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Diagnostic Techniques for Pre-Term Labor Ch 13

Diagnostic Techniques for Pre-Term Labor Ch 13. 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study. Diagnosis of PTL. Objectives - Understand the diagnostic techniques for PTL Definition Cervical Length FFN. Definition. Between 20 and 37 weeks EGA

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Diagnostic Techniques for Pre-Term Labor Ch 13

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  1. Diagnostic Techniques for Pre-Term LaborCh 13 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  2. Diagnosis of PTL • Objectives - Understand the diagnostic techniques for PTL • Definition • Cervical Length • FFN USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  3. Definition • Between 20 and 37 weeks EGA • Documented uterine contractions (4 per 20 minutes or 8 per 60 minutes) • Documented cervical change USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  4. Normal Cervical Length Bladder Cervix Intrauterine http://www.scielo.br/img/revistas/bjmbr/v37n5/4786i02peq.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  5. Cervical Length Normal Cx Length No Funneling • Measure length of cervix using trans-vaginal ultrasound • Greater than 2.5 to 3 cm is considered normal (references differ) Best PPV if use 3 cm as cutoff. www.Mdconsult.com USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  6. Shortened Cervix 9mm is not normal for CL • Less than 2 cm with high PPV for PTL • Can be affected by bladder (full vs. empty), want empty • Change vs. stability over time - if 2.5 cm but no change, may not be PTL http://www.studiolift.com/fetal/site/Short%20cervix.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  7. Funneling and PTL Funneling present • Funneling • Present when patient valsalva’s or with fundal pressure by sonographer • Residual length is important https://vss121.viux.com/iame_com/learning/cervlength/figure7.jpg USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  8. Fetal Fibronectin (FFN) Posterior Fornix FFN is presesnt when cervix starts to change. No gel on speculum • Very good NPV (Neg test result consistent with no delivery within 7 days) PPV not as good (can be false positive) • Blood can give false positive. If speculum, cervical exam, intercourse (anything in vagina) in past 24 hours, can give false results, so cannot be done in those circumstances. http://www.laboratoryalliance.com USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

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