Re: Short Cervix
From: Charlie Chambers (cchamber@gorge.net)
Sun Oct 13 23:10:57 2002
if no prior pregnancies, nothing.
On Sunday, October 13, 2002, at 07:21 PM, Dean Huffman wrote:
> .
>
>
> Again, this is a general question, not a specific question for a
> specific patient. For the sake of argument, however, assume that the
> cervix is 1.5 cm. (15 mm.) at 18 weeks, otherwise completely normal
> ultrasound, singleton pregnancy, no symptoms, although the patient
> admits that she "might" be feeling very slight pelvic pressure.
>
> Same question, different patient, 24 weeks, 8 mm cervix, no funneling,
> normal ultrasound.
>
>
>
> What would you do, if anything. Cerclage? Bed rest? Stopping work?
> Tocolytics? Nothing?
>
> What if there were funneling, or feeling of pelvic pressure/fullness?
>
>
>
> - - - -
>
> At 02:48 PM 10/13/2002 -0500, you 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
>
>
>
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=
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--
Charlie Chambers
Hood River, OR USA
cchamber@alumni.rice.edu
"All good things...come by grace,
and grace comes by art,
and art does not come easy."
Norman Maclean
=
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