Advertisement

Alternatives to management of cervical prolapse in labor

Published:December 30, 2009DOI:https://doi.org/10.1016/j.ajog.2009.11.027
      To the Editors:
      I read with interest the publication by Sit and Fu,
      • Sit A.
      • Fu H.
      To push or not to push?.
      who successfully treated their patient with cervical prolapse and achieved vaginal delivery. Variability in evaluation of the patients with cervical prolapse in labor is seen often, depending on the cause. Significant edematous prolapse often cannot be reduced and leads to a cesarean section delivery. Local magnesium sulfate compresses help in the reduction of this edematous cervix, which leads to successful spontaneous vaginal delivery.
      • Lau S.
      • Rijhsinghani A.
      Extensive cervical prolapse during labor: a case report.
      • Baxi L.V.
      • Walsh C.A.
      Topical magnesium sulfate for cervical dystocia.
      In extreme cases, when a patient arrives in advanced labor with no anesthesia on board and with the fetal head in the cervix, yet almost outside the vagina or extrapelvic, the infant could be delivered expeditiously by a Dührssen's incision between a ring forceps that is applied on the cervix on either side of the incision. This incision could be a last resort that is preceded by local magnesium sulfate compression to reduce the edematous cervix and to glide it over the fetal head. This management is a way out in developing countries with limited resources.

      References

        • Sit A.
        • Fu H.
        To push or not to push?.
        Am J Obstet Gynecol. 2009; 201: 120.e1
        • Lau S.
        • Rijhsinghani A.
        Extensive cervical prolapse during labor: a case report.
        J Reprod Med. 2008; 53: 67-69
        • Baxi L.V.
        • Walsh C.A.
        Topical magnesium sulfate for cervical dystocia.
        J Reprod Med. 2009; 54: 189-190

      Linked Article

      • To push or not to push?: The patient had not disclosed a problem that would complicate labor
        American Journal of Obstetrics & GynecologyVol. 201Issue 1
        • Preview
          A 38-year-old woman (gravida 2, para 1) presented at 34 weeks' gestation with ruptured membranes. Two years earlier, she gave birth to an infant weighing 6 lb 5 oz via a normal, spontaneous, vaginal delivery.
        • Full-Text
        • PDF
      • Reply
        American Journal of Obstetrics & GynecologyVol. 202Issue 6
        • Preview
          We appreciate Dr Baxi's letter regarding the alternatives to management of cervical prolapse in labor. In our case, the edematous cervix was reduced successfully and resulted in a spontaneous vaginal delivery after “laboring down.”1 However, if the cervix is trapped or not reducible during labor and is not increasing rapidly, a trial of topical magnesium sulfate may be considered to facilitate reduction of the prolapse.2,3 Such a noninvasive method of local application of gauzes that are soaked in magnesium sulfate onto the edematous cervix is an alternative to a cesarean delivery.
        • Full-Text
        • PDF