Measurement of cervical length in pregnancy: comparison between vaginal ultrasonography and digital examination.
ABSTRACT 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.
- SourceAvailable from: informahealthcare.com[Show abstract] [Hide abstract]
ABSTRACT: The risk of early birth increases markedly with decreasing cervical length (CL) in both singleton and multiple pregnancies. Transvaginal ultrasound of CL can be useful in determining women that are at risk of preterm delivery and may be helpful in preventing unnecessary intervention. Appropriate technique is essential for correct results. Factors that affect the value of CL in the prediction of spontaneous preterm delivery include gestational age, patient obstetrical and medical history, symptoms and the number of fetuses. The value of CL consists of identifying high-risk women for therapeutic strategies, to reduce the rate of spontaneous preterm birth, such as progestogens, cervical cerclage and more recently, cervical pessary. Progestogens and cervical cerclage are more effective in gestations with prior preterm birth.Expert Review of Obstetrics & Gynecology 01/2014; 8(4).
- [Show abstract] [Hide abstract]
ABSTRACT: Our objective was to determine the relationship between the Pelvic Organ Prolapse Quantification (POP-Q) examination for determining cervical length (CL) and CL at hysterectomy. Secondary objectives were to define cervical elongation using both measures in a urogynecologic population, determine the relationship between POP-Q estimate and CL on ultrasound (US) and examine the interobserver reliability of each mode of measurement. This was a prospective cohort study of women scheduled for hysterectomy at the Los Angeles County + University of Southern California (LAC + USC) medical center. CLs were measured by POP-Q and at the time of hysterectomy. Transvaginal US CLs were determined when available. Exam CL (eCL) was compared with anatomic (aCL) and US (uCL) CL. Repeat measures of eCL, uCL, and aCL were all compared for interobserver reliability. The study enrolled 151 women. Median eCL was 3.0 cm (0.5-9.0) (n = 149); average uCL was 2.3 cm ± 0.7 (n = 108), average aCL 2.8 cm ± 1.1 (n = 87); eCL correlated fairly with aCL (r = 0.3, p = 0.005, n = 88) but poorly with uCL (r = -0.13, p = 0.18, n = 105); uCL correlated poorly with aCL (r = 0.19, p = 0.14, n = 64). Interobserver reliability for eCL and aCL were good to excellent (eCL α=0.881; aCL α=0.889) but for uCL adequate (α=0.699). The 97.5 percentile cutoff for aCL was 5.0 cm and for eCL 8.0 cm. The POP-Q examination estimate of CL correlates fairly with aCL at the time of hysterectomy; uCL does not appear to correlate with aCL or eCL. Cervical elongation may be defined as an anatomic length of 5.0 cm or a POP-Q estimate of 8.0 cm.International Urogynecology Journal 10/2013; · 2.17 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Tocolysis is an important treatment in the improvement of outcome in preterm labor and preterm birth, provided that its use follows clear evidence-based recommendations. In this expert opinion, the most recent evidence about efficacy and side effects of different tocolytics is being reviewed and evidence-based recommendation about diagnosis and treatment of preterm labor is given. Further aspects such as progesterone administration or antibiotic treatment for the prevention of preterm birth are included. Our review demonstrates that an individualized choice of different tocolytics and additional treatments is necessary to improve short- and long-term neonatal outcome in preterm labor and preterm birth.Archives of Gynecology 01/2014; · 0.91 Impact Factor