Two 2nd trimester pregnancy loss…
Clincal criteria fullfilled…then why not go for direct cervical cerclage…?
What if the Abortions were not due to Cervical Incompetence and we do a cerclage where its not needed?
We will do more harm than good to the patient.
So check for the Cervical length ,if <2.5 cm do the prophylactic cerclage.
means…always do usg… Before cerclage.
(Clinical criteria does not matter).
the patient is just 9 weeks.
I agree she has fulfilled the criteria.
But my " Next Step" would be USG and not directly Cerclage to look for any bulging membranes, PROM/ preterm labour as such.
If my USG findings are consistent , I will go with a Prophylactic Cerclage at 12-14 weeks
if clinical criteria is fulfilled and USG is showing >2.5cm cervical length still we do cervical cerclage in 2nd trimester . Cervical cerclage is done in 2nd trimester for the same reason you mentioned .
if, in question 14 weeks pregancy, clinical criteria fulfilled… Direct cerclage…no need usg.
In question 9 wks… Thats why… Usg…?
If any gravid pt Fulfills this history : atleast 2 painless preg loss in 2nd trimester : even if USG says cervical length is >2.5cm : we will do CERCLAGE ( but we will only do it in 2nd trimester )
If there’s any uncertainty in clinical history : we will do USG and then plan for CERCLAGE of length <2.5cm
I don’t think that answer here should be USG . Because USG to check cervical dilatation IS DONE IN 2nd Trimester and she is 9week pog only .
If in option it would have just mentioned USG : it would be correct answer as we routinely do 1st trim USG . But here it’s saying USG to check for cervical dilatation which is done in 2nd trim .
So I think ans should be : bed rest and recall after 3-4 weeks