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Do I need stitches on my uterus for a successful pregnancy?

Monday, 24 October 2005
Answered by: Dr. B.S. Baliga
Senior Consultant, Department of Gynaecology and Obstetrics
Sagar Apollo Hospital
Bangalore
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Q. I am 30 years old and 8 weeks pregnant. Early this year I had a miscarriage of a 4th months old fetus and the doctor said that my uterus mouth is very short so it can't hold the baby. This time they have to put stitches from down to uterus mouth before the end of the 3rd month. Is it true and how much will it cost and what are the precautions I have to take? Do I need to take bed rest? I am quite depressed and don't like eating anything. I just like to drink water and I don't feel hungry at all. I am taking duphaston twice a day; folic acid once a day and Justrin once a day for 20 days. The doctors have also given cyclogest vaginal tablet for 20 days. Please help me.

A.  If the reason for the previous abortion has been diagnosed, that is good - as it can be remedied. So cheer up. In many cases no cause can be detected despite numerous tests. Yes, you will require the stitch - cervical encirclage. Usually it is done after 3 months of pregnancy. After the stitch is inserted, you need to take rest for 1 week. The purpose of putting the stitch is that the uterus mouth is kept closed, and that you can be ambulatory. However, depending upon the past history (e.g. if there are repeated abortions) and the length of the cervix, the patient may still be advised prolonged bed rest for the entire length of pregnancy. Your doctor would be the best person to answer this question for you. You should avoid sex, avoid lifting heavy weights, take adequate rest, eat nutritious food, and not be depressed. Regarding medicines, they seem to be OK. I don't know why aspirin is being given - ask your doctor. The most important thing to remember after insertion of stitch is that it should be removed at 37 weeks of pregnancy or earlier in case you go into preterm labour or have premature rupture of bag of waters (amniotic fluid starts leaking). In case the stitch is not removed when you are having labour pains (abortion/preterm labour or normal labour), the baby will be forced out leading to rupture of uterus (a major complication). Therefore it is customary for all doctors to tell their patients about this possible complication. This helps the patient to remember to tell the doctor on duty that she has a stitch that needs to be removed- just in case she reaches the hospital in labour, without her discharge slip having the operation notes (which is quite likely). The stitch has a good success rate for carrying the pregnancy to term - around 85-90%.

A.  If the reason for the previous abortion has been diagnosed, that is good - as it can be remedied. So cheer up. In many cases no cause can be detected despite numerous tests. Yes, you will require the stitch - cervical encirclage. Usually it is done after 3 months of pregnancy. After the stitch is inserted, you need to take rest for 1 week. The purpose of putting the stitch is that the uterus mouth is kept closed, and that you can be ambulatory. However, depending upon the past history (e.g. if there are repeated abortions) and the length of the cervix, the patient may still be advised prolonged bed rest for the entire length of pregnancy. Your doctor would be the best person to answer this question for you. You should avoid sex, avoid lifting heavy weights, take adequate rest, eat nutritious food, and not be depressed. Regarding medicines, they seem to be OK. I don't know why aspirin is being given - ask your doctor. The most important thing to remember after insertion of stitch is that it should be removed at 37 weeks of pregnancy or earlier in case you go into preterm labour or have premature rupture of bag of waters (amniotic fluid starts leaking). In case the stitch is not removed when you are having labour pains (abortion/preterm labour or normal labour), the baby will be forced out leading to rupture of uterus (a major complication). Therefore it is customary for all doctors to tell their patients about this possible complication. This helps the patient to remember to tell the doctor on duty that she has a stitch that needs to be removed- just in case she reaches the hospital in labour, without her discharge slip having the operation notes (which is quite likely). The stitch has a good success rate for carrying the pregnancy to term - around 85-90%.

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