Diagnosis Of Cervical Incompetence Research Articles

ASSESSMENT OF CERVICAL LENGTH, SHAPE AND CONSISTENCY BETWEEN 18-24 WEEKS GESTATIONAL AGE BY TRANSVAGINAL ULTRASOUND FOR PREDICTION OF PRETERM LABOR

Background: Preterm labor is the presence of uterine contractions of sufficient frequency and intensity to affect progressive effacement and dilation of the cervix prior to term gestation. Shortening and funneling of the cervix was first described to be associated with the diagnosis of cervical incompetence, Transvaginal sonographic measurement of cervical length could be used to predict a risk for preterm delivery for a significant proportion of preterm births. Cervical length is measured by transvaginal ultrasound from internal os to external os while the urinary bladder is empty. Objective: To determine the value of measurement of cervical parameters by transvaginal ultrasound between 18 and 24 weeks' gestation in the prediction of spontaneous preterm delivery. Patients and Methods: The study was carried out at Bab EL-Sha'aria University Hospital between 1/10/2018 and 31/12/2019 on 200 primigravida women with single pregnancy and intact membranes. Women with scarred uterus, women with chronic medical diseases or obstetric problems, women who underwent cerclage and fetal anomalies were excluded from the study. For all participants, transvaginal ultrasound was done between 18 and 24 weeks' gestation for measurement of cervical length, shape and consistency. Results: Infant means weight at delivery was 1589 g with SD 215 in preterm delivery, while Infant mean weight at delivery was 3024 g with SD 200 which was significant. 33.3% of preterm birth delivered vaginally, while 66.7% delivered by C.S. 62.6% of full term delivery delivered vaginally, while 37.4% delivered by C.S. No statistically significant difference was found regarding mode of delivery. Cervical length was significant in prediction of preterm labor with sensitivity 88.9%, specificity 91.2%, PPV 50.0% and NPV 98.8 %. Cervical consistency index was significant in prediction of preterm labor with sensitivity 88.9%, Specificity 93.4%, PPV 57.1% and NPV 98.8 %. Funneling was present in 33.3% of preterm delivery, and 4.4% of full term delivery which was significant. Measurement of cervical length, shape and consistency was a reliable method for prediction of preterm labor. Conclusion: Measurement of cervical length, shape and consistency by transvaginal ultrasound between 18 and 24 weeks' gestation was a reliable method for prediction of preterm labor.

ASSESSMENT OF CERVICAL LENGTH, SHAPE AND CONSISTENCY BETWEEN 18-24 WEEKS GESTATIONAL AGE BY TRANSVAGINAL ULTRASOUND FOR PREDICTION OF PRETERM LABOR

Background: Preterm labor is the presence of uterine contractions of sufficient frequency and intensity to affect progressive effacement and dilation of the cervix prior to term gestation. Shortening and funneling of the cervix was first described to be associated with the diagnosis of cervical incompetence, Transvaginal sonographic measurement of cervical length could be used to predict a risk for preterm delivery for a significant proportion of preterm births. Cervical length is measured by transvaginal ultrasound from internal os to external os while the urinary bladder is empty. Objective: To determine the value of measurement of cervical parameters by transvaginal ultrasound between 18 and 24 weeks' gestation in the prediction of spontaneous preterm delivery. Patients and Methods: The study was carried out at Bab EL-Sha'aria University Hospital between 1/10/2018 and 31/12/2019 on 200 primigravida women with single pregnancy and intact membranes. Women with scarred uterus, women with chronic medical diseases or obstetric problems, women who underwent cerclage and fetal anomalies were excluded from the study. For all participants, transvaginal ultrasound was done between 18 and 24 weeks' gestation for measurement of cervical length, shape and consistency. Results: Infant means weight at delivery was 1589 g with SD 215 in preterm delivery, while Infant mean weight at delivery was 3024 g with SD 200 which was significant. 33.3% of preterm birth delivered vaginally, while 66.7% delivered by C.S. 62.6% of full term delivery delivered vaginally, while 37.4% delivered by C.S. No statistically significant difference was found regarding mode of delivery. Cervical length was significant in prediction of preterm labor with sensitivity 88.9%, specificity 91.2%, PPV 50.0% and NPV 98.8 %. Cervical consistency index was significant in prediction of preterm labor with sensitivity 88.9%, Specificity 93.4%, PPV 57.1% and NPV 98.8 %. Funneling was present in 33.3% of preterm delivery, and 4.4% of full term delivery which was significant. Measurement of cervical length, shape and consistency was a reliable method for prediction of preterm labor. Conclusion: Measurement of cervical length, shape and consistency by transvaginal ultrasound between 18 and 24 weeks' gestation was a reliable method for prediction of preterm labor.

