Objective cervical portio length measurements: consistency and efficacy of screening for a short cervix.

San Diego Perinatal Center and Sharp Mary Birch Hospital for Women, San Diego, California, USA.
The Journal of reproductive medicine (Impact Factor: 0.58). 06/2007; 52(5):385-9.
Source: PubMed

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.
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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.
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