scholarly journals Transvaginal Sonographic Evaluation of the Cervix in Asymptomatic Singleton Pregnancy and Management Options in Short Cervix

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Resul Arisoy ◽  
Murat Yayla
Keyword(s):  
Preterm Delivery ◽  
Cervical Length ◽  
Transvaginal Sonography ◽  
Singleton Pregnancy ◽  
Management Options ◽  
Short Cervix ◽  
Cervical Gland ◽  
Prophylactic Cerclage ◽  
Singleton Pregnancies

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

Comparison of Transabdominal and Transvaginal Sonograms in Evaluation of Cervical Length During Pregnancy

2021 ◽  
pp. 875647932110126
Author(s):  
Anna Fitzpatrick ◽  
Dora DiGiacinto
Keyword(s):  
Preterm Delivery ◽  
Diagnostic Yield ◽  
Cervical Length ◽  
Transvaginal Sonography ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Short Cervix ◽  
Time Period ◽  
The Relationship ◽  
Singleton Pregnancies

Objective: A short cervix during pregnancy indicates a higher risk of preterm delivery. Transvaginal sonography is widely used for the detection of a short cervix. The literature indicates that 21–24 weeks is the most sensitive gestational age to assess transvaginal cervical length (TV CL) of ≤2.5 cm for potential preterm delivery. Pregnancies between 18 and 20 weeks’ gestation are generally performed transabdominally; thus, it could be beneficial to have a recognized correlation between the transabdominal cervical length (TA CL) measurement and the TV CL measurement at this earlier time period. Materials and Methods: An online database search produced 13 research articles to be reviewed. Inclusion criteria consisted of TA CL and TV CL assessment of singleton pregnancies with intact membranes. Results: Findings indicate high diagnostic yield when a TA CL of <2.9 cm or TV CL of <2.5 cm is used for defining a shortened cervix when measured between 18 and 20 weeks’ gestation. Conclusion: This review of the literature indicates a correlation between average TA CL and average TV CL measurements, although the relationship widens as CLs become shorter.

scholarly journals The Feasibility of Cervical Elastography in Predicting Preterm Delivery in Singleton Pregnancy with Short Cervix Following Progesterone Treatment

2021 ◽  
Vol 18 (4) ◽  
pp. 2026
Author(s):  
Yun Ji Jung ◽  
Hayan Kwon ◽  
Jeongeun Shin ◽  
Yejin Park ◽  
Seok-Jae Heo ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Fold Increase ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Spontaneous Preterm Delivery ◽  
Progesterone Treatment ◽  
Singleton Pregnancies

Previous studies demonstrated an association between cervical strain and risk of spontaneous preterm delivery (sPTD). The present study aimed to assess the efficacy of elastography in predicting sPTD at <32 weeks of gestation in women with singleton pregnancies receiving progesterone for short cervix (≤2.5 cm) diagnosed between 16 and 28 weeks of gestation Among 115 participants eligible for analysis, nine had sPTD at <32 weeks. Preprogesterone (PP0) mean internal os strain (IOS), elasticity contrast index (ECI), hardness ratio (HR), one-week postprogesterone (PP1) IOS, mean external os strain (EOS), ECI, and HR were significantly different between groups. Higher PP0 IOS, PP1 IOS, and PP1 EOS were associated with a 2.92, 4.39 and 3.65-fold increase in the risk of sPTD at <32 weeks, respectively (adjusted for cervical length (CL) at diagnosis; p = 0.04, 0.012 and 0.026, respectively). A combination of CL at diagnosis, PP0 IOS and PP1 EOS showed a significantly higher area under the receiver operating characteristic curve (0.858) than that of CL alone (p = 0.041). In women with singleton pregnancies receiving progesterone for short cervix, cervical elastography performed before and one week after progesterone treatment may be useful in predicting sPTD at <32 weeks of gestation.

scholarly journals A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery

2018 ◽  
Vol 46 (5) ◽  
pp. 489-501 ◽  
Author(s):  
Edgar Hernandez-Andrade ◽  
Eli Maymon ◽  
Suchaya Luewan ◽  
Gaurav Bhatti ◽  
Mohammad Mehrmohammadi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Shear Wave ◽  
Wave Speed ◽  
Shear Wave Elastography ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Shear Wave Speed ◽  
Spontaneous Preterm Delivery

AbstractObjective:To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD).Materials and methods:This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18–24 weeks of gestation. Frequency of sPTD <37 (sPTD<37) and <34 (sPTD<34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS <25thpercentile).Results:There were 31/628 (4.9%) sPTD<37 and 12/628 (1.9%) sPTD<34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD<37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7–43.9); P<0.0001] and the risk of sPTD<34 by 120-fold [RR 120.0 (95% CI 12.3–1009.9); P<0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD<37 by 4.5-fold [RR 4.5 (95% CI 2.1–9.8); P=0.0002] and of sPTD<34 by 21-fold [RR 21.0 (95% CI 2.6–169.3); P=0.0003] compared to a non-soft cervix.Conclusions:A soft cervix at 18–24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.

