Re: Cervical Length
From: DuBose, Terry (DuboseTerryJ@exchange.uams.edu)
Tue Dec 2 21:29:55 1997
Wayne, I am interested in your graph: 501-686-6513
Or if you have it on your computer, just send it as an attachment.
Thanks, Terry J. DuBose
>-----Original Message-----
>
>From: Wayne Persutte [SMTP:wpersutte@brown.uhcolorado.edu]
>Betsy,
>I have been working on nomograms for cervical length measurement
>for approximately two years. I will be presenting these data at the
>Society of Perinatal Obstetricians Meeting in Miami in February 1998. I
>would be happy to send you (or anyone else) a graph showing the 10%
>cervical length for gestational age and the abstract if you would like.
>Let me know your fax #.
> Sincerely,
> Wayne.
>
> Date: Sat, 29 Nov 1997 19:09:45 -0500 (EST)
> To: gjconnolly@juno.com (Janice & George Connolly)
> From: elishyde@connix.com (Betsy Hyde)
>
> >Now, would you care to respond to my question?
> >Janice
> In our practice, the majority of US are done by RDMSs who work part time
> for us. They do all the gyn scans, and the majority of the cervical length
> us, as well as most of the ob stuff. Some of our scans are done by an RN
> with approx 15 years scanning who is in the process of certification. It
> is, of course, appropriate that well-trained practitioners do these scans.
> All our level II scans and doppler flow studies are referred to Yale
> Perinatal Unit.
>
> However, one of the RDMS sonographers in our practice feels that *NO ONE*
> is even qualified to turn on a machine unless they are RDMSs. She has said
> that CNMs should not even sign off the reports because they are not
> sonographers. (IMO this is a bit like saying I shouldn't check labs because
> I am not a medical technologist, and couldn't run an assay for liver
> function tests. She forgets that although I don't do the tests, I know how
> to interpret the results and make a plan for the patient.) And this is why
> your post got my back up a little. I felt like the ultrasound police were
> checking into who I am and what I do! She forgets that she works very
> parttime, and that there are times when I am the only person in the office
> and I need to check presentation in 3rd trimester (particularly when the
> woman is obese and in early labor), or viability in 1st and 2nd trimester
> when she is bleeding/cramping. I need to do these things on the labor floor
> as well. I assume you would allow that folk other than RDMS can tell the
> difference between a head and a butt, and that they can find an FH in the
> 1st trimester. And do BPPs. And measure AFIs excluding pockets with cord.
> This is pretty basic. Although I have picked up 2 fetuses with hydrocephaly
> and one thanatophoric dwarf, I am always quite specific with the woman
> about my skills..."I am not a sonographer, I can tell if you are breech or
> head down. I can tell if the pregnancy is viable. You will need to see one
> of our sonographers for your official scan, but I need to check some things
> right now."
> Do you have problems with this? My colleague does.
>
> When John Hobbins was at Yale, he did a week long course for MDs, CNMs and
> a few RNs who needed to do just these very basic things. It was a *basic*
> course, but taught dating parameters,basic anatomy, presentation,
> placentation, BPP, AFI etc.
>
> Now, back to my original question. There is a wide variety of opinion on
> the definition of incompetent cervix, and the management thereof. There is
> not even a clear cut definition of which cervical length = an incompetent
> cervix in the second trimester. Some people say <3.0 cm, some say <2.5 cm.
> Some factor in funnelling and beaking. Some look at what happens with
> fundal pressure or standing. We have *2* board certified RDMSs doing scans,
> 5 board certified OBs, 1 sonographer in training, refer to a tertiary care
> perinatal unit and there is disagreement. I don't feel that my question was
> unreasonable ...
>
> 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
>
>--
>Wayne H. Persutte, B.S., R.D.M.S.
>Assistant Professor
>Department of Obstetrics and Gynecology
>University of Colorado Health Sciences Center, Denver, CO
><<WPersutte@Brown.UHColorado.Edu>>
>Telephone (303) 372-1026
>FAX (303) 372-1816
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