McDonald’s suture: A successful case

Cervical incompetence is characterized by painless dilatation of the incompetent cervix and results in miscarriages and preterm delivery during second trimester. Cervical cerclage (CC) has been utilized for the cure of loss in second trimester pregnancy. The detection of cervical incompetency is difficult. Usually patients have history of repeated second trimester demise or early preterm delivery after cervical dilatation without pain having no bleeding, contractions, or other reasons. We report a 28years old patient, 3rd gravida, para 0+2, at 11 weeks’ gestation with the diagnosis of cervical incompetence, in whom cervical cerclage (McDonald’s suture) was performed successfully. There were no operative or immediate postoperative complications. A healthy infant was delivered at 37 weeks by caesarean section. After delivery the suture was removed. Cervical cerclage during pregnancy can be safe and effective treatment for well-selected patients with cervical incompetence.

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation.Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension.“Why Should Emergency Physicians Be Aware of This?”New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.