This document discusses cervical cerclage, a surgical procedure used to treat and prevent preterm birth. It provides guidelines on when cervical cerclage is indicated based on history of prior preterm births or short cervical length on ultrasound. Major professional organizations like ACOG, RCOG, and SOGC recommend offering cervical cerclage to women with a history of late second trimester losses or prior preterm births before 34 weeks who currently have a short cervix. Cerclage placement can reduce the risks of preterm birth, low birthweight, and perinatal mortality.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
DEBATE - SHORT CERVIX - OS TIGHTNING BY DR SHASHWAT JANI
1. Dr. Shashwat K. Jani
M. S. ( Obs – Gynec ) , FIAOG.
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Born Too Soon
The Global Epidemiology Of 15 Million
Preterm Births.
Hannah Blencowe et al
Why Worry About Preterm Births…???
15-Jan-20
Dr Shashwat Jani.
99099 44160.
2
4. Goldenberg RL et al. The preterm prediction study. Am JPublic Health. 1998;88:233-38
The Preterm Prediction Study
15-Jan-20
Dr Shashwat Jani.
99099 44160.
4
5. Etiology
TRAUMA:
Gyn Cervical Trauma
D/C & D/E
Cervical amputation
Cervical conization
Obst Cervical Trauma
Cervical lacerations and tears in precipitate labor, Breech
extraction, Forceps delivery, Large baby,
15-Jan-20
Dr Shashwat Jani.
99099 44160.
5
6. Congenital defects :
Bicornuate uterus, Sub Septate uterus, Septate
uterus
Connective tissue ,fibrous tissue & smooth
muscles
Smooth muscle :7-17-27
From ext os ---endocervical canal--- int os
15-Jan-20
Dr Shashwat Jani.
99099 44160.
6
7. Defining Short Cervix
The discriminatory length of cervical
shortening varies widely between
26mm ( lams et al ) to 15 mm ( Hassan et al ).
15-Jan-20
Dr Shashwat Jani.
99099 44160.
7
8. Basic Parameters
Standard cervical measurements use the
“white stripe” of the internal cervical os as an
anatomic landmark for proper caliper
placement.
• Anderson found an average cervical length of
45 ± 7mm at 14 to 30 weeks.
• Lams et al found a mean cervical length of
35 ± 8 mm at 24 weeks.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
8
9. ULTRASOUND DIAGNOSIS
Cervical length < 2.5 cm or progressive cervical
shortening
Width of internal os 1.5 cms or more during 1st trimester
and > 2 cms in the second trimester (Maharan) is
diagnostic
Funneling of cervix
V-shaped and U-shaped lower segment
Herniation of bag of membranes into the cervical canal
15-Jan-20
Dr Shashwat Jani.
99099 44160.
9
10.
11. Definition Cervical Cerclage
Cervical cerclage refers to a variety of
surgical procedures in which sutures or
synthetic tape are used to mechanically
increase the tensile strength of the cervix,
thereby reducing the occurrence of preterm
birth .
(Norwitz et al. 2007)
15-Jan-20
Dr Shashwat Jani.
99099 44160.
11
13. In Whom Is A Cervical
Cerclage Indicated?
( RCOG 2011 )
15-Jan-20
Dr Shashwat Jani.
99099 44160.
13
14. History- indicated Cerclage
Insertion of a cerclage as a result of factors in a
woman’s obstetric or gynecological history
Is performed as a prophylactic measure in
asymptomatic women and done at 12–14 weeks of
gestation.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
14
15. Ultrasound- indicated cerclage
Insertion of a cerclage as a therapeutic measure
when cervical length < 25 mm in asymptomatic
women without exposed fetal membranes in the
canal .
TVS to be done between 14 and 24 weeks of
gestation.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
15
16. Rescue Cerclage
(Emergent Cerclage)
Cervix dilated > 2 cm with no perceived uterine
Contractions
Premature cervical effacement > 50 %
Presence of pelvic sensation of pressure’.
Heavy mucoid vaginal discharge
Bulging membranes through the cervical os
Broad spectrum antibiotics
( RCOG Green-top Guideline 2011 No. 60 4 of 21 )
15-Jan-20
Dr Shashwat Jani.
99099 44160.
16
17. Treatable Anatomical Cause For Preterm Labour &
2nd Trimester Loss
15-Jan-20
Dr Shashwat Jani.
99099 44160.
17
18. How The Intervention Would Work?
Cerclage may provide a degree of
structural support to a ‘weak’ cervix.
It’s role in maintaining the cervical
length and the endocervical mucus plug
as a mechanical barrier to ascending
infection may be more important.”
http://www.rcog.org.uk/files/rcog-corp/GTG60cervicalcerclage.pdf
15-Jan-20
Dr Shashwat Jani.
99099 44160.
18
20. SHORT CERVIX BEFORE 20 WEEKS
The examination should be repeated
because of the inability to adequately
distinguish the cervix from lower uterine
segment in early pregnancy.
ACOG Practice Bulletin Nov 2018
15-Jan-20
Dr Shashwat Jani.
99099 44160.