McDonald’s suture: A successful case

Cervical incompetence is characterized by painless dilatation of the incompetent cervix and results in miscarriages and preterm delivery during second trimester. Cervical cerclage (CC) has been utilized for the cure of loss in second trimester pregnancy. The detection of cervical incompetency is difficult. Usually patients have history of repeated second trimester demise or early preterm delivery after cervical dilatation without pain having no bleeding, contractions, or other reasons. We report a 28years old patient, 3rd gravida, para 0+2, at 11 weeks’ gestation with the diagnosis of cervical incompetence, in whom cervical cerclage (McDonald’s suture) was performed successfully. There were no operative or immediate postoperative complications. A healthy infant was delivered at 37 weeks by caesarean section. After delivery the suture was removed. Cervical cerclage during pregnancy can be safe and effective treatment for well-selected patients with cervical incompetence.

The Indication for Cervical Cerclage and Pregnancy Outcome in a Teritiary Hospital in South-South Nigeria: A Five Year Review

Background: Cervical incompetence is a major cause of second trimester miscarriage. Recurrent pregnancy loss in the second trimester is associated with significant distress. However, there should be a justifiable indication before a cerclage is inserted. There is no documentation of the indication of cervical cerclage and pregnancy outcome in Yenagoa, southsouth Nigeria. Objectives: This paper focuses on documenting the indication and obstetric outcome following cervical cerclage insertion at the Federal Medical Center Yenagoa, Bayelsa State. Methodology: A 5 year retrospective study was carried out in women who had cervical cerclage for cervical incompetence in the Federal Medical Centre, Yenagoa. The study was conducted from the 1 st of January 2014 to 31st of December 2018. All the case files of patients who had cervical cerclage were retrieved and reviewed. Results: A total of 41 patients had cervical cerclage. The commonest indication for cervical cerclage insertion was history indicated cerclage 59.4%. This was followed by ultrasound indicated cerclage 28.1% and rescue cerclage accounting for 12.5%. All patients employed McDonald’s method of cervical cerclage. The position of the knot wasin 12 0’ clock position in 53.1% of the patients and in the 6 0’clock position for 46.9% of the patients. The success rate following insertion of cerclage was 79.3%. The mode of deliveries was vaginal in 90.6% of the patients and 9.4% had caesarean section. Conclusion: There may be concern about the diagnosis of cervical incompetence. However, findings from this study clearly showed that the application of cervical cerclage is associated with good obstetric outcome.

