Last night, I took care of a patient that had an abdominal cerclage placed when she was 14 weeks. This was the first time I'd ever heard of such a thing. I obviously know about the usual cerclage, but this was different. If I understood right, it can be place before conception or afterwards. And it is permanent so she'll have to have a c-section. She'd had 2 second trimester losses, an incompetent cervix and a failed cerclage previously, so she went to a large university hospital to have an abdominal cerclage placed. Now she's 35 weeks, so apparently it works. Anyone else know much about these? I'd like to ask one of the docs about it or research it a bit, but I didn't have the time last night. It sounded like it's fairly new, and the patient said the doc who placed it said it seems to work much better at maintaining a pregnancy when there has been evidence that prior pregnancies were lost only due to cervical incompetence. I'm guessing it's a newer thing? But, like I said, I'd not heard of it. None of us working had. My imagination dreamed up this image of the doc making the incision, taking this big honkin' rope and just tying it around the lower part of the uterus, above the cervix, kinda like tying up a garbage bag. I've got a vivid imagination, but actually it sounds like that's sort of what they're doing. I'm curious to learn more.
On a side note, I remember my first patient who delivered before viability at 21 weeks. I bet I'll always remember how that night went, her doc, her name and he little son's name. She has since gone on to have another baby and she came in last night for a labor check with her 3rd baby at 38 weeks. I had bonded with them when she was hospitalized on bedrest. She had been 3 cm at her 20 week sono, and so she spent about a week or so on strict bedrest to try to get her to viability. I was just off orientation and pregnanct with Clara but not showing much through scrubs. She hadn't been contracting, denied any pain at all. She called at one point because she felt wet. Her water had broke. Her doc said to just watch her, because there wasn't much we could do. She told me she needed to have a BM, and I was filled with dread, worrying that it really wasn't stool she was feeling. So, I gave her the bedpan. She hit her call light within a minute or two and the look on her face gave it away: she was delivering. He was born alive, perfect, but not ready to be out of the womb. At first, she didn't want to see him. It was shock I think, but when she realized he was still alive and that she could keep him warm and next to her as he passed, she decided she did want to hold her son. She and her husband had about 2 hours with him. I saw her the next a.m. and they showed me pictures. We all had a cry together. I had typed up this beautiful poem I found on thick paper and had it laminated, which she still carries in her purse, which she showed me last night. I remember when she had her second son 2 years later. And it's was again great to see her pregnant and due anytime.