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The increasing number of elderly mothers and high-risk pregnancies are a great concern for family happiness. There must be a lot of things that prospective parents should pay attention to for a healthy meeting with their baby. A healthy pregnancy process is directly related to the health of the fetus, so proper treatment and management are important. We take a look at ‘pregnancy and childbirth’, which is more important to overcome the era of birth rate crisis, with Professor Bae Jin-gon, a specialist in obstetrics and gynecology at Keimyung University Dongsan Hospital.

[윤윤선 MC]
The question I would like to ask this time is that there are quite a few people who have undergone this procedure, and it is ‘when the fetus comes out without pain’. This is called cervical incompetence. Looking at it, the length of the cervix is ​​short, so there is a risk that the child may flow down. What kind of situation is this?

[배진곤 산부인과 전문의]
The child does not flow. So, no small child needs uterine contractions to deliver them and no contractions to deliver without them. However, because the cervix is ​​weak, the cervix can open and the amnion can come out. However, there is definitely that, but when mothers say that their child is flowing, it becomes the reason why mothers lie down and cannot walk upright.

Therefore, implantation itself is not implanted in the space of the uterus as if it were attached to the wall, but penetrates into the endometrium and becomes implanted. However, there are people who have a weak cervix. Such people generally say that the cervix is ​​short. In general, if you say that the cervix is ​​short, when the cervix is ​​shorter than 2.5 cm, then it is said that the cervix is ​​short.

Among those who come to us as an outpatient, there are a lot of cases like “3cm but short”, “3.5cm but short”, “I think it is short”, but I would like to tell you in advance that we are using 2.5cm as the standard. It’s such a classic paper, but it was already almost 20 years ago that Dr. Iams announced in 1996, “I measured the cervix of all people giving birth prematurely, and it seemed that 2.5cm was the critical point.” It was almost 30 years ago, and there is no disagreement about it until now, so if you say a short cervix, it’s 2.5cm.

And, in the case of the same length as the normal cervix, it is usually about 3.5 cm around 20 to 24 weeks. So the average is 3.5 cm. It can be shorter or longer than 3.5 cm. At 24 to 28 weeks of pregnancy, the average is about 3.2 cm. Then it can be shorter or longer than 3.2 cm. That’s why if we’re not shorter than 2.5cm, we don’t have to worry too much. Of course you can take a closer look. Also, even if it is shorter than 2.5 cm, surgery is not unconditionally performed. That’s why I think it won’t be a problem if you discuss these things with expert teachers enough.

In this case, a lot of us come to our outpatient department. Cervical conization, because cervical cancer treatment is very common these days, there are a lot of people who do conization. This is a very old story. This is a procedure that was done a very long time ago, and these days, McDonald’s surgery is not performed even if a conicectomy is performed.

In general, McDonald’s surgery is performed after conical resection when the measurement is shorter than 2.5 cm. In this case, if you look at the indications for McDonald’s surgery now, you are a high-risk mother, a mother who has previously had a premature birth or has had a history of cervical surgery. In such high-risk mothers, when the cervical length is shorter than 2.5 cm, we perform McDonald’s surgery. So, among mothers who have undergone conization, surgery is performed if the cervix is ​​shorter than 2.5 cm, otherwise surgery is not performed.

So, if you think about it, then what will be the problem with preventive surgery, preventive surgery. Being preventive is a good thing. If the McDonald’s surgery itself is harmless, it won’t matter if you do it preventively. However, the McDonald’s operation is also clearly a procedure in which the cervix is ​​tied 360 degrees by pricking a needle, and the thread is left in there until delivery. It’s because you put something in it that can cause infection. Because of that, there have been cases of actual infection and sepsis, and there have been cases where the water has burst due to infection, and there have been cases where the nose has rotted. Because various complications arise, it is necessary to think very much about whether we will do it prophylactically rather than observing all these indications when we do McDonald’s surgery. It is also a part that all obstetrics professors are very worried about and worried about because it is thought that great morality is needed.

Then, they are very curious about how many weeks the McDonald’s surgery to tie the cervix can be performed. Currently, all societies around the world recommend surgery up to 24 weeks. Of course, depending on the teachers, there are some who do up to 25 weeks and some who do up to 26 weeks. If this is something that has changed a lot since the old days, when we collect all the data, it is cervical incompetence when the cervix opens without contraction. In the absence of contractions, when the cervix is ​​opened and the amniotic sac is expelled, average data is collected in the absence of contractions, and the pregnancy is maintained if there are no contractions for about 6 or 7 weeks. If you add 6 to 7 weeks to 24 weeks, you get about 30 weeks.

Because medicine has advanced so much, the survival rate of children after 28 to 30 weeks is almost 95%. That’s why, rather, if the amniotic sac came out, the cervix seems weak, I need emergency surgery, an infection occurs, or the amnion ruptures, you have to give birth at 24 weeks. Therefore, it is said that it would be good to observe because there is no contraction anyway without surgery after about 24 weeks around the world, and the results are all good. In addition, in the case of twins, the cervix can be weak, so McDonald’s surgery should be preventive. Many people say that, but it is to the extent that such a case is not discussed. Even if you have twins, you never have to do McDonald’s surgery to pre-tie the cervix.

(Composition: Park Da-eun)

2023-08-25 01:00:02

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