Prevention of preterm delivery in women with multiple pregnancy

The objective — to asses the effectiveness of obstetric pessary for cervical incompetence correction in women with multiple pregnancy and infertility in the anamnesis, treated by ART. 30 ART treated pregnant women with infertility in the anamnesis, with dichorionic diamniotic twins (DCDA) were divided into 3 groups, depending on the gestational age when cervical incompetence was diagnosed and vaginal pessary placed: the I group consisted of 5 pregnant women (17%), whom pessary was inserted at 19–22 gestational weeks, the II group included 18 (60.0%) women with correction of cervical insufficiency from 23 to 27 weeks of gestation, the III — 7 (23%) of the patients with pessary implementation in terms of 28–32 gestational weeks. Diagnosis of cervical incompetence was based on the FMF criterias, the Score Rating Scale (Shtember Scale in the modification of G.M. Savelieva) and cervical indices (CI). The sonographic evaluation of cervical insufficiency considered the cervical length (less than 25 mm), opening of the internal os and / or cervical canal (9 mm or more), ICSC>0.22, IPC>0.18 and the Rating Scale score > 5–6 points. With the aim to treat cervical incompetence during pregnancy, silicone vaginal pessary (ASQ, perforated) was used. The cervical assessment by transvaginal ultrasound probe was performed every 2 weeks and evaluated 1 month after correction. The data obtained were processed statistically, using the Microsoft Excel software. The average age of pregnant women was 27.7±2.8 years (28–38 years). Extragenital pathology was determined in 83.3% of women. All pregnant women had infertility in anamnesis, treated by ART, 18 (60%) by standard IVF procedure and 12 (40%) using ICSI method. The number of primiparous and multiparous women was the same. Within pregnancy duration, there were artificial abortions in 8 (53,3%), miscarriages in 7 (46,7%), prematurity in 3 (20,0%) and term delivery in 2 (13,3%) patients in the anamnesis. The current pregnancy was complicated by threatened abortions in all groups, which clinical signs most often occurred within 8–10 and 14–17 weeks of gestation. The average duration of pessary placement in groups was 15.0±1.8; 12.2±1.6 and 4.7±2.1 weeks, respectively. According to ultrasonography evaluation, the visual lengthening of the cervix from 21.6±3.4 mm to 30.2±3.6 mm (p<0,05) were observed in all groups, during the first week of treatment. Preterm delivery occurred in 6 (20%) women, among them before 32 weeks — 3.3%, 32–34 weeks — 10% and in 35–36 weeks — 6.5% of observations. 16.7% of pregnant women had vaginal delivery, 25 (83.3%) underwent Cesarean Section, 76.7% of them had a planned CS. No cases of antenatal or intranatal fetal death happened, as well as newborns with extremely low body weight were not observed in women of all three groups. Results were obtained testify the role of cervical incompetence in the pathogenesis of perinatal losses in women with multiple pregnancy. Evaluation and diagnosis of cervical insufficiency to predict and prevent premature labor in such group of patients should be based on criteria of Fetal Medicine Foundation (FMF), using the method of transvaginal ultrasound cervicometry. An additional calculation of cervical indices may improve the reliability of the prognostic technique. The safety, accessibility and efficacy of obstetric vaginal pessary usage for non-surgical correction of cervical incompetence, as well as absence of severe complications in women with twin pregnancies, have been demonstrated.

Prophylactic Cerclage in the Management of Twin Pregnancies

To determine if prophylactic cerclage improves pregnancy outcomes in women with twin pregnancies without a history of cervical insufficiency. Women with twin pregnancies who received outpatient preterm labor surveillance services between January 1990 and May 2004 for ≥1 day beginning at < 28.0 weeks' gestation were identified from a database. Patients with previous preterm delivery or a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded. Twin pregnancies managed with prophylactic cerclage were compared with twin pregnancies in which cerclage was not placed. The primary outcome was incidence of preterm birth prior to 32 weeks. Groups were compared using Fisher exact and Mann-Whitney U test statistics. Overall, 8,218 twin pregnancies met inclusion criteria, of which 146 women (1.8%) received prophylactic cerclage. Patients who received prophylactic cerclage had a significantly higher incidence of preterm birth before 32 weeks and infants with lower mean birth weight and longer nursery stays. No significant difference was seen in mean gestational age at delivery. This study had 80% power to detect a 7% reduction in the primary outcome. Prophylactic cerclage was not associated with a lower risk of preterm birth and adverse neonatal outcomes in twin pregnancies without history of cervical insufficiency.

Technique to reduce complexity and improve safety of laparoscopic cervical cerclage, case series

Abdominal cerclage is a management option for patients with diagnosis of cervical incompetence and impossible or recurrent failure of vaginal cerclage. Impossible vaginal route is seen in patients with previous...

Salvaging Twin 2 After Abortion Of Twin 1: A Case Report

We present intentional delayed delivery of twin 2 after a spontaneous membrane rupture and abortion oftwin1 in a dichorionic twin pregnancy at 14 weeks. As signs of infection were missing, we adopted a conservative (not expectant) management. The pregnancy was prolonged to 35 weeks' gestation. In the absence of additional risk factors, the role of conservative management of multiple pregnancies after loss of one fetus in prolonging the pregnancy to fetal viability in resource-poor setting is highlighted. The gained gestational age of 20 weeks and 4 days (144 days in all), for the remaining fetus and the healthy mother and child pair after delivery at 35 weeks are discussed. The perinatal, economic and psychological implications are highlighted. The importance of good clinical assessment in the diagnosis of cervical incompetence and using ultrasound scan as a complimentary instrument is emphasized.

