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Re: 2 questionsFrom: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)Thu Oct 10 11:06:39 2002
-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Thursday, October 10, 2002 9:53 AM To: Multiple recipients of list OB-GYN-L Subject: 2 questions 28 YO G2P0, with an 18 week loss secondary to PROM less than one year ago returned to my office at 22 weeks estimated gestational age. Her prenatal examination noted a slightly dilated external OS, and that weekend she had been tinged vaginal discharge. I reexamined her and her external OS seemed slightly more dilated, and therefore I put a cervical cerclage in her two days ago. Part of her preoperative evaluation I got a fetal fibronectin so I could have a baseline. Wouldn't you know it, but it came back positive. I have her on Indocin for 48 hours postop, but now what do I do? [Lynn D. Montgomery, M.D.] Rich, the FFN will be positive when there is cervical change already. You really don't need the FFN when the cervix is telling you the whole story already. Further, there is really no data that I am aware of on FFN results following a cerclage placement-my guess is that the cerclage would also contribute to positivity. This is actually a good case where cervical measurements may have been helpful beginning at 16-18 weeks. If you had seen a dynamic shortening, intervention may have occurred sooner. I think you have done the right thing and now it is up to the stitch. Second question: have you heard of this, and is anybody doing this in Houston? Tolerance-hyperbaric test (THT) that finds gestational hypertension and preeclampsia 23 weeks earlier than would be suspected clinically. [Lynn D. Montgomery, M.D.] Can't speak for Houston, but nobody is doing it in Montana. Lynn Richard Chudacoff, MD, FACOG Chudacoff Obstetrics & Gynecology, PLLC 15200 Southwest Freeway, #270 Sugar Land, TX 77478 Tel: 281-277-3900 Fax: 281-277-3901 rchudacoff@mylinuxisp.com Richard.Chudacoff@obgyn.net http://www.mdhub.com/281-277-3900 http://www.chudacoffobgyn.yourmd.com ********************************************************************** Neither the confidentiality nor the integrity of this message can be guaranteed following transmission on the Internet. ********************************************************************** --
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