From the twelve o'clock position at the level of the cardinal ligament, 3-4 cm from the
cervical os, the two-way needle with the suture material was passed to the level of four o'clock and eight o'clock.
It is now classified as either major, in which the placenta is covering the internal
cervical os, or minor, when the placenta is sited within the lower segment of the uterus, but does not cover the cervical os1.
[9,10,11,12] But, as per American Brachytherapy Society (ABS) Guidelines, high dose rate (HDR) interstitial brachytherapy (ISBT) is a better option, for patients with carcinoma cervix in certain clinical scenarios like bulky lesions, a narrow vaginal apex, inability to negotiate the
cervical os, extensive disease up to the lateral parametria or pelvic sidewall, and involvement of lower third of vagina, in an attempt to improve local control.
Bimanual examination revealed tenderness in the left adnexal region and no hemorrhage in closed
cervical os. Ultrasound showed a live fetus of 12+2 weeks in the uterus, an irregular heterogeneous hypoechoic mass in front of the uterus, and massive fluid in the pelvis [Figure 1].
But misoprostol (Cytotec) alone for women with a closed
cervical os can require a second dose or intervention.
On examination under anaesthesia,
cervical os was open with lower segment ballooned up and fibroid felt protruding from
cervical os.
It is common to have difficulty finding the
cervical os during surgery for OF, or when the cervix is found, there is often no identifiable anterior cervical stroma.
The uterine cervical longitudinal axis was measured when at least three of the following five recognition points on the plane were clearly visible: (1) the external
cervical os, (2) the internal
cervical os, (3) the cervical canal, (4) the cervical/vaginal interface, and (5) the cervical corpus [10].
During nuchal translucency ultrasound, pregnancy noted to be located within the cervix, specifically, 8mm from the external
cervical os (Figure 1).
Formerly, a catheter was placed in the
cervical os, although the catheter dropped out soon after the surgery.
The
cervical os was found to be only 2 cm dilated and there was a 4 cm tear in the posterior cervical lip, which was bleeding, suggesting that the patient had aborted through the tear (Fig.
On per-vaginal examination,
cervical os was tightly closed with no vaginal involvement.