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.
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ABSTRACT: To assess the diagnostic performance of transabdominal sonographic measurement of cervical length in identifying patients with a short cervix. Cervical length was measured in 220 pregnant women using transabdominal and transvaginal ultrasound (US). Reproducibility and agreement between and within both methods were assessed. The diagnostic accuracy of transabdominal US for identifying cases with a cervical length <25 mm was evaluated. Twenty-one out of 220 cases (9.5%) had a cervical length <25 mm by transvaginal US. Only 43% (n = 9) of patients with a short cervix were correctly identified by transabdominal US. In patients with a cervical length of <25 mm by transvaginal US, transabdominal measurement of the cervix overestimated this parameter by an average of 8 mm (95% LOAs, -26.4 to 10.5 mm). Among women without a short cervix, transabdominal US underestimated cervical length on average (LOA) by 1.1 mm (95% LOAs, -11.0 to 13.2 mm). Transvaginal US was also more reproducible (intraclass correlation coefficient: (ICC) (0.96; 95% CI, 0.94 to 0.97) based on comparisons between 2D images and immediately acquired 3D volume datasets relative to transabdominal US (ICC: 0.71; 95% CI, 0.57 to 0.84). Transvaginal US detected 13 cases with funneling and six cases with sludge whereas only three cases of funneling and one of sludge were detected by transabdominal US. Transabdominal measurement overestimated cervical LOA by 8 mm among women with a short cervix and resulted in the underdiagnosis of 57% of cases.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 01/2012; 25(9):1682-9. · 1.36 Impact Factor
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ABSTRACT: PURPOSE: To predict the success of labor induction by sonographic cervical measurements, maternal/obstetrical factors, and the Bishop's score. METHODS: Between February 2008 and February 2010, 190 consecutive pregnant women underwent clinical examination to assess the Bishop's score and transvaginal sonographic cervical measurements (cervical length, fetal head stage, and cervical dilatation) before labor induction. The following outcomes were analyzed: overall vaginal delivery and vaginal delivery up to 24 hours after labor induction. RESULTS: Overall vaginal delivery occurred in 133 (70.0%) patients and vaginal delivery 24 hours after labor induction happened in 119 (62.6%) patients. The sonographic cervical measurements were significantly associated with all outcomes (p < 0.01). The areas under the ROC curve (AUC) of all ultrasound cervical parameters to predict the two events were 68.9% and 72.0% (cervical length); 71.6% and 73.6% (fetal head stage); and 72.0% and 73.4% (cervical dilatation). Mathematical equations were obtained to calculate the probability for each event considering the sonographic cervical measurements in association with clinical factors after regression analysis, which increased the AUC for both events (80.1% and 79.3%). CONCLUSIONS: Transvaginal sonographic cervical measurements can predict the successful labor induction, especially when associated to clinical analysis (Bishop's score). © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012.Journal of Clinical Ultrasound 04/2012; · 0.70 Impact Factor
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ABSTRACT: Transvaginal sonography of the cervix has emerged as a useful window into preterm parturition. Cervical sonography allows measurements of cervical length (CL), which can aid clinicians in identifying women at risk for preterm birth. The use of transvaginal assessments of CL can assist in the triage of patients with possible preterm labor. Recent studies also support the use of CL measurements as a means of determining appropriate candidates for cerclage placement and progesterone supplementation to reduce the risk of premature birth, further highlighting the importance of this modality in modern obstetric management.Clinical obstetrics and gynecology 03/2012; 55(1):324-35. · 2.06 Impact Factor