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Re: Fwd: Cervical LengthFrom: Karen (beez@ivnet.net)Tue Dec 2 10:42:38 1997
Hi Janice and list. thanx for posting this, it looks real good, but can i ask some questions. May I assume these measurements are all by sono. so is there a way to correlate sono measurement to measurements done with fingers. As a midwife, one note i always try to chart on an initial OB exam is the length of the cervix, since lengths vary sooooo...much. now 20 mm is 2cm right? it seems i have noted 2cm before from the beginning and these women have gone to term. I have a hard time with that 100% thing, what was the population she is basing this on? what i worry about is the softening and funneling. now some of these cervices were really wide, and some were very narrow - is that a variable? thank you, karen >>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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