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Re: 2 questions From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca) Fri Oct 11 15:32:24 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: Endometrial CA" Previous message: Mark Perloe: "Re: .PGD and translocation" In reply to: Richard Chudacoff, MD: "2 questions" At Thu, 10 Oct 2002, Richard Chudacoff, MD wrote: > >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? > >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. > >-- >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. >********************************************************************** > >********************************************************************** > Richard I think it was reasonable to do the cerclage especially if the previous PROM and loss was associated with silient dilation of cervix, your the one that did the serial exams if you felt there was real change then cerclage was reasonable, unfortunately benificial effect of cerclage is very small. Fibronectin postive is not corelated with high predictive value of going into labor, fibbornectin negative would have been reassuring that chance of prem labor in next 2-3 weeks would have been 1% at most. I don't think fibronectin will turn out to be a very usefull test, patients who present with symptoms of prem labor have vague symptoms, and the gold standard cervical change usually means who have missed the boat. It will be great for the maker of the test as these patients who we use to treat with tocolysis(with no proven benifit long term) will now get serial fibronectin every month. As for the second question, who cares. I guess if you believe strongly in low dose aspirin you could start that, other wise I don't see how it changes my managment, these tests dont't seem to be much better than a positive roll over test. -- Take care, John Next message: Efrain Ramirez: "Re: Endometrial CA" Previous message: Mark Perloe: "Re: .PGD and translocation" In reply to: Richard Chudacoff, MD: "2 questions"

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