Objective cervical portio length measurements: consistency and efficacy of screening for a short cervix.
ABSTRACT To determine the consistency of 4-quadrant cervical portio length measurements with an objective cervical measuring device and to identify patients who may benefit from transvaginal ultrasound.
Prenatal patients (12-34 weeks) derwent 4-quadrant cervical portio measurements and transvaginal ultrasound by different, blinded examiners. Cervical portio quadrant measures were analyzed by correlation analysis, and the predictive ability of cervical portio length measurements to identify short cervices with transvaginal ultrasound was assessed.
The right and left lateral cervical portio measurements were consistently available and correlated highly with each other. Cervical portio length had excellent sensitivity (88%), specificity (92%) and negative predictive value (99%) in identifying patients with a short cervix (< 30 mm) by transvaginal ultrasound.
Right and left lateral cervical portio length measurements are highly consistent and provide an effective screen for patients with short cervixes who may benefit from transvaginal ultrasound.
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ABSTRACT: Abstract Objective: A short cervix measured by transvaginal ultrasound has been correlated with increased risk for preterm delivery (PTD). Many patients presenting with a complaint of possible premature labor (PL); may not have access to cervical length (CL) screening by ultrasound. Cervilenz is an FDA cleared disposable device for obtaining vaginal CL measurements. This study was conducted to correlate Cervilenz measurements of CL with the occurrence of PTD. Methods: Women presenting with regular uterine contractions at gestational age (GA) ≥22 and <34 weeks with intact membranes and cervical dilation <3 cm were recruited. A speculum examination was performed and Cervilenz measurement of CL was obtained. Patients were treated with tocolytics and/or corticosteroids based upon the attending physician's judgment. The occurrences of PTD as a result of PL or premature rupture of membranes within 7 days, <32 weeks, <34, and <37 weeks, were determined. Patients who were delivered preterm for other maternal or fetal indications were excluded. Negative predictive value (NPV) was calculated. Results: Of the 220 women recruited, 20 were subsequently excluded from analysis because they required PTD for unrelated indications. The mean GA at enrollment was 29.8 ± 2.8 (SD) weeks. One (0.5%), 2 (1.0%), 4 (2.0%) and 29 (14.5%) women delivered at ≤7 days from enrollment, ≤32 weeks, ≤34 weeks, and ≤37 weeks, inclusively. Seventy-seven (38.5%), 39 (19.5%) and 19 (9.5%) women had Cervilenz measurement of ≤30 mm, ≤25 mm, ≤20 mm, respectively. The NPV for a Cervilenz measurement of >20 mm for delivery at, ≤32 weeks, ≤34 weeks, and ≤37 weeks were 99.2%, 98.3% and 86.7%, respectively. Conclusion: Cervilenz measurement >20 mm appears to have high NPV for PTD prior to 34 wks.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 06/2013; DOI:10.3109/14767058.2013.811484 · 1.21 Impact Factor
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ABSTRACT: Preterm birth is a major health problem for the neonate, family, country, and society in general. Despite many risk factors being identified for women destined to deliver preterm, short cervical length detected on transvaginal ultrasound is the most plausible, practical and sensitive risk factor for prediction of spontaneous preterm birth. The definition of short cervix has varied in various studies, but most commonly accepted is ≤2.5 cm in the midtrimester of pregnancy, though risk of spontaneous preterm birth (sPTB) increases as the cervical length decreases. Vaginal progesterone, a naturally occurring steroid hormone, is the most bioavailable form of progesterone for uterine and cervical effects with the fewest side effects. Multiple prospective studies have consistently shown its benefits in decreasing sPTB rate in women with asymptomatic midtrimester short cervix. The safety for mother and fetus, and tolerability of vaginal progesterone, particularly the gel form, is also well established. Vaginal progesterone is a minimally invasive intervention that is not painful and is very safe, with reasonable cost where the benefits (even if argued to be small) clearly outweigh the risks. Thus there should be little hesitation for implementation of universal transvaginal cervical length screening and preventive vaginal progesterone treatment for women with short cervix.International Journal of Women's Health 01/2012; 4:481-90. DOI:10.2147/IJWH.S28944
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ABSTRACT: Abstract Objective: To assess the accuracy and reliability of cervico-portio (CP) length estimated using the Cervilenz™ compared to transvaginal ultrasound (TVU) cervical-length in women at high- and low-risk of spontaneous preterm birth (SPTB). Methods: Cervical-length was assessed longitudinally across gestation utilising CP-length measured with Cervilenz™ and TVU. Altman-Bland plots were used to compare Cervilenz™ and TVU cervical-length. Regression analysis was used to assess the effect of gestational age, previous SPTB and previous cervical surgery on Cervilenz™ accuracy. Receiver operator curves (ROC) were utilised to determine the CP-length measured by Cervilenz™ with the optimum sensitivity and specificity for predicting TVU cervical-length <25mm. ROCs were utilised to compare the ability of Cervilenz™ with TVU to predict SPTB. Results: Seventy-five women were recruited (low risk N=57, high-risk N=18). A total of 259 TVU and 253 Cervilenz™ measurements were taken with up to six measures in each woman. The Cervilenz™ CP-length was on average 9mm shorter than TVU measured cervical-length. The difference decreased with advancing gestational age (p<0.001). Cervilenz™ CP-length <24mm was a good predictor of TVU cervical-length <25mm (AUC=0.867). After accounting for baseline Cervilenz™ measurements, the relationship between Cervilenz™ and TVU measures was not influenced by pregnancy risk status. There were no significant differences between Cervilenz™ (AUC=0.716) and TVU (AUC=0.706) in predicting SPTB. Conclusion: Cervilenz™ is an effective tool for screening cervical-length in comparison to TVU. Cervilenz™ may facilitate greater access to cervical-length measurement and assessment of risk of preterm birth.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 10/2012; DOI:10.3109/14767058.2012.712564 · 1.21 Impact Factor