Analysis of Cervical Dynamics by Ultrasound Imaging

Preterm birth is generally due to cervical ripening during the second trimester of pregnancy. The diagnosis of cervical incompetence is mostly based on the measurement of the shortened cervical length from transvaginal ultrasound (TVUS) images. We investigated the cervical dynamic response to spontaneous or imposed variations of intrauterine pressure, which may induce cervical shortening. The TVUS images of the cervix sagittal cross-sections were recorded from six women in mid pregnancy. The cervical dynamics was observed while the subject was either in a supine position, kneeling, or had undergone transfundal pressure in a supine position. Each subject was tested in all three positions, but the dynamic response was observed in only one of them. The time-dependent analysis was performed on consecutive TVUS images at time intervals of 1 s to extract the dynamic response of the funneling geometry and the closed cervical length. The internal os was considered as being a point on the uterine wall and characterized by a sharp gradient of the inner wall of the uterine cavity. Dynamic evaluation of TVUS images revealed that shortening of the cervical length was greater than 30% and that the funneling percentage was greater than 40%. This study demonstrates the clinical potential for dynamic assessment of cervical response due to excessive uterine pressure, in addition to its application for the conventional measurement of cervical length.

Management of cervical incompetence in Aba, south-eastern Nigeria

There have been relatively few reports on the outcome of cervical cerclage performed in non-tertiary centres. The aim of this study was to determine the pregnancy complications and outcome in patients following cervical cerclage. Seventy-one patients who had 103 pregnancies and underwent cervical cerclage at Women's Hospital, Aba over a ten-year period were reviewed. The diagnosis of cervical incompetence was made from the history in 90.6% of cases and also in some cases by hysterosalpingography and ultrasonography. The Shirodkar (65%) and McDonald (35%) techniques were employed and 10.7% of cases were done as emergency procedures. The more common post-insertion complications were urinary tract infection (50.4%), preterm rupture of membranes (20.4%) and vulvovaginitis (14.6%). Common labour associated complications were antepartum haemorrhage, perineal/cervical tears and malpresentations. The preterm birth rate was 32%. Term births accounted for 68% of the deliveries. The overall fetal salvage rate was 92.2%. Antepartum haemorrhge was a significant indication for caesarean section delivery. The perinatal mortality was 63.2 per 1000 and there was no maternal death. The high fetal salvage rate of 92.2% justifies the procedure of cervical cerclage.

Laparoscopic abdominal cerclage during pregnancy: A case report and a review of the described operative techniques

Abstract A case report and systematic review of the literature. We report on a 26-year-old patient, gravida 2, para 0, at 12 weeks gestation with the diagnosis of cervical incompetence, in whom transvaginal cerclage was not technically possible and laparoscopic transcervical abdominal cerclage was performed. The operation lasted 100 minutes and was completed successfully. The patient was discharged the next day and the remainder of her pregnancy was uneventful. A healthy infant weighing 3010 g was delivered at 38.4 weeks by cesarean section. Laparoscopic transcervical abdominal cerclage approach is safe and effective to pregnant patients when abdominal cerclage is recommended and offers faster patient recovery.

