shortened cervix and length of stay

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Hi

We are noticing an increase in the amount of patients that have shortened cerivx as their admitting diagnosis. These patients are being admitted on to the antepartum unit and stay usually until they are 34 wks or deliver.

What is your LOS for this diagnosis? Are your case managers using and clinical care guidelines, such as Millimans to benchmark los?

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Shortened cervix as a diagnosis?? Are these pts. ones who previously had a preterm delivery? Noncompliant pts. that the docs want watched? I personally haven't heard that one yet, but it sounds a bit fishy to me...

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Specializes in Maternal - Child Health.

I've never seen this as an admitting diagnosis either.

I had problems with PTL in my first pregnancy, on bedrest, meds and home monitoring from 26 weeks on, with a number of hospital stays for increasing contractions that were treated with MgSO4.

Early in my second pregnancy, I had an U/S to measure cervical length, and found it was only 1cm, so I was essentially 75% effaced in the first trimester. My docs continued to monitor cervical length as I went into PTL at 23 weeks, but my admissions were always for contractions, not due to shortened cervix.

What care and monitoring do you provide for these patients, especially if they are not contracting?

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I have seen this many times as an admitting diagnosis. Its the new way the docs are assessing the risk of preterm delivery and preterm labor. I think there is thinking that PTL and incompetent cervix are somehow related. We had a pt admitted recently with cervical length of 0.5 cm (should be 4 cm), Was transferred to antepartum side after Mag sulfate therapy was completed, started laboring about 3 hours later and went to 10cm almost immediately it seemed. 25-27 weeks.

We also had a pt once that was with us for weeks on Mag for PTL, she broke threw at 33 weeks and delivered. Her next pregnancy 1 year later, doc did a cerclage at 15 weeks and she carried to term. Interesting stuff!

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I, too had a cerclage placed about the 15th wk of my pregnancy, but it was for cervical dilatation, not shortening. Does anyone else out there use the fetal fibronectin test for possible PTL threats? We have started using it-too early for me to evaluate...

Connie

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Specializes in Community, OB, Nursery.

We use FFN but it's infrequent. The times I've seen it it's been pretty accurate.

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Specializes in Maternal - Child Health.
I, too had a cerclage placed about the 15th wk of my pregnancy, but it was for cervical dilatation, not shortening. Does anyone else out there use the fetal fibronectin test for possible PTL threats? We have started using it-too early for me to evaluate...

Connie

Is there any evidence that cerclage is effective in preventing or stopping shortening of the cervix? I thought it was effective for dilation only.

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Specializes in Community, OB, Nursery.

We've never used for shortening - only early dilatation.

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Is there any evidence that cerclage is effective in preventing or stopping shortening of the cervix? I thought it was effective for dilation only.

A shortened cervix, diagnosed by translady partsl u/s, is treated with Indocin therapy which has been shown to "reconstitute" the cervix. The issue of a short cervix becomes less critical as the pregnancy progresses- by 34 weeks, it's pretty irrelevant. I have never heard of a shortened cervix being treated by cerclage.

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But are you seeing that your mds are admitting these patients and keeping them in house until the 34 wk gestation?

Our docs are not even trialing bedrest at home and my length of stay is through the roof.

Any ideas?

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Specializes in Community, OB, Nursery.

The people I've had w/ shortened cervix have stayed til they delivered. Most did not make it to 34 weeks.

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Specializes in Maternal - Child Health.

Elvish, are they contracting as well, or dilated with hourglass membranes?

I just can't wrap my head around keeping otherwise stable patients hospitalized solely for shortened cervix.

BTW, my shortened cervix was diagnosed in the first trimester. I was told at that point to limit my activity as much as possible. (I wasn't working at the time, but was home with a 2 year old.) I went into PTL at 23 weeks, failed Indocin due to dangerously low fluid levels, and made it to 36 weeks, primarily treated with a terbutaline pump, with a number of MgSO4 admissions.

Whew! I'm glad I didn't try that again!

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