1. REPLY
I wish to thank Drs Habek and Prka for their comments
regarding my article, “Cervical pregnancy: 13 cases treated
with suction curettage and balloon tamponade.”
While performing a dilation, evacuation, and curettage to
emergently treat a cervical pregnancy (gestational age unknown)
they encountered profuse arterial hemorrhage. This bleeding
was controlled with suction curettage and cervical packing.
This outcome reinforces my recommendation to do no
cervical dilation prior to suction curettage evacuation, and
sharp curettage is to be avoided. In my view, the approach by
Drs Habek and Prka to not use a cervical infiltration hemo-
static agent may have contributed to their patient’s blood loss.
Use of this agent can be accomplished quickly and it is a step
that I do not recommend be excluded. I can support not
placing the cerclage suture because I have never had to tie this
during the procedure. Large Foley catheter balloons should be
readily available, and I would prefer this for tamponade over a
gauze packing because of ease and control of removal. The
balloon can be gradually deflated over time in the anticipation
of persistent bleeding. -
Donald L. Fylstra, MD
Obstetrics and Gynecology
Medical University of South Carolina
96 Jonathan Lucas St., CSB 634F
Charleston, SC 29425
fylstrad@musc.edu
The author reports no conflict of interest.
ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.
2014.09.024
MONTH 2014 American Journal of Obstetrics & Gynecology 1
Letter to the Editors ajog.org