloon is a device ROicO is easy to make, easy to use, cost effective and can Ne used in cases of secondtrimester prolapse of memNranes to salvage tOe pregnancyO Conflict of interest: NoneO Gisclaimer: NilO References RO GeN P, AftaN N, Muzaffar SO Prediction of Outcomes for Emergency Cervical Cerclage in tOe presence of Protruding MemNranesO Hnternational ScOolarly ResearcO NetRorkO S0RS; S0RSHSI: Article HG YTSYTR SO MisOra N, AgraRal S, GulaNani K, SOrivastava CO Use of an Hnnovative Condom Balloon Tamponade in Postpartum HaemorrOage: A ReporO ONstet Gynaecol HndiaO S0R6; 66HRI: 6SN7O SO Prasad N, TOampan AS, NagaratOnamma RO Emergency cervical cerclage and pregnancy outcomesO Hnt J Reprod Contracept ONstet GynecolO S0R7; 6: R99SNY TO OgaRa M, Sanada H, Tsuda A, Hirano H, Tanaka TO Modified cervical cerclage in pregnant Romen RitO advanced Nulging memNranes: Knee cOest positioningO Acta ONstet Gynecol ScandO R999; 7YH9I: 779NYSO 5O Tsapanos VS, Gecavalas GO, Adonakis GI, Kourounis GSO Iate or emergency HsalvageI cerclage of a dilated cervix after tissue support RitO pelvicol implant: A caseO J Biomed Mater Res B Appl BiomaterO S005; 7SHSI: S6YN7SO _______________________________________ S4efali Tyagi1, Swapnil O4agat2, S4reeja Karan3 1 Oonsultant, Obstetrics and Gynaecology; 2 Oonsultant Radiologist; 3 Bssociate OOG, Oloud Nine Hospital, Oangalore, Karnataka, India. Sol Nlw Hukphu Iouyuhs om OBGYN. 2019 (Iusy-Clcltily); 6(1) 61 Rere Nulging till OsO Hn parallel patient’s complete Nlood count HCBCI and C reactive protein HCRPI Rere sent for examination, laN report sOoRed total count Ras R0,0T0O cumm and CRP Ras normalO Urine Ras sent for microscopy and cultureO After explaining to tOe patient aNout tOe possiNility of preterm laNour, rupture of memNranes and poor outcome of pregnN ancy, decision for cervical cerclage Ras taken RitO patient’s consentO Patient Ras put on Hnj Cefuroxime RO5gm iOv BG, Hnj Proluton depot 500 mg intramuscular prior to cerclage procedureO Uterine tocolysis Ras givenO To pusO tOe memNranes Nack in uterus Re used COOattisgarO Nalloon, preparation steps as given Ny Nalini MisOra et alOS COOattisgarO Nalloon Ras prepared manually as folloRs – RI Collected a Foley’s catOeter of size S0NSS, a packed condom, scissors, tRo S0 ml syringes and 500 ml Nottle of saline in a trayO SI From tOe drainage tuNe of catOe

ter, cut tRo rings of approximately RNS mm RidtOO SI Excised Hnot merely inciseI tOe NulN of tOe catOeter after inflating it RitO airO TI Unfolded tOe condom over distal one tOird of tOe catOeterO 5I Used tOese rings encircling tRice only Hlike a ruNNer Nand in a ponytailI to secure tOe condom over catOeter leaving RO5 – S cm from NotO tOe ends of condomO 6I Excised tip of tOe Foley’s catOeter and condom ROicO Rere RasOed RitO antiseptic solutionO TOe procedure Ras performed under general anaestOesia RitO tOe patient in litOotomy positionO Urinary Nladder Ras catOeterized and emptiedO Sims speculum Ras placed in tOe posterior vaginal Rall first and tOen anotOer narroR speculum Ras placed on tOe anterior vaginal RallO TOe anterior lip of cervix Ras Oeld Ny sponge OolderO TOe Nalloon Ras prepared and inflated RitO 50ml of salineO TOe inflated condom Ras pusOed inside tOe cervix to pusO tOe memNranes inside tOe cervix and furtOer inflated RitO around R00ml salineO TOe COOattisgarO Nalloon pusOed tOe memNranes updue to ROicO tOe cervical margins Rere free to apply tOe Macdonald’s cerclageO Mersilene tape H5mmI Ras used for tOe cerclageO TOe condom Ras deflated gradually and tOen taken out completely Nefore tigOtening tOe cervical sutureO TOe ultrasound Ras done in parallel to tOe procedure and sOoRed memNranes intact, post stitcO distal cervix approximated to RO5 cmsO TOe patient Ras continued on CepOalosporins H Cefuroxime I H 5 days I and Tocolysis H R5 daysIO Micronized Progesterone HS00 mg daily x R5 daysI Ras also addedO Patient Ras discOarged on tOird postNoperative dayO SOe folloRed up regularly in OPG ROere tOe stitcO Ras cOecked and found to Ne in positionO Rest of Oerpregnancy Ras uneventfulO SOe Rent into laNour at S5 Reeks and after removal of tOe stitcOes, sOe delivered a female NaNy ReigOing SO7 kg vaginallyO BaNy did not require NHCU admissionO Giscussion Cervical cerclage Ras first proposed Ny SOirodkar in R955 and tOen Ois tecOnique Ras simplified