A gravida 3 female with kilo 2 previous 2nd trimester aboion presents at 22 weeks of gestation with funneling of cervix Most appropriate management would be:
**Core Concept**
In a pregnant woman with a history of second-trimester abortions and cervical funneling, the primary concern is preventing preterm birth due to cervical insufficiency. The cervix's inability to maintain its shape and stay closed during pregnancy leads to preterm labor and potential fetal loss.
**Why the Correct Answer is Right**
The McDonald stitch, also known as the cerclage, is a surgical procedure that involves stitching the cervix closed to prevent preterm labor. This procedure is typically recommended for women with cervical insufficiency, a history of preterm birth, or multiple gestations. The stitch helps maintain the cervical canal's integrity, reducing the risk of preterm birth and fetal loss. The McDonald stitch is the most commonly used type of cerclage, and it is usually performed between 12 and 24 weeks of gestation.
**Why Each Wrong Option is Incorrect**
**Option A:** Administering dinoprostone, a prostaglandin E2 analog, would actually induce labor and exacerbate the situation, making it an inappropriate choice for a woman with cervical funneling.
**Option B:** Misoprostol is a prostaglandin E1 analog that can cause uterine contractions and is often used for labor induction. Administering misoprostol would be contraindicated in this scenario, as it would increase the risk of preterm labor and fetal loss.
**Option C:** Applying a Fothergill stitch, also known as a shoestrings cerclage, is a type of non-surgical cerclage that involves placing two strings in the cervix. However, it is not as effective as the McDonald stitch and is not recommended as a primary treatment for cervical insufficiency.
**Clinical Pearl / High-Yield Fact**
A McDonald stitch should be considered for women with a history of second-trimester abortions, cervical insufficiency, or multiple gestations. The stitch is most effective when performed between 12 and 24 weeks of gestation, and it requires close monitoring of the cervix and fetal well-being throughout the pregnancy.
**✓ Correct Answer: D. Apply McDonald stitch**