Pharyngo-conjunctival Fever
Authors: E. J. C. Kendall, R. W. Riddle, H. A. Tuck, K. S. Rodan, B. E. Andrews, J. C. McDonald
Journal: BMJ (1957)

HABITUAL ABORTION BRDIBPTLSH 131 knotting.But in the pregnant woman it is another matter; one must use one's own judgment; the suture should be tied with very little tension.The two incisions are then closed with catgut in the ordinary way and the patient is sent back to bed.The foot of the bed should be raised for 48 hours or more if the patient is pregnant. Mode of DeliveryWith a history of repeated abortion and with a pregnancy which has reached term after this operative procedure it is tempting to deliver the child by means of caesarean section.Where there is no other obstetric indication, however, it seems reasonable to allow the patient to go into labour and divide the suture, which by this time may be found to lie just deep to the endocervical mucosa.Then, if labour proceeds normally within 48 hours, operative intervention is not indicated.If, however, after division of the suture delivery is not imminent after 48 hours, it seems to us desirable to deliver the patient by caesarean section.DiscussionWithout detailing the underlying causes, Malpas (1938) suggested that after three abortions the chance of spon- taneous cure was 27%.Swyer and Daley (1953), however, found that this pessimistic assessment was far too low; that approximately 50, of such women had a chance of pro- ducing a live baby without treatment.It is, of course, not difficult, in cases where there is a history of habitual abortion, to perform a Lash or Shirodkar type of operation, either before or during pregnancy, and if subsequently the patient carries to term there would be a natural tendency to claim that any successful result was due to the operation itself.In our opinion, success can be attributed to the operation only if a history of repeated early rupture of the membranes is obtained, or if actual incompetence of the internal os can be demonstrated.It is quite obvious that to amass a series of cases sufficient to produce statistically significant results will take a long time owing to the relative rarity of this cause of habitual abortion.This preliminary communication is published in the hope that it may stimulate other workers in this field to carry out investigation and treatment along similar lines.Summary Deficiency of the internal cervical os is an occasional cause of habitual abortion.Such insufficiency may be either congenital or the result of trauma at gynae- cological operation or during childbirth or miscarriage.The deficiency may be suspected from the history of repeated early rupture of the membranes followed by abortion, and may be demonstrated in the non-pregnant woman by a special x-ray technique or by the passage of a No. 4 cervical dilator freely into the uterine cavity.During pregnancy it may be confirmed by the observa- tion that the membranes are bulging and that the cervix is partially dilated in the absence of bleeding or obvious uterine contractions.A method of reinforcement of the inefficient internal os, based on Shirodkar's original technique, is described, and seven cases so treated are listed in detail.Five have now been delivered, and two are not yet pregnant.ADDENDUM.-Sincesubmitting this paper for publication we have operated on five more patients between the 15th and 20th weeks of pregnancy: none of these have aborted and all have proceeded to term normally.