Re: Short Cervix
From: art fougner, md (evsono@pipeline.com)
Sun Oct 13 18:58:36 2002
at this point it seems we can identify folks at high risk - the problem
seems to be what to do about it.
art
At Sun, 13 Oct 2002, Efrain Ramirez wrote:
>
>Same questions - plus - symptoms? other U/S findings?
>
>>At Sun, 13 Oct 2002, Charlie Chambers wrote:
>>
>>Does she have any other deliveries? Any other risk factors?
>>
>>On Sunday, October 13, 2002, at 08:09 AM, Dean Huffman wrote:
>>
>>> What do the members of this list do for a patient who has a short
>>> cervix in the mid trimester, e.g., a cervix less than 25 mm. at 16 - 18
>>> weeks?
>>>
>>> See:
>>>
>>> JAMA 2001 Sep 19;286(11):1340-8, Mid-trimester endovaginal sonography
>>> in women at high risk for spontaneous preterm birth. Owen J, Yost N,
>>> Berghella V, Thom E, Swain M, Dildy GA 3rd, Miodovnik M, Langer O,
>>> Sibai B, McNellis D; National Institute of Child Health and Human
>>> Development, Maternal-Fetal Medicine Units Network.
>>>
>>> CONTEXT: Although shortened cervical length has been consistently
>>> associated with spontaneous preterm birth, it is not known when in
>>> gestation this risk factor becomes apparent.
>>>
>>> OBJECTIVE: To determine whether sonographic cervical findings between
>>> 16 weeks' and 18 weeks 6 days' gestation predict spontaneous preterm
>>> birth and whether serial evaluations up to 23 weeks 6 days' gestation
>>> improve prediction in high-risk women.
>>>
>>> DESIGN, SETTING, AND PARTICIPANTS: Blinded observational study
>>> performed between March 1997 and November 1999 at 9
>>> university-affiliated medical centers in the United States in 183 women
>>> with singleton gestations who previously had experienced a spontaneous
>>> birth before 32 weeks' gestation.
>>>
>>> OBSERVATION: Certified sonologists performed 590 endovaginal
>>> sonographic examinations at 2-week intervals. Cervical length was
>>> measured from the external os to the functional internal os along a
>>> closed endocervical canal. Funneling and dynamic cervical shortening
>>> were also recorded.
>>>
>>> MAIN OUTCOME MEASURE: Spontaneous preterm birth before 35 weeks'
>>> gestation, analyzed by selected cutoff values of cervical length.
>>>
>>> RESULTS: Forty-eight women (26%) experienced spontaneous preterm birth
>>> before 35 weeks' gestation. A cervical length of less than 25 mm at the
>>> initial sonographic examination was associated with a relative risk
>>> (RR) for spontaneous preterm birth of 3.3 (95% confidence interval
>>> [CI], 2.1-5.0; sensitivity = 19%; specificity = 98%; positive
>>> predictive value = 75%). After controlling for cervical length, neither
>>> funneling (P =.24) nor dynamic shortening (P =.054) were significant
>>> independent predictors of spontaneous preterm birth. However, using the
>>> shortest ever observed cervical length on serial evaluations, after any
>>> dynamic shortening, the RR of a cervical length of less than 25 mm for
>>> spontaneous preterm birth increased to 4.5 (95% CI, 2.7-7.6;
>>> sensitivity = 69%; specificity = 80%; positive predictive value = 55%).
>>> Compared with a single cervical measurement at 16 weeks' to 18 weeks 6
>>> days' gestation, serial measurements at up to 23 weeks 6 days
>>> significantly improved the prediction of spontaneous preterm birth in a
>>> receiver operating characteristic curve analysis (P =.03).
>>>
>>> CONCLUSIONS: Cervical length assessed by endovaginal sonography between
>>> 16 weeks' and 18 weeks 6 days' gestation, augmented by serial
>>> evaluations, predicts spontaneous preterm birth before 35 weeks'
>>> gestation in high-risk women.
>>>
>>**************************************************************************
>>**
>>**************************************************************************
>>
>>--
>>**************************************************************************
>>Charlie Chambers
>>**************************************************************************
>>Hood River, OR USA
>>cchamber@alumni.rice.edu
>>
>>"...not because I regard fishing as being so terribly
>>important but because I suspect that so many of the other
>>concerns of men are equally unimportant-and not nearly
>>so much fun."
>> John Voelker
>>**************************************************************************
>>***
>>**************************************************************************
>>**************************************************************************
>>
>--
>"Life is neither the notes nor the silence between the notes, but the music that
> arises out of sound and silence felt as a living whole. Stop choosing...between
> chaos and order, and live at the boundary between them, where rest and action
> move together..." David Whyte
>
--
art fougner, md
ich bin ein New Yorker
