Prediction of preterm labor (PTL) and premature delivery (PTD): comparison of transvaginal ultrasound (TVU) vs direct cervical length

Abstract

(PTD): COMPARISON OF TRANSVAGINAL ULTRASOUND (TVU) VS DIRECT CERVICAL LENGTH MICHAEL ROSS, LARRY COUSINS, ROSALYN BAXTER-JONES, ROSE BEMIS-HEYS, LINDY YOW, HarborUCLA Medical Center, Department of Obstetrics and Gynecology, Torrance, CA Mary Birch Hospital for Women, San Diego, CA Cervilenz, Irvine, CA OBJECTIVE: Despite efforts directed at prediction and prevention of PTL, the incidence of PTD in the United States has not decreased. Cervical length (CL) measurement, via ultrasound or digital exam, has been proposed for screening and intervention of patients at risk of PTD. Although transvaginal ultrasound (TVU)more accurately predicts PTD than digital examination, TVU ismore costly and technology intensive. TheCervilenz (Cervilenz trade;, Irvine, CA) measuring device reliability quantifies vaginal CL in comparison to TVU. We sought to compare Cervilenz and TVU measurements for the detection of short CL ( < 3 cm) and prediction of PTL and PTD in a group of at-risk pregnancies. STUDY DESIGN: In consented patients (n = 52) at risk for PTD (multiple gestation) Cervilenz and TVU CL were measured by different, blinded examiners) at 12 to 34 weeks. Cervilenz right and left forniceal measurements were averaged to determine the lateral CL. All patients were treated as clinically indicated by the TVU results. Data were analyzed by T-tests. RESULTS: Among the screened patients, there was a 38% PTD. Cervilenz identified a greater proportion of short CL (11.5 vs 7.7%) as compared to TVU, with a sensitivity of 75% and specificity of 94%. Both Cervilenz and TVU detected 13% (4 of 30) of PTL patients. Cervilenz detected 15% (3 of 20) of PTD patients as compared to TVU (10%; 2 of 20). CONCLUSION:Cervilenz is an excellent screening device, detecting nearly all patients with short CL (as identified by TVU) and equal or greater ability to detect patients at risk of PTL or PTD. The relatively low percentage of PTD associated with short CL is further evidence of the multifactorial etiologies of PTD.