Prevention of preterm Labour

Cervical weakness: Threatened Preterm Labour: Prevention of preterm labour: Why we at al put a stitch? We have to make our conscious clear and accountable to Medl science as to ‘On which indication we are banking upon before contemplating on STITICH”. Broadly speaking the indications of Prophylactic Cerclage:-are of tree types: - Prophylactic Cerclage are of three types:-

 A) First & possibly commonest indication is Symptom Oriented : Dependent –“Guided”-but  unsupported by USG features ( new appearance of “Whites symptoms in preg ”  which increase as weeks passes , & Mild abd “cramps in tummy-which was absent earlier and unassociated with constipation & UTI”).

Secondly:-history oriented Cerclage: - in the form past one or two spont midtrimeser pregnancies whether no definite cause could be ascertained with certainty .Again supported by USG but unsupported by USG findings.

C) More scientific :- i.e. Sonologically documented serial USG confirmed progressive cervical changes: In such cases irrespective of parity and symptoms if there is serial USG confirmed progressive cervical changes then one can consider put prophylactic stitches. On the whole repeated HSG, SIS, Trial Transfer & Hysteroscopy are more becoming indication of stitch in the era of 21st. century,

 So far as multiple pregnancies there is no sound and valid initiation of putting a Cerclage as cervical tissue integrity is not comprised in any way. In fact there is no documentation that cervical structural & functional capacity is compromised in multiply preg in any way. Whatever the defect is there is limited to cleavage of embryo and or release of any oocytes from poly-ovular follicles. In fact. Cerclage can initiate PTL,

 But in case of already existing cong abnormality of uterus, yes, hopefully there is rationality off strengthen Cx. More so if she had repeated insult in Cx in the form of HSG/Hysteroscopy etc.