Re: Cervical Length
From: Annette Knobloch (abdk@cajunnet.com)
Wed Dec 3 06:40:26 1997
I would like copy of your graph and abstract also. Thanks
DuBose, Terry wrote:
> 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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