Measurement of cervical length: Comparison between vaginal ultrasonography and digital examination

Department of Obstetrics and Gynecology, Ohio State University, Columbus.
Obstetrics and Gynecology (Impact Factor: 5.18). 09/1990; 76(2):172-5.
Source: PubMed


Evaluation of the gravid cervix uteri is an important part of prenatal care, especially in the patient at risk for preterm birth. Seeking a method of cervical length measurement that could be used easily regardless of patient habitus, location of the cervix, and gestational age, we used a vaginal probe with a 240 degrees scanning angle in gravidas at various gestational ages to test the theoretical advantages of the wide scanning angle. Among the first 201 examinations, cervical length was measured successfully in 99.5% of cases. This success rate compares favorably with those of abdominal sonography and vaginal sonography using the standard 90 degrees scanning angle sector probes. We also compared this method with digital examination in a double-blind fashion. Only a fair degree of association between sonographic cervical measurements and measurements obtained by digital examination was found, reflected in a correlation coefficient of 0.49.

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    • "In addition, three review papers [23, 25, 26] and one cohort study [22] stated that transvaginal cervical length measurement was acceptable for patients. Three of these articles referred to questionnaire surveys that had assessed the acceptability of transvaginal ultrasound in the first or second trimester of pregnancy [9, 10, 13, 29]. In contrast, one qualitative review noted patients’ reticence to have transvaginal ultrasound performed, but did not provide further details [21]. "
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    ABSTRACT: Transvaginal cervical length measurement in women with symptoms of preterm labor has been used to decide if treatment is necessary. Cervical length measurement may also have additional effects on patients, such as providing reassurance, although the evidence to support this is unclear. We explored and summarized to what extent additional effects of cervical length measurement in women with threatened preterm labor have been reported in the clinical literature and what the magnitude of these effects was. We performed a systematic review of the literature to identify articles reporting on cervical length measurements in women with symptoms of preterm labor. We assessed whether these articles reported patient outcomes other than preterm delivery. The electronic and hand search resulted in 764 articles, of which 172 met initial criteria for further eligibility assessment. We found 12 articles that reported additional effects of cervical length measurement in symptomatic women, such as the reassurance or the sensory consequences related to the transvaginal procedure. None of the articles quantified such additional effects. There appears to be a gap between the presumed effects of cervical length measurement on patient outcomes, such as patients' reassurance, and the actual assessment of these effects during test evaluations. We suggest that future evaluations of prognostic preterm labor tests include a comprehensive assessment of patient outcomes.
    Archives of Gynecology 04/2011; 284(3):521-6. DOI:10.1007/s00404-011-1892-z · 1.36 Impact Factor
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    • "All the scoring systems currently used to quantify the risk of preterm delivery based on maternal anamnesis and clinical assessment (digital examination) are unreliable and unable to identify more than 70% of preterm births (Goldenberg et al. 1998, Reis et al. 2002). The digital examination of the uterine cervix in pregnancy is based on subjective parameters, included in the Bishop scoring system, that are known to underestimate the real cervical length (Sonek et al. 1990). In fact, cervical digital examination does not allow the early recognition of the initial modifications that involve the internal cervical os and the uterine canal. "
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    ABSTRACT: This study sought to determine whether 3-D transvaginal ultrasound (3D-TVS), compared with the 2-D transvaginal approach (2D-TVS), offers a better identification of some specific features of the uterine cervix that could be useful in the prediction of spontaneous preterm delivery (PTD). A total of 103 women with singleton pregnancies were prospectively evaluated with 2D-TVS and 3D-TVS in the second or third trimester of pregnancy. Statistical analysis was performed with Wilcoxon matched-pairs test, chi2 and Pearson test (p<0.05 was considered significant) and receiver operating characteristic (ROC) curve analysis. Significant differences between these approaches were found for cervical length (p<0.001). A significant correlation was identified between 3D-TVS cervical length and the interval between ultrasound examination and delivery as well as the gestational age at delivery (both p<0.001). ROC curve identified a threshold for 3D-TVS cervical length of 35 mm as an optimal predictor of PTD in the second trimester (sensitivity 100%, specificity 88%). 3D-TVS evaluation of the cervix in pregnancy seems to be an effective, noninvasive method for predicting PTD risk.
    Ultrasound in Medicine & Biology 09/2003; 29(9):1261-5. DOI:10.1016/S0301-5629(03)01011-1 · 2.21 Impact Factor
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