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Cervical Cerclage in the Prevention of Spontaneous Preterm Birth in Twin Gestations: A Case Control Study
S70
Ultrasound in Medicine and Biology
There is an explosion of new sonographic applications for airway management in critically ill children and adults. We will review these cutting edge applications for the emergency physician, intensivist, anesthesiologist, and neonatologist. The session includes an orientation to the sonographic appearance of important airway structures, as well as an up-to-date literature summary and practical ‘‘how-to’’ approach for bedside ultrasound in airway management. We will discuss prediction of difficult intubation and appropriate endotracheal tube size, evaluation of stomach contents, confirmation of correct endotracheal tube placement, ultrasound guidance for surgical airways and airway nerve blocks, prediction of failed non-invasive ventilation in neonatal respiratory distress syndrome, assessment of laryngeal edema, and pre-extubation diaphram measurements. Images and videos will help illustrate these techniques and findings. We will describe a simple and inexpensive airway ultrasound phantom model, as well as future research directions in this exciting new area.
New Ultrasound Applications in Soft Tissue Lesions: From Skin to Muscle
Volume 41, Number 4S, 2015
increased risk for delivery ,35 weeks’ gestation (75% vs 36%, RR, 2.15; 95%CI, 1.15-4.01). In this session we will be presenting a retrospective case controlled study to evaluate if cervical cerclage reduces the rate of SPTB in dichorionic diamniotic (DCDA) twins. The study occurred in two institutions where both performed cervical length (CL) screening. One institution considered cerclage placement for cervical length ,25 mm and the other did not. Forty cases treated with cerclage were matched with 40 controls for CL and gestational age at cerclage/scan (62 weeks). The patients were also matched for maternal age, race, BMI, smoking, use of IVF and parity. In the cervical cerclage group, the median CL was 12 mm (range 5 to 23) at a median of 21.9 weeks’ gestation (range 16.1 to 24.9). In the control group, the median CL was 12 mm (range 5 to 24) at a median of 22.9 weeks’ gestation (range 16.6 to 24.9). The results show that SPTB ,32 weeks’ gestation was less frequent in the cervical cerclage versus control group (20.0% vs. 50.0%; relative risk, 0.40; 95% confidence interval [CI], 0.20 to 0.80). The gestational age at birth, and birth weights of twin A and B, were significantly greater in the cerclage group (p,0.0001 for all). In DCDA twins with a short cervix, treatment with cervical cerclage significantly reduces the rate of SPTB. The findings recommend an adequate RCT on cerclage in twins with a short cervix.
Moderator: Levon Nazarian, MD Diagnostic Dilemna: Soft Tissue Hematoma vs. Sarcoma Jason Wagner Oklahoma University Health Science Center, Oklahoma, Oklahoma, United States
Ultrasound in Global Health Lecture Series: Part 2 Moderator: Megan Leo, MD, RDMS
Ultrasound is commonly used to evaluate soft tissue masses and fluid collections. This presentation will explore the use of ultrasound in characterization and diagnosis of masses and collections with emphasis on the difficult differentiation between hematoma and sarcoma.
Temas y Controversias en el Ultrasonido Obstetrico (In Spanish) Moderator: Luis Izquierdo, MD, MBA, CPE Cervical Cerclage in the Prevention of Spontaneous Preterm Birth in Twin Gestations: A Case Control Study Edwin Raphael Guzman Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States There is a worldwide movement in identifying treatment modalities for the prevention of spontaneous preterm birth (SPTB) in twin gestations. A meta-analysis on the use of cerclage for short cervix in 49 sets of twins revealed a significantly
Global Health Ultrasound Research: How-to Insights From the Best Studies of 2014 David Mackenzie1,2 1Emergency Medicine, Maine Medical Center, Portland, Maine, United States; 2 Emergency Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States Ultrasound is a powerful diagnostic modality in resource-limited settings, and a growing body of literature supports its use in low- and middle-income countries. Further investment from key stakeholders to develop and fund ultrasound programs may be contingent on strengthening the quality and depth of evidence for the use of ultrasound in global health. More research is also needed to guide educational initiatives and program development, and to evaluate clinical effectiveness. This session will provide an overview of the most significant ultrasound studies in low resource settings reported during the past year. These projects will be used to illustrate effective approaches to planning and conducting ultrasound research in global health. Review of the studies will also provide the opportunity to discuss key logistic and ethical challenges to developing an ultrasound research project in a resource-limited environment.
