Re: Cervical length/OPD management
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Feb 7 08:10:57 2006
I sure like them if the patient's cervix is long (35 mm or more) and she
is undilated clincially!
Garry
Ef's case is a tough one; I would probably keep her in a few days "just
because" and then consider discharge. Tocolytics? Who know?
At Mon, 6 Feb 2006, Henry Gregor wrote:
>
>Fellow listers,
>
> What thoughts have you on sonographic cervical lenght assessments?
>
> I've been to courses and have read pubs wherein some "gurus" dicscuss the utility of such measurements in managing PTL or at risk for PTL patients. Others have downplayed their usefulness...most impressively done on a few occasions with photos of patients exhibiting significantly changing cervical lenghts when followed serially over time, be it one or two hours or one or two days.
>
> The one thing the speakers seemed to have uniformly in common, was a pattern of being on the speakers' lists at some pretty posh locations, in hotels with pretty obscenely priced "special conference rates", lol.
>
> Hank
>
>"S Osterling M.D." <sdoesterling-obgyndotnet@yahoo.com> wrote:
> It's always hard to manage the preterm labor patient.
>The diagnosis has gotten blurry with fetal fibronectin and cervical
>ultrasound. Just wait until proteomics hits clinical practice! Its
>also very easy to play Monday morning quarterback with these ladies.
>
>After that disclaimer-
>
>The patient has a 1.5 cm cervix that is closed and a +FFN in a preterm
>case. No previous pregnancy history to guide us. I will also assume
>no documented cervical change.
>
>I would have to go on contractions. I would give her mag sulfate
>(being careful not to use any unapproved abbreviations) until she has
>completed her course of steriods.
>
>I'd wean her to nothing after that and carefully try to correlate her
>reported contraction with any cervical change. If I can document
>contractions on the toco and she can feel them, I'd try oral nifedipine
>20 mg q 6 and bump to q 4 as needed. 48 hrs of indocin may also help.
>
>I'd try to send her home two days after her mag was turned off. I
>usually tell my PTL patients that if everything goes perfectly, they'll
>be in house for 5 days - longer if they don't respond.
>
>If I send them home, they go on bed rest with bathroom privileges until
>34 weeks.
>
>On Feb 6, 2006, at 8:00 PM, Efrain Ramirez wrote:
>
>> No dilation - soft, anterior....
>>
>> Ef
>>
>>> At Mon, 6 Feb 2006, S Osterling M.D. wrote:
>>>
>>> There is a role for outpatient management.
>>>
>>> How far dilated is she?
>>>
>>> On Feb 6, 2006, at 4:52 AM, Efrain Ramirez wrote:
>>>
>>>> 30 y/o- GI - found to have a cx length of 1.5 cms around 28 weeks -
>>>> positive fibronectin (blind method 30 secs. in vagina) hospitalized
>>>> -
>>>> on tocolytics, corticosteroids, stable, no contractions (at least on
>>>> EFM) - is there place for OPD management?
>>>>
>>>> Ef
>>>>
>>>> --
>>>> “ The greatest obstacle to knowledge is not ignorance,
>>>> it is the illusion of knowledge.” Daniel J. Boorstin - Historian
>>>>
>>> S. Osterling M.D.
>>> California
>>
>> --
>> “ The greatest obstacle to knowledge is not ignorance,
>> it is the illusion of knowledge.” Daniel J. Boorstin - Historian
>>
>S. Osterling M.D.
>California
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
