A 32 year old female with a history of 2 mid-trimester aboions, comes now with 32 weeks of pregnancy and labour pains with Os dilated 2 cm. All are done, except:
A cerclage is best done between 12 to 24 weeks ( American Guidelines). In India we do cerclage even up till 28 weeks since fetus is said to be ble after 28 weeks in India still. If a patient is 32 weeks and already in labour, performing a cerclage is not of much benefit since bility of the fetus is already achieved . Management protocol here will include steroids to make sure that the newborn does not get Respiratory distress of Newborn. Any cervical handling will only increase the local prostaglandins which will fuher increase the preterm labour contractions.
Immediate circlage
Betamethasone
Antibiotics
Tocolytics
Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)