Ultrasound in Medicine and Biology
There is an explosion of new sonographic applications for airway management in critically ill children and adults. We will review these cutting edge applications for the emergency physician, intensivist, anesthesiologist, and neonatologist. The session includes an orientation to the sonographic appearance of important airway structures, as well as an up-to-date literature summary and practical ‘‘how-to’’ approach for bedside ultrasound in airway management. We will discuss prediction of difficult intubation and appropriate endotracheal tube size, evaluation of stomach contents, confirmation of correct endotracheal tube placement, ultrasound guidance for surgical airways and airway nerve blocks, prediction of failed non-invasive ventilation in neonatal respiratory distress syndrome, assessment of laryngeal edema, and pre-extubation diaphram measurements. Images and videos will help illustrate these techniques and findings. We will describe a simple and inexpensive airway ultrasound phantom model, as well as future research directions in this exciting new area.
New Ultrasound Applications in Soft Tissue Lesions: From Skin to Muscle
Volume 41, Number 4S, 2015
increased risk for delivery ,35 weeks’ gestation (75% vs 36%, RR, 2.15; 95%CI, 1.15-4.01). In this session we will be presenting a retrospective case controlled study to evaluate if cervical cerclage reduces the rate of SPTB in dichorionic diamniotic (DCDA) twins. The study occurred in two institutions where both performed cervical length (CL) screening. One institution considered cerclage placement for cervical length ,25 mm and the other did not. Forty cases treated with cerclage were matched with 40 controls for CL and gestational age at cerclage/scan (62 weeks). The patients were also matched for maternal age, race, BMI, smoking, use of IVF and parity. In the cervical cerclage group, the median CL was 12 mm (range 5 to 23) at a median of 21.9 weeks’ gestation (range 16.1 to 24.9). In the control group, the median CL was 12 mm (range 5 to 24) at a median of 22.9 weeks’ gestation (range 16.6 to 24.9). The results show that SPTB ,32 weeks’ gestation was less frequent in the cervical cerclage versus control group (20.0% vs. 50.0%; relative risk, 0.40; 95% confidence interval [CI], 0.20 to 0.80). The gestational age at birth, and birth weights of twin A and B, were significantly greater in the cerclage group (p,0.0001 for all). In DCDA twins with a short cervix, treatment with cervical cerclage significantly reduces the rate of SPTB. The findings recommend an adequate RCT on cerclage in twins with a short cervix.
Moderator: Levon Nazarian, MD Diagnostic Dilemna: Soft Tissue Hematoma vs. Sarcoma Jason Wagner Oklahoma University Health Science Center, Oklahoma, Oklahoma, United States
Ultrasound in Global Health Lecture Series: Part 2 Moderator: Megan Leo, MD, RDMS
Ultrasound is commonly used to evaluate soft tissue masses and fluid collections. This presentation will explore the use of ultrasound in characterization and diagnosis of masses and collections with emphasis on the difficult differentiation between hematoma and sarcoma.
Temas y Controversias en el Ultrasonido Obstetrico (In Spanish) Moderator: Luis Izquierdo, MD, MBA, CPE Cervical Cerclage in the Prevention of Spontaneous Preterm Birth in Twin Gestations: A Case Control Study Edwin Raphael Guzman Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States There is a worldwide movement in identifying treatment modalities for the prevention of spontaneous preterm birth (SPTB) in twin gestations. A meta-analysis on the use of cerclage for short cervix in 49 sets of twins revealed a significantly
Global Health Ultrasound Research: How-to Insights From the Best Studies of 2014 David Mackenzie1,2 1Emergency Medicine, Maine Medical Center, Portland, Maine, United States; 2 Emergency Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States Ultrasound is a powerful diagnostic modality in resource-limited settings, and a growing body of literature supports its use in low- and middle-income countries. Further investment from key stakeholders to develop and fund ultrasound programs may be contingent on strengthening the quality and depth of evidence for the use of ultrasound in global health. More research is also needed to guide educational initiatives and program development, and to evaluate clinical effectiveness. This session will provide an overview of the most significant ultrasound studies in low resource settings reported during the past year. These projects will be used to illustrate effective approaches to planning and conducting ultrasound research in global health. Review of the studies will also provide the opportunity to discuss key logistic and ethical challenges to developing an ultrasound research project in a resource-limited environment.