Re: Cerclage For Short Cervix
From: Steve & Eryl Raymond (eryl@intekom.co.za)
Fri Jun 4 14:19:58 2004
I thought all this talk about shortening had been cut short by the
reliability of TVS findings on funnelling - Y, U or V shaped canals.
The significant change is not in the length of the cervix, but in the
length of the canal.
Steve
Lynn D. Montgomery, M.D. wrote:
> Art,
> This seems to be the finding of several studies. What seems to be the
> most advantageous route of follow for patient's with a known shortened
> cervix (< 2.5 cm between 16-20 weeks) is weekly measurement of the
> cervix until at least 24 weeks and only placing a stitch in those who
> demonstrate a "dynamic" change (either further shortening or funneling).
> This seems to lessen the number of unnecessary cerclages and also the
> risk of preterm birth imparted by simply placing a cerclage. The
> disadvantage is the weekly visits for cervical measurement.
> Lynn
>
> Lynn D. Montgomery, M.D.
> Maternal-Fetal Medicine, OB/GYN
> Rocky Mountain Women's Health
> 2835 Fort Missoula Rd., Suite 303
> Missoula, Montana, 59804
> 406-549-0978
> fax 406-549-0987
> e-mail: apgar10@montanadsl.net
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
> fougner, md
> Sent: Friday, June 04, 2004 5:42 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: OB: Cerclage For Short Cervix
>
>>From "The Lancet"
>
> The future of cervical suture
>
> 'The insertion of a Shirodkar suture in women with a short cervix does
> not substantially reduce the risk of early preterm delivery'
>
> Cervical cerclage has been widely used to prevent preterm birth and its
> associated neonatal mortality and morbidity. Meekai To and colleagues
> aimed to test the hypothesis that cervical cerclage in women with a
> short cervix is associated with a three-fold reduction in early preterm
> delivery. Although routine transvaginal sonographic measurement of
> cervical length at 22-24 weeks' gestation identifies a group at high
> risk of early preterm delivery, the investigators conclude that
> insertion of a Shirodkar suture in such women does not substantially
> reduce the risk of prematurity.
>
> Lancet Volume 363, Number 9424 05 June 2004
>
> Cervical cerclage for prevention of preterm delivery in women with short
> cervix: randomised controlled trial
>
> Meekai S To, Zarko Alfirevic, Victoria C F Heath, Simona Cicero, Ana
> Maria Cacho, Paula R Williamson, Kypros H Nicolaides, on behalf of the
> Fetal Medicine Foundation Second Trimester Screening Group*
>
> art
>
> --
> art fougner, md
> ich bin ein New Yorker
>
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