20
21. SHORT CERVIX AT OR AFTER 20 WEEKS
• Should prompt assessment of the fetus
for anomalies
• Uterine activity to rule out contractions
• Maternal factors to rule out
chorioamnionitis
ACOG Practice Bulletin Nov 2018
15-Jan-20
Dr Shashwat Jani.
99099 44160.
21
22. SHORT CERVIX IN THE THIRD TRIMESTER
• If labour or chorioamnionitis not present
expectant management may be considered
• Cerclage in the treatment of woman with
cervical insufficiency after determining fetal
viability has not adequately assessed
ACOG Practice Bulletin Nov 2018
15-Jan-20
Dr Shashwat Jani.
99099 44160.
22
23. McDonalds procedure 1957
Shirodkars procedure 1951
Wurms procedure (Hefner cerclage) 1959
Lash and Lash procedure 1950
Tansabdominal (Benson &Durfee 1965)
Laparoscopic transabdominal cervico-isthmic
cerclage during pregnancy - traditional and the new
‘Soo’ procedure
15-Jan-20
Dr Shashwat Jani.
99099 44160.
23
24. Advantages
Prevents Miscarriages
Prevents Preterm Labour
Prevents ascending infection
Immediate result ( No frequent f/up TVS )
Decrease In Neonatal Morbidity & Mortality
Very Minimum Complications
Cost Effective
85 – 90 % success rate
15-Jan-20
Dr Shashwat Jani.
99099 44160.
24
25. ADVERSE EFFECTS
( Mainly Theoretical )
• Suture displacement
( very very rarely )
• Rupture of membranes
( Possible in Rescue cerclage )
• Chorioamnionitis
( if PPROM / PID )
15-Jan-20
Dr Shashwat Jani.
99099 44160.
25
28. Can cerclage be performed as a day -
case procedure?
Transvaginal cerclage can safely be
performed as a day - case procedure.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
28
29. Should women receive supplemental
progesterone following cerclage?
Routine use of progesterone
supplementation following cerclage is
not recommended.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
29
30. Should perioperative tocolysis be used
for insertion of cerclage?
There is no evidence to support the
use of routine perioperative tocolysis
in women undergoing insertion of
cerclage.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
30
31. Bed rest after cerclage ?
Bed rest in women who have
undergone cerclage should not be
routinely recommended, but the
decision should be individualized
15-Jan-20
Dr Shashwat Jani.
99099 44160.
31
32. Should perioperative
antibiotics be given?
The decision for antibiotic prophylaxis
at the time of cerclage placement
should be at the discretion of the
operating team
15-Jan-20
Dr Shashwat Jani.
99099 44160.
32
33. Perinatal outcome of Multiple gestation does
prophylactic cerclage make a difference?
Prophylactic cerclage decreased significantly the
incidence of extremely LBW neonates in Multiple
pregnancies. The proportion of neonates delivered
at 31 weeks or more, and at 32 weeks or more was
higher in the cerclage group.
J Maternal Fetal Med. Elimian A et al 1999 May-Jun;8(3):119-22.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
33
44. ACOG Recommends . . .
Cerclage is indicated in the second trimester in
women with singleton pregnancies who:
• Have a history of second-trimester pregnancy loss
associated with painless cervical dilation without labor
• Have had cerclage in a previous pregnancy due to
painless dilation;
• Currently have painless cervical dilation;
• Previously had a spontaneous preterm birth before 34
weeks and, in the current pregnancy, have a cervical
length < 25 mm before 24 weeks' gestation.
ACOG Practice Bulletin No.188, Jan 2018: Cerclage for the
management of cervical insufficiency. Obst Gynacol 2014
Feb;123:372-9.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
44
45. SOGC CLINICAL PRACTICE GUIDELINES
• Women with a history of three or more second-
trimester pregnancy losses or extreme premature
deliveries, in whom no specific cause other than potential
cervical insufficiency is identified, should be offered
elective cerclage at 12 to 14 weeks of gestation. (I-A) 5.
• In women with a classic history of cervical
insufficiency in whom prior vaginal cervical cerclage has
been unsuccessful, abdominal cerclage can be considered
in the absence of additional mitigating factors. (II-3C)
Brown et al, Cervical Insufficiency and Cervical Cerclage; J
Obstet Gynaecol Can Dec 2013;35(12):1115–1127
15-Jan-20 45
46. SOGC CLINICAL PRACTICE GUIDELINES
Cerclage should be considered in singleton
pregnancies in women with a history of
spontaneous preterm birth or possible cervical
insufficiency if the cervical length is ≤ 25 mm
before 24 weeks of gestation. (I-A)
Brown et al, Cervical Insufficiency and Cervical
Cerclage; J Obstet Gynaecol Can Dec
2013;35(12):1115–1127
15-Jan-20
Dr Shashwat Jani.
99099 44160.
46
48. COCHRANE REVIEW RECOMMENDS
• Overall, cerclage probably leads to a reduced
risk of perinatal death when compared with no
cerclage.
• Pregnant women with cerclage were less
likely to have preterm births compared to
controls before 37, 34 and 28 completed weeks
of gestation.
Alfirevic Z, Stampalija T, Medley N. Cervical cerclage for preventing preterm birth in
singleton pregnancy.
Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008991.
15-Jan-20
Dr Shashwat Jani.
99099 44160.
48