Ny McGonald’s in R957O Treatment options RitO advanced cervical dilatation are limited to eitOer expectant management or placement of an emergency cervical cerclageO Guring cerclage tOe prolapsed memNranes must Ne placed Nack in tOe uterine cavity Nefore tOe procedure to avoid OigO risk of iatrogenic PPROMO TOis is accomplisOed least traumatically Ny placing tOe patient in tOe litOotomy position RitO a steep TrendelenNurg tilt, comNined RitO tOe administration of tocolytics SO Urinary catOeterization can also Oelp to reposition tOe memNranes in tOe uterusO HoRever, a full Nladder tends to reduce exposure of tOe operative field and pusO tOe cervix OigOer up into tOe pelvisO Hnvasive metOods for reducing tOe fetal memNranes include directly pusOing tOem Nack RitO a smootO surfaced device, sucO as a Foley’s catOeter Nalloon, or pusOing RitO gauze mounted on a clamp or an inflated Nalloon of tOe type used for endoscopic preperitoneal dissection, or a metreurynteror minimetreu Ha ruNNer Nalloon deviceI inside tOe cervical osO Alternatively, transaNdominal amniocentesis and amnioreduction under ultrasound guidance can Ne performed T in pregnant Romen RitO adv

anced Nulging memNranesO TOe patient Ras placed in tOe kneeNcOest position and a metreurynter RitO a NulN Ras inserted GOH N R0OSRS76OoNgynOS0R9O6OROR5 HSSN Oyput – 2454-2334; HSSN Ouspul – 2454-2342 A case report on management of cervical insufficiency using COOattisgarO Nalloon in second trimester cerclage for fetal memNrane prolapse SOefali Tyagi, SRapnil BOagat, SOreeja Karan Correspondence: Dr. Shefali Tyagi; Senior Consultant, Department of Obstetrics and Gynecology, Cloudnine Hospital, Karnataka, India; Email - shefali.tyagi@hotmail.com 5istributed under Bttribution-Non Oommercial-S4are Blike 4.0 International (OO OY-NO-SB 4.0) BOSTRBOT Many second trimester miscarriages and neonatal deatOs are caused Ny cervical incompetenceO Hn second trimester if tOe memNranes prolapse in vagina due to cervical incompetence it can Ne tecOnically very difficult for tOe clinician to pusO tOe memNranes Nack in cervix and apply cerclage to prolong tOe pregnancyO We present a case of S0 year old primi gravida ROo came to emergency at SS Reeks of gestation RitO cervix dilated to T cms and memNranes prolapsing till tOe vaginaO After ruling out possiNility of infection, decision for rescue cerclage Ras takenO TOe memNranes Rere deposited Nack in tOe uterus RitO Oelp of COOattisgarO Nalloon and Mac Gonald’s stitcO Ras appliedO Patient could successfully carry Oer pregnancy till S5 Reeks and NaNy did not need NHCU admissionO COOattisgarO Nalloon can Ne a useful tool in loR resource country like Hndia ROere it can Ne easily prepared, inexpensive and less traumatic compared to otOer alternatives availaNle as of noRO KeyRords: Cervical incompetence, memNrane prolapse, COOattisgarO Nalloon, MacGonald’s stitcOO Many second trimester miscarriages and neonatal deatOs are caused Ny cervical incompetenceO Hn second trimester if tOe memNranes prolapse in vagina due to cervN ical incompetence it can Ne tecOnically very difficult for tOe clinician to pusO tOe memNranes Nack in cervix and apply cerclage to prolong tOe pregnancyO Emergency cervical cerclage can play a major role inimproving tOeneonatal outcomesROCOOattisgarO Nalloon Ras used to pusO memNranes Nack into cervix folloRed Ny applying tOe MacGonald’s CerclageO Case report A S0 year old SS Reeks primigravida underRent usual anomaly scan ROere cervical opening H cervix opened and memNranes prolapsing outI Ras reported and sOe Ras referred Ny Oer primary gynaecologist to our OospitalO Patient presented in our Oospital in emergency RitO tOe ultrasound reportO On examination Oer vitals Rere found to Ne staNleO Speculum examNination sOoRed Nulging memNranes in vagina and it Ras also noted tOat tOere Ras no rupture of memNranes or leaking of amniotic fluid vaginallyO A vaginal sRaN for culture and sensitivity Ras taken and a gentle Nimanual vaginal HPVI examination Ras done ROere it Ras found tOat tOe Os Ras Tcm dilated and memNranes C SD RDOORS Received: SYtO August S0R9O Accepted: RRtO MarcO S0R9O Tyagi S, BOagat S, Karan SO A case report on management of cervical insufficiency using COOattisgarO Nalloon in second trimester cerclage for fetal memNrane prolapseO TOe NeR Hndian Journal of OBGKNO S0R9; 6HRI:60NS