MacDonald surgery

McDonald's surgery sutured the internal cervix with a nylon thread or a 10th wire loop, tightening and ligating. It is suitable for pregnancy, easy to use and easy to remove. There is no effect on pregnancy, there is no risk of cervical wound splitting, and cesarean section is not necessarily required during childbirth. Relaxation of the internal cervix is also called uterine insufficiency, which is one of the causes of habitual abortion and premature delivery in the second trimester. When the internal cervix is relaxed, the function of the isthmus sphincter is reduced and the internal cervix is pathologically dilated. After the second trimester, the fetal sac can protrude from the inner end of the cervical canal, causing a contraction and abortion. The reason for the relaxation of the internal cervix is caused by congenital cervical tissue dysplasia and secondary injury. Therefore, when asking about medical history and physical examination, it often has the following characteristics: 1 There have been more than 2 episodes of spontaneous abortion in the mid-term pregnancy, and a history of preterm birth, and other factors that can cause habitual abortion and premature birth are excluded. 2 There are history of cervical surgery such as cervical dilatation, multiple curettage, cervical resection, or history of dystocia and dystocia, resulting in cervical tissue damage. 3 The internal cervix is large, and it can be used for 1 finger or uterine lipiodol angiography during non-pregnancy. It can be found that the cervical canal is pathologically dilated. The purpose of surgical treatment is to repair the cervix and establish the formation and function of the normal internal cervix, so that pregnancy can be maintained to the advanced stage. The inner end of the cervix was sutured with a nylon thread or a 10 gauge wire, and the ligature was tightened. It is suitable for pregnancy, easy to use and easy to remove. There is no effect on pregnancy, there is no risk of cervical wound splitting, and cesarean section is not necessarily required during childbirth. Treating diseases: cervical diseases Indication McDonald's surgery is suitable for patients who have been diagnosed as having a loose internal cervical tract without children, during pregnancy or during non-pregnancy surgery. According to the degree of relaxation of the internal cervix, pregnancy or not, and the month of pregnancy, different surgical methods are used. Contraindications 1. Pregnant women have comorbidities, such as pregnancy-induced hypertension syndrome, fetal malformations. 2. There are signs of threatened abortion or threatened preterm birth. Preoperative preparation 1. Carefully check for indications suitable for performing a circumferential suture. 2. Pregnancy surgery is prone to cause bleeding and miscarriage. Therefore, it should be used for 3 to 5 days before surgery to prevent miscarriage, such as intramuscular injection of progesterone 20 ~ 30mg / d, oral sedative. Inject phenobarbital sodium 0.1g half an hour before surgery. The operation time is recommended to be 14 to 18 weeks pregnant. 3. Non-pregnancy surgery, 3 ~ 7d after menstruation is appropriate. If there is acute inflammation in the vagina and cervix, it should be treated first and cured after surgery. 4. The suture selection is for the gestational age. The nylon thread, the 10th double thread or the cotton thread can be used. Because the cotton thread is twisted, the ligation is not easy to slip off. The 10th monofilament thread is used for gestational age or for purslane stitching. Surgical procedure 1. Carefully check the length of the cervix and the area of the inner mouth. Exposure of the cervix after routine disinfection. Use a rat tooth forceps or an oval clamp to clamp the upper lip of the cervix and pull it down. Push the vaginal mucosa and bladder up with a vaginal hook. 2. The triangular needle wears the nylon thread or the 10th silk thread at the proximal end of the cervix from the anterior wall of the cervix, which is equivalent to 10 to 11 points. It penetrates into the muscular layer of the cervix. After the needle is removed, it continues at the cervix 7-8 points, 5 to 4 Point, 2 to 1 point for circular suture, that is, four needles around the cervix. The needle is pulled out from the cervix at 1 o'clock, and the ends of the suture are tightened. After tightening, the needle is retained at the end of the knot. complication The uterus is sensitive during pregnancy, and surgery is a stimulating factor, which may cause miscarriage and premature birth. Therefore, attention should be paid to the fetus before and after surgery. The operation is meticulous and gentle, and the bleeding is complete.