Cervical Incompetence and the Role of Emergency Cerclage

Objective:To evaluate the role of emergency cerclage for women who present with a dilated external cervical os and bulging or “hour-glassing” membranes. We examined overall experiences at Kingston General Hospital (KGH) from 2000 to 2004 and conducted a literature review for the period January 1, 1995, to December 31,2004.Methods:A search for cerclages placed by operators in Kingston revealed 12 pregnancies in the period between 2000 and 2004. We reviewed the charts for these women and for their infants. We conducted a literature review, using the terms “cerclage,” “cervical,” “emergent or emergency cerclage,” “rescue cerclage,” and “incompetent cervix,” using an OVID interface to access MEDLINE records. We excluded articles in which the diagnosis of cervical incompetence was made using ultrasound, because its predictive value has not been shown in randomized trials. The most recent review of this type was carried out in 1995; since then, an additional 24 articles have been published that met our inclusion and exclusion criteria.Results:The average time between cerclage placement and delivery at KGH was 7 weeks, which allowed for 10 of 13 infants (one twin pregnancy) to be born at 28 weeks or later. Three infants were born weighing under 1 kg; the 10 remaining infants weighed over 1 kg. Histological data are available for 12 placentas of the 13 infants delivered; 7 infants had a histological diagnosis of chorioamnionitis; none of the blood cultures from any of the infants postdelivery revealed septicemia. The literature review identified 638 women. Where reported, the average prolongation of the pregnancy was 7 weeks plus 1 day. This allowed for 60% of infants (range 26% to 80%) to be born after 28 weeks, with an average neonatal survival of over 70% (range 47.2% to 96%). Preterm premature rupture of membranes complicated an average of 29% of pregnancies (range 1 % to 58%), and chorioamnionitis was reported in 5% to 80% of pregnancies.Conclusions:The KGH data collected and the data available in the literature suggest that emergency cerclage, under ideal circumstances, can significantly prolong pregnancy and increase the chance of viable pregnancy outcome. However, in counselling women about the potential therapeutic benefit of emergency cerclage, the increased risk of chorioamnionitis and its associated risk of fetal inflammatory brain injury, as well as the risk of extending a pregnancy from previability to severe prematurity, should be discussed. A longer-term follow-up than has been carried out here is required for better elucidation of the effect of chorioamnionitis on those infants in childhood and beyond.

Prophylactic cerclage in the management of triplet pregnancies

ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies.Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant.ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. To determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. Triplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. In triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes.

Diagnostik und Prophylaxe der Cervixinsuffizienz in der Mehrlingsschwangerschaft

Fragestellung: Der Ausprägungsgrad von Frühgeburtlichkeit bestimmt in Mehrlingsgraviditäten massgeblich den Ausgang der Schwangerschaft. Nachdem Cervixinsuffizienz einer der häufigen Auslöser einer vorzeitigen Entbindung bei höhergradigen Mehrlingen ist, kommt ihrer Früherkennung und Prophylaxe hohe Bedeutung zu. Methoden: Mehrlingsschwangerschaften unter volumetrischer Cervixüberwachung bzw. nach prophylaktischer Cerclage konnten mit Kontrollgruppen verglichen werden. Ergebnisse: Die Volumenbestimmung der Cervix uteri gelang bei allen 34 Untersuchungen, auch bei den 6% der Mehrlingsschwangerschaften, bei denen die konventionelle abdominelle Cervixlängenmessung aufgrund einer Obstruktion der Ultraschallebene misslang. Der Gebärmutterhals war durchschnittlich 28,7 mm (SD 7,7) lang. Das mittlere Cervixvolumen betrug 30,0 cm³ (SD 16,0). Ein signifikanter Zusammenhang zwischen Volumen und Länge der Cervix uteri (p = 0,01) ist an der sukzessiven Verminderung beider Parameter im Schwangerschaftsverlauf abzulesen. Eine prophylaktische Cerclage war bei 17% der untersuchten Drillingsmütter im Mittel in der 16. (+2) SSW (98.–138. Tag) und bei 50% der untersuchten Vier- und Fünflingsschwangerschaften in der 15. (+2) SSW (78.–152. Tag) gelegt worden. Das mittlere Zeitintervall zwischen der Operation und der Entbindung betrug für Drillinge 106 Tage (62–119) und für Vier-/Fünflinge 96 Tage (57–142). Die prophylaktisch intendierte Cerclage konnte die Tragzeit nicht verlängern. Ebenso wurde kein positiver Effekt auf die Schwangerschaftsbetreuung (Hospitalisierung, Tokolyse) oder die kindlichen Parameter erreicht. Schlussfolgerungen: Trotz des Versagens einer operativen Frühgeburtsprophylaxe wird durch die frühzeitige, nichtinvasive Diagnostik einer Cervixinsuffizienz die risikoadaptierte Schwangerschaftsbetreuung möglich.