scholarly journals Cervical length measurement by transvaginal sonography in predicting preterm labour in low risk women

2017 ◽  
Vol 6 (12) ◽  
pp. 5563
Author(s):  
Sandeep Sethumadhavan P. ◽  
Raju Agarwal ◽  
Jayamol M. Anilkumar ◽  
Anup Ramchandran Pillai
Keyword(s):  
Preterm Delivery ◽  
Gestational Age ◽  
Preterm Labour ◽  
Screening Method ◽  
Cervical Length ◽  
Low Risk ◽  
Military Hospital ◽  
Transvaginal Sonography ◽  
Short Cervix ◽  
Low Risk Women

Background: Preterm birth is the leading cause of perinatal morbidity and mortality. Transvaginal sonographic measurement of the cervix is a reliable alternative method for the assessment of cervical length as it allows better quality and more accurate visualization of the uterine cervix. Several studies have reported that cervical assessment on transvaginal sonography may be useful in the prediction of preterm delivery. The objective of this study was to assess cervical length at 20 to 24 weeks of gestation in low risk women and correlate with the gestational age at delivery.Methods: A prospective cohort study conducted in a tertiary care Military Hospital in Pune, India. 354 asymptomatic low risk antenatal women with gestational age of 20 to 24 weeks were studied. Cervical assessment with transvaginal sonography for the measurement of cervical length was performed using a 10 MHz transvaginal probe.Results: 7 percent women delivered preterm. The incidence of short cervix in low risk women was only 0.56%. 100% women with short cervix delivered preterm and, only 6.9% patients who had cervical length more than 25 mm delivered preterm. Cervical length 25 mm has got sensitivity and NPV of 100% and a specificity of 93.46%. However, the PPV was only 8%.Conclusions: The study reported significant inverse relation between short cervix and the occurrence of preterm delivery. Our findings suggest that cervical length can be used as a screening method for preterm labour in low risk women. However strong evidences from large randomized control trials would be required to assess its cost-effectiveness. 

scholarly journals Use of cervical length, measured by transvaginal sonography at 22 to 26 weeks, as a predictor of preterm labour in twin pregnancy

2018 ◽  
Vol 7 (9) ◽  
pp. 3590
Author(s):  
Ricky Saini ◽  
Reena Yadav ◽  
B. Pathak
Keyword(s):  
Twin Pregnancy ◽  
Prospective Observational Study ◽  
Preterm Labour ◽  
Tertiary Care ◽  
Cervical Length ◽  
Transvaginal Sonography ◽  
Perinatal Morbidity ◽  
Short Cervix ◽  
Time Of Presentation

Background: Preterm labour and delivery contributes significantly to perinatal morbidity and mortality in twin gestation. Measurement of cervical length during antenatal period and subsequent follow up may identify women at risk for preterm labour.  The purpose of this study was to determine if measurement of cervical length at 22 to 26 weeks can be used as a predictor of preterm labour in twin pregnancy.Methods: This prospective observational study was carried out in 50 women with twin gestation in a tertiary care teaching hospital. Cervical length was measured using transvaginal sonography and repeated every four weeks till delivery. Cervical length of ≤30 mm was taken as short cervix and delivery before 37 weeks was taken as preterm delivery.Results: Total of 18 out of 50 women (36%) delivered between 32 to 34 weeks, 14 out of 50 (28%) delivered between 34 to 37 weeks, 7 out of 50 (14%) delivered at less than 32 weeks. Therefore, total preterm deliveries at less than 37 weeks were 78%. Total 11 out of 50 (22%) delivered at term i.e. at more than 37weeks. In women, who had short cervical length (≤ 30 mm) at the time of presentation, 14 out of 37 (38 %) delivered between 30 to 34 weeks, 12 out of 37 (32 %) women delivered between 34 to 37 weeks, 5 out of 37 (14%) delivered at ≤ 30 weeks. Rest 6 out of 37 (16 %) delivered after 37 weeks.Conclusions: Short cervical length of ≤30 mm on transvaginal sonography at 22-26 weeks of gestation in twin pregnancy may be used as a screening tool in prediction of preterm labour in asymptomatic twin pregnancy.

