OB-GYN-L Messages for December, 1995: Re: Prognosis of Ultrasonically

Re: Prognosis of Ultrasonically

From:

Terrence.Jones@ncal.kaiperm.org

Thu Dec 21 00:21:01 1995

Can't help with the first few questions, will try tackling the last, regarding the use of the terminology: funneling.

Not sure who coined the particular term, but the concept is clear enuf. Just have a look at the bottom half of your state, on the trailer to your e-mail. Now - let's say Austin is the internal os...

Some might refer to it as beaking, or tapering. Since you're writing the textbooks, I suppose accuracy and consistency is a priority. Here, on the range, we all kinda' know what it is our sono colleagues are describing. They are kind enuf to quantify, and careful to consider bladder fullness. I'm doubtful you REALLY need references, but here goes. Might start with Hertzberg, Radiology 9/95 (vol 196:721-4), for specific quantification (length X width...) as well as up to date ref source. Descriptions go so far as to include TERM pts undergoing induction (AJOG 10/94, vol 171: 1081-7 {co-author Timor-Tritsch}) - showing reduced latent phase and delivery interval with funneling. Dr Nzeh gives a pointed :) description of these findings with specific ref to incompetent cervix in mid-trimester (Int J Gynaecol Obstet 3/92, vol 37:179-84) - evaluating mean int os measurement in pts with incompetent cx compared with term controls. Drs Romero & Guzman have digitalized and quantum mechanized the description (AJOG 10/94, vol 171: 956-64) - introducing the term: "cervical index" = funnel length + 1, divided by the (remaining) cervical canal length: (FL + 1)/CL. There are diagrams, nice colorful sono pictures of various funnel shapes, the patented Romero ROCC's (receiver-operator characteristic curves), and I find the statistical analysis particularly useful during those sleepless nights...

I'd just like to step back (whoops, careful) and see the process on a more molecular level. Collagen fibers keep the membranes intact, the cervical stroma firm. Fibronectin (fetal tissue FN) helps keep the membranes tightly bound to the decidua. If interleukin-6 (generated from Il-1 released by tissue macrophages in response to some nasty microbe), or tissue plasminogen activator (activated by decidual thrombin receptors in response to decidual hemorrhage {translation - abruption}, or CRH (cortico-tropin releasing hormone, or if you'd prefer - angiogenin), (released in a pos feed-back response to fetal ischemia/stress &/or maternal stress) is degrading FFN and collagen by activating metalloproteinases (interstitial collagenase); then stitching the cervix shut is unlikely to be helpful. Each of us has different prevalence patterns of the above variables, and controlling for them would be no easy task with current technology - making comparisons of outcome difficult to extrapolate to our pt populations. Now, for that small number of pts who have de novo (heritable), or post-traumatic cervical fibrillar protein deficiency, a li'l help from ol' McDonald jus mite help - if not this time 'round, maybe next time. Here, at our facility, the patient decides.

Would love to stay and talk epistomology, and semantics some more, but I've got angels on this pinhead I've gotta count! Terry.

PS Speaking of pinheads, what-say we start paying our legislators peanuts - the MOLDY kind. A bit o' hepatic encephalopathy might just improve their mentation, and help prevent perpetuation of the species (I hear aflatoxin's toxic to sperm in RATS -- see Ibeh, Int J Fertil Menopausal Stud., Jul-Aug 1994, vol 32: 208-14). Mmmmmm, maybe I'll read the Pelican Brief... :)tj. --------------------------( Forwarded letter 1 follows )---------------------

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