Re: Fwd: Cervical Length
From: Terry J. DuBose (tjdubose@juno.com)
Mon Dec 1 21:23:10 1997
Janice. Good answer. Thanks for doing the research. Peace, Terry J.
DuBose
On Mon, 01 Dec 1997 19:34:28 EST gjconnolly@juno.com (Janice & George
Connolly) writes:
>On Sat, 29 Nov 1997 19:09:45 -0500 (EST) elishyde@connix.com (Betsy
>Hyde) writes:
>>I still do not have an answer to my original question....if you can
>>define the parameters of abnormal, I would be most grateful.
>>Betsy Hyde CNM
>>Branford, CT
>>
>>Betsy,
>First, to answer your question. From a recent in-service for OG-gyns
>that I attended, given by Dr. Eleanor Diss Sabin, here are exerpts
>from an outline she gave us about her observations from studies and
>research she had done with cervical length.
>
>1. Patients with cervical length over 30mm did not deliver before 36
>weeks.
>2. A cervical length of less than 20mm has positive predictive of
>100%
>
>What is normal?
>
>1. There is bell-shaped curve for cervical length
>2. A wide variation in length until 20 weeks (measurements may
>include lower uterine segment).
>3. A funnel is NOT normal before 32 weeks.
>>
>Who to use cervical ultrasound on for preterm delivery prevention
>
> 1. multiple gestations
> 2. previous history of PROM/PTL
> 3. hx of rapid labors
> 4. cervical surgery
> 5. uterine anamolies/DES
> 6 previa
> 7. polyhydramnios
>
>When to start looking
>
> 1. start at 16 - 38 weeks
>> 2. scan cervix every 1-2 weeks dependent upon degree of suspicion
>
>Who not to treat
>
> 1. cervices that are greater than 30mm in length and don't
>funnel
>
>The bottom line is, that she felt 30mm was the cut-off point.
>
>I asked her about whether it was considered funneling when a tiny
>beaking is noted at the internal os, but the amnion is curved, and she
>said that was a normal appearance
>as the membrane is not bulging into the os at that point.
>
>There is also graph that can be used that depicts percentiles for
>cervical lengths versus gestational age, but there is some controversy
>about its use. Sometimes short cervices are overcalled with it. Some
>doctors like it, some don't.
>
>I hope this has helped.
>
>I would like to see all ultrasound done by registered sonographers for
>many reasons.
>I understand your point that there are times when all you need to know
>is where the
>baby's head is, and it sounds as though you have more training than
>most. I applaud your use of registered sonographers.
>
> But sometimes head position isn't the only thing that's there, and
>that is the difference between sonographers doing a study and others
>doing it for one piece of information. We are always looking a bit
>beyond the obvious...like the lady I did who was term with
>contractions. Just check head position. O.K. The baby was in a
>vertex lie, low, but not low enough. There was failure to progress.
>Hmm, I wonder why. Do a quick transperineal scan--there was a bunch
>of cord not visible transabdominally stuck between the head and the
>os. C-section time!
>
>Janice
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