scholarly journals Role of cervical length assessment at mid-trimester scan for predicting preterm births: An experience from Tertiary Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 187-192
Author(s):  
Suman Raj Tamrakar ◽  
Rubina Shrestha
Keyword(s):  
Preterm Delivery ◽  
Predictive Value ◽  
Preterm Births ◽  
Tertiary Hospital ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Pattern Of Care ◽  
Short Cervix ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Ultrasound has revolutionized the pattern of care and management. Mid trimester ultrasound (transabdominal) is a valuable method for pregnant clients to predict preterm births. Objectives: To assess cervical length at 20 to 24 weeks obstetric scan for predicting risk of preterm delivery and to determine the sensitivity and specificity of assessing cervical length as a predictor of preterm delivery. Methodology: This is a prospective study conducted at a Tertiary Hospital. Pregnant clients with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for assessing cervical length as a predictor of preterm delivery. Results: Of 1027 pregnant clients screened, the mean age was 22.92±3.45. Mean gestational age during scan was 21+5 weeks of gestation. About 2.43% of clients were found to have short cervix < 2.5 cm with mean cervical length 3.8 cm. The risk of preterm delivery was almost two fold when cervical length was < 2.5 cm. The sensitivity, specificity, positive predictive value and negative predictive value to predict preterm delivery were 32%, 85.9%, 5.44% and 98.04% respectively. Conclusion: Assessment of the cervical length at mid-trimester can be useful tool for predicting risk of preterm delivery.

scholarly journals A longitudinal follow-up of cervical length during pregnancy

2004 ◽  
Vol 57 (9-10) ◽  
pp. 457-461 ◽  
Author(s):  
Aleksandra Novakov-Mikic ◽  
Sinisa Stojic
Keyword(s):  
Longitudinal Study ◽  
Preterm Delivery ◽  
Reference Values ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Prospective Longitudinal Study ◽  
Group Iii ◽  
Group I ◽  
Prospective Longitudinal

A prospective longitudinal study of cervical length during pregnancy included 60 women. Three groups of patients were analyzed: group I - cervical length was measured in all three trimesters, group II - cervical length was measured in the first and second trimesters, and group III - length was measured in the second and third trimesters. Cervical length was measured in each group individually, with the aim of establishing the trend of change. In the group in which the cervical length was measured in all three trimesters, there was either a mild progressive cervical shortening or cervix remained of the same length. The number of examined women is very small, though, so more valid is the information that the trend of mild shortening occurs in the second and third trimesters. None of the trends is particularly explicit and shows that there is a period in an uncomplicated singleton pregnancy of low risk for preterm delivery, during which there is a significant shortening before delivery takes place. During pregnancy there are different, individual modes of cervical changes, which leads to individualization when estimating the risk for preterm delivery. Reference values should be established for cervical length in order to assess risk for preterm delivery, rather than use the ?cut-off? value after which the risk is considered higher.

scholarly journals Evaluation of pre induction scoring by clinical examination vs transvaginal sonography

2016 ◽  
Vol 6 (1) ◽  
pp. 228
Author(s):  
Sonali Kaur Sharma ◽  
Madhu Nagpal ◽  
CL Thukral
Keyword(s):  
Vaginal Delivery ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Transvaginal Sonography ◽  
Bishop Score ◽  
Unfavourable Cervix ◽  
Successful Induction ◽  
Singleton Pregnancies

Background: The aim of the study was to find out pre-induction cervical length by TV Sonography, determine Bishops score and to co-relate the obstetric outcome with these two variables.Methods: A study was done on 100 women with singleton pregnancies at 37-42 weeks of gestation, admitted for induction of labour in the Department of Obstetrics and Gynaecology at SGRDIMSR, Vallah, Amritsar, Punjab, India. All women underwent cervical assessment by both transvaginal ultrasound and Bishop Score and the outcome of labour induction was determined.Results: Of the 100 women, 53 women had vaginal delivery and 47 landed into LSCS. Bishop score < 6 and cervical length > 3 cm are cut off values of cervical unfavourablity. Successful induction was achieved among 87.5% and 78% women with favorable cervix according to Bishop Score and Cervical length respectively .Among the 92 and 50 women with unfavourable cervix according to Bishop score and cervical length, 48 (52.17%) and 14 (28%) had vaginal delivery respectively.Conclusions: Hence, cervical length by transvaginal ultrasound is a better predictor for the success of induction of labour as compared with assessment by Bishop Score alone.

Ultrasonographic Transabdominal Measurement of Uterine Cervical Length for the Prediction of a Midtrimester Short Cervix

2020 ◽  
Author(s):  
Paul Guerby ◽  
Annie Beaudoin ◽  
Geneviève Marcoux ◽  
Mario Girard ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Roc Curve ◽  
False Positive Rate ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Nulliparous Women ◽  
Key Points ◽  
Positive Rate ◽  
The Mean

Objective This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester. Study Design We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed. Results A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: −6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95–0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%. Conclusion Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm. Key Points

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