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?

If there is no sign of PTL, most of those with shortened cervical length go home and have weekly or semiweekly u/s scans to monitor the cervix. We do fFN too, so the results of that may factor into the decision to keep a patient or to send her home.

As far as I know there is no reason to keep them in the hospital continuously; they are at risk for preterm birth but not precipitous birth.

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 ones we've kept have been multips w/ shortened cervix. If I can recall correctly (it's been a few months since I took care of this type of issue). Usually it's a constellation of issues - shortened cervix along with some dilatation, doesn't necessarily have to be a lot.

One that I remember vividly was a G4P3 dxed with a shortened cervix at 27 weeks, dilated 2cm. This pregnancy was twins. Membranes intact. She was with us all of 2.5 weeks. One night around midnight she broke her water and from then til delivery she did not last an hour. I'm glad she was with us.

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I myself was admitted for shortened cervix. I had irritable uterus and one night went in because i felt odd (wasn't contracting) but cervix was extremely short (80% effaced) I was only 29weeks. I was then admitted until all steroids were on board. Sent home on strict bedrest with the threat of hospital stay the rest of pregnancy if I was "caught" doing anything but lying down.

(BTW no history of preterm delivery just preterm labor for both kiddos).

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

FFN is only truely accurate if its negative. Positive means nothing.. lol but if you see a positive your likely to have an early delivery just because there was something else usually that indicated that test needing to be done like PTL.

I had a positive at 26w, 29w, and 32w and delivered 1 day before due date so it really means a whole lot of nothin :p

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Specializes in Labor room.

where i work, we have patients admitted for weeks also. the interesting thing about this "condition" is that it varies greatly from one ultrasound to another. we have had patients admitted with cervixes as short as say 1.5cm, and one week later, when they were remeasured the cervix was not really short. how do you deal with this? not only does it increase our length of stay, it causes the patients such great stress , in my opinion this, is more dangerous then the shortened cervix.

is there any evidence about shortned cervixes and treatment options? what about the reimbursment from insurance? do they pay for all those days/weeks/months, or do they stop paying at some time? my guess is the latter.

i think that malpractice has changed everything, and our docs are being forced to admit them rather than follow them closely at home. what an injustice all around!!!:twocents:

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Specializes in Labor and Delivery.

Our hospital recently had a shortened cervix admission of a multip who would not stay in bed at home. She was kept for a few weeks and give steriods and then sent home at 29 weeks. Don't know how insurance handles these things but I have my doubts she was hospitalized if the insuranced did not pay. I know she certainly did not pay out of pocket.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

That alone is a poor criteria for admission. Now if other factors are present, Positive ffn, infection, contractions, bleeding, etc. then it is of course, a different story. We see shortened cervices all the time. We give preterm labor precautions to these patients and watch closely but do not admit them for this alone.

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I know what you are speaking of. I work at state run hospital that is also a teaching facility. We have had a lot of admits due to shortened cervix. I have one now with a CL of 0.6cm and medicaid has denied her stay. Nothing is being done but the usual daily NST's. My doctors are insisting that she must stay until she is 34 wks. I was no the internet tonight trying to find more information on the reasoning behind this. I have not found anything to support the los. I have had one that has been in the hospital over a month. I need something to to defend the stay or to explain to the Doc's why they will not meet criteria.

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Specializes in L&D/Antepartum, Neuro.

This is an epidemic at my hospital. Most stay until 34wks unless they have advanced dilitation then they stay until they deliver. Main reason we have so many is because we're a big city teaching hospital and we aquire many transfers from small rural hospitals with no NICU. Some of our patients live hours away and so they stay and stay and stay...

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That is the same problem we have. How are you getting them to meet criteria? Or how is your facility handling this issue. Medicaid is not approving this for us.

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