A randomised controlled trial of outpatient versus inpatient cervical cerclage

Fifty patients with cervical incompetence were randomised to have cervical cerclage either as inpatients, spending 3 days in hospital post-procedure on supervised bed rest or as outpatients spending the time at home on bed rest. Both groups had a clinical diagnosis of cervical incompetence and both had either McDonald or Shirodkar cerclage with mersilene tape. Both groups were given salbutamol tablets for tocolysis, postoperatively. There were no significant difference in the demographic variables between the groups such as previous cerclage, gestational age at insertion, parity and gestational age at delivery. There were also no significant differences in early complications such as bleeding. Most late complications were also not different, including the spontaneous abortion rate, premature rupture of membranes, cervical dystocia and preterm delivery. However, more patients in the outpatient group had premature contractions (26·1% vs. 4·3% P =0·0479). More patients in the inpatient group had a delivery of a live neonate, 86·9% vs. 78·3%, but the difference was not statistically significant. In conclusion, out patient cerclage appears to be a valid option, the higher rate of premature contraction in this group is not a cause for concern in view of the similar mean gestational age at delivery.

Sonographic diagnosis of cervical incompetence for prevention and management

Sonographic diagnosis of cervical incompetence for prevention and management

Sonographic diagnosis of cervical incompetence for prevention and management

ABSTRACTCervical shortening, as seen by transvaginal sonography increased concentrations of maternal salivary estriol, inflammatory cytokines in amniotic fluid, and fetal fibronectin expression in cervicovaginal mucus are all detected weeks to months before a preterm birth, providing evidence that spontaneous preterm birth is the result of a long-term process, with varying clinical manifestations and dynamics and a dilated cervix as the common terminal pathway.Routine pelvic examination has not been shown to be predictive of preterm labor. The examination of the cervix by transvaginal sonography is more objective and has been shown to be superior to the digital examination in estimating the risk of premature birth. Thereby, the sonographic structure of the cervix (length, funneling) determines, more than any other clinical findings, the interval to the delivery.During normal pregnancy, the pregnant woman spends part of her time in an upright position. Therefore, we have established longitudinal sonographi...

Sonographic diagnosis of cervical incompetence in twin pregnancies

AbstractTransvaginal sonography (TVS) of the cervix has been shown to be superior to the digital examination in detecting patients at risk for sponatenous preterm birth. The cervical length, width, length or area of the internal os (funneling) and, to some extent, the position and structure of the cervix, can be determined from ultrasound images. We have established longitudinal sonographic criteria separate for twin and singleton pregnancies in a vertical and horizontal position of the patient. Shortening of the cervical length and funneling occur earlier in an upright compared to a supine maternal position and in twin compared to singleton pregnancies. For dividing high-risk and low-risk groups, we considered the cut-off values specific for gestational age, position and singleton or twin pregnancy. Multiple logistic regression revealed that, between 20 and 24 + 6 weeks and between 25 and 29 + 6 weeks, funnel width in an upright position and the detection of fibronectin were the most significant independ...

Sonographic assessment of the incompetent cervix during pregnancy

C ervical examination is important in the evaluation of the pregnant cervix. Digital assessment of cervical dilatation, effacement, consistency, and position are indispensable in the diagnosis of cervical incompetence, preterm labor, and term labor. Since 1979, when Sarti et al 1 described the use of transabdominal sonographic examination of the uterine cervix, sonography has been advanced as a means of obtaining objective, accurate, precise, reproducible, reliable, dynamic, and detailed assessment of the cervix during pregnancy. Sonographic examination allows visualization of the internal cervical os and the portion of the cervix that lies above the vaginal fornices, providing information that is inaccessible to digital examination.

Cervical length in normal pregnancy as measured by transvaginal sonography

Cervical length may have potential use as a predictor of preterm delivery [1,2] and diagnosis of cervical incompetence. To determine the risk of preterm delivery or outcome of cervical incompetence, a normogram of cervical length for each period of pregnancy is essential. The objective of this longitudinal study is to determine the cervical length in normal pregnancy as measured by transvaginal sonography. This study was undertaken at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University Thailand, from 1 March 1992 to 30 September 1996. The subjects met the following inclusion criteria: (1) gestational age between 14 and 40 weeks; (2) history of regular menstruation and knowledge of the exact dates of the last menstruation; (3) singleton pregnancy without medical or