Hysteroscopic Resection Of Uterine Septum Research Articles

Hysteroscopic Uterine Septum Resection: Is it a Successful Treatment for Infertile Patients?

Hysteroscopic Uterine Septum Resection: Is it a Successful Treatment for Infertile Patients?

Comment on “Evaluation of the success of hysteroscopic uterine septum resection”

Comment on “Evaluation of the success of hysteroscopic uterine septum resection”

To Study the Efficacy of Intrauterine Device and Endometrial Regeneration Therapy versus Endometrial Regeneration Therapy Alone in the Prevention of Adhesions after Hysteroscopic Resection of Uterine Septum

Abstract Background: Septate uterus is a very common defect of the female reproductive system. Septate anomalies are associated with diminished fertility and increased risks for adverse pregnancy outcomes. Treatment must aim for optimization of pregnancy outcomes with minimum adverse effects. Aims: The aim of this study was to compare the presence or absence of adhesions and assess the efficacy of intrauterine device (IUD) along with endometrial regeneration therapy (ERT) vis-a-vis ERT alone in the prevention of adhesions after hysteroscopic resection of septum. Objectives: (1) To compare the two groups with respect to their efficacy. (2) To analyze the side effects of therapy in each group, e.g., intermittent spotting/bleeding and cyclical pain. (3) To assess endometrial thickness after 3 months, i.e., preovulatory endometrium without therapy. Settings and Design: This was a prospective observation study. Materials and Methods: A sample size of 42 was calculated for each study group for comparative analysis and subjects were randomly allocated into one of the two groups using computer-generated randomization tables. Group 1 received IUD and ERT while group 2 received ERT alone. Results: In first group receiving IUD + ERT therapy, 10 patients reported side effects in the form of hypomenorrhea, amenorrhea, severe pelvic pain and prolonged spotting as compared to only 8 patients developing side effects in the second group which received ERT alone therapy.: The rates of postsurgical intrauterine adhesion and other complications were not statistically significant in both groups (P = 0.457). There was no statistically significant difference between the groups with respect to preovulatory endometrial thickness. Conclusion: The findings from this clinical study reconfirm the results of already published efficacy and safety studies of the use of IUD and ERT preventive therapies following hysteroscopic metroplasty.

Single Euploid Embryo Transfer Outcomes After Uterine Septum Resection

ObjectiveTo study pregnancy outcomes after single euploid embryo transfer (SEET) in patients who underwent prior uterine septum resection to those with uteri of normal contour, without Müllerian anomalies or uterine abnormalities including polyps or fibroids, and without a history of prior uterine surgeries. DesignRetrospective cohort study SettingSingle academic affiliated center Patients60 cycles of patients with prior hysteroscopic uterine septum resection who underwent an autologous SEET between 2012-2020 were used as the investigational cohort. A 3:1 ratio propensity score matched control cohort of 180 single euploid embryo transfer cycles from patients without a history of uterine septa were used as the control group. Intervention(s)No interventions administered. Measurements and Main ResultsPregnancy, clinical pregnancy loss, ongoing clinical pregnancy, and live birth rates in patients with history of uterine septum resection compared to matched patients without Müllerian anomalies or uterine surgeries. Patients with a prior uterine septum had significantly lower rates of chemical pregnancy (58.33% vs 77.2%, p=0.004), implantation (41.67% vs 65.6%, p=0.001), and live birth (33.33% vs 57.8%, p=0.001) per transfer. No statistical difference in clinical pregnancy loss rates was found when comparing septum patients with controls (8.33% vs 7.8%, p=0.89). ConclusionPatients with history of hysteroscopic resection who undergo in vitro fertilization are more susceptible to suboptimal clinical outcomes compared to patients with normal uteri. Early pregnancy loss rates in patients with a uterine septum are higher than in those without, however, after resection, the rates are comparable. Patients born with septate uteri require assessment of surgical intervention prior to SEET and to optimize their reproductive outcomes.

Evaluation of the Success of Hysteroscopic Uterine Septum Resection.

The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.

A case of uterine rupture in second term delivery after septum resection

Introduction: The decision to resect a uterine septum remains individualized. Hysteroscopic approach is the gold standard for uterine septum resection. Uterine rupture in subsequent pregnancy is a known but rare complication without identified methods of prevention. Case Report: A 32-year-old woman underwent uncomplicated hysteroscopic uterine septum resection followed by uncomplicated term vaginal delivery, with uterine rupture and intrauterine fetal demise at 38 weeks gestational age in the subsequent pregnancy. Conclusion: Term uterine rupture is possible when the only history of uterine surgery is hysteroscopic septum resection, even with an intervening delivery. Providers should have a low threshold to initiate diagnostic evaluation with fetal or maternal distress in pregnancy after any uterine surgery. Modifiable risk factors for uterine rupture after septum resection may include residual septa, short interval between surgery and pregnancy, and labor induction methodology. Providers should consider these factors when counseling regarding the risks and benefits of resection.

NONCARDIOGENIC PULMONARY EDEMA AS SEQUEL OF VENOUS AIR EMBOLISM IN A CASE OF OPERATIVE HYSTEROSCOPY – A CASE REPORT.

Hysteroscopy is minimally invasive procedure performed widely for diagnosis and treatment of intrauterine and endocervical pathologies.Venous air embolism,though rare complication,is catastrophic if encountered.We report one such case of venous air embolism leading to non-cardiogenic pulmonary edema encountered by us during hysteroscopic uterine septum resection done for infertility under general anaesthesia.Quick identification,preventing further gas entry and timely intervention saved our patient.

Hysteroscopic Resection of Uterine Septum: An Updated Approach

<h3>Study Objective</h3> Demonstrate an updated technique for hysteroscopic resection of uterine septum. <h3>Design</h3> Case Study–Surgical Technique. <h3>Setting</h3> Major academic medical center. <h3>Patients or Participants</h3> Patient with known uterine septum undergoing hysteroscopic resection of septum with concomitant indicated laparoscopy. <h3>Interventions</h3> Operative hysteroscopy with resection of septum, with laparoscopic assistance. <h3>Measurements and Main Results</h3> The purpose of this video is to demonstrate the combined technique of traditional hysteroscopic scissors with an advanced hysteroscopic tissue removal system to optimally remove the avascular septal tissue and restore normal uterine cavity architecture. The patient later underwent a successful intrauterine device insertion with sonographic guidance, demonstrating a normal uterine cavity and fully resected septum. <h3>Conclusion</h3> Use of an advanced hysteroscopic tissue removal system in combination with traditional incision of the uterine septum results in optimal anatomic cavity restoration. This technique can be used alone or in combination with indicated laparoscopy, which provides additional visual confirmation of adequate resection using a "jack-o-lantern" technique. Further prospective studies should be conducted to evaluate the impact of this updated technique on gynecologic (i.e., bleeding) and obstetric outcomes.

Reproductive outcomes after uterine septum resection in patients with recurrent miscarriage or infertility: a retrospective study in Chinese women.

Septate uterus is the most common structural uterine anomaly, which is related to the adverse pregnancy outcomes in women of childbearing age. This article provides a retrospective review of hysteroscopic uterine septum resection performed in our hospital during recent years, focusing on the patients with recurrent miscarriage and primary infertility, and also to identify which patients are more likely to benefit from the surgery. This is a single-center retrospective study. Cases of women who underwent hysteroscopic septum resection at West China Second Hospital of Sichuan University from January 2014 to December 2019, retrieved through the medical record system, were divided into three groups: Group A was the recurrent miscarriage group, Group B had a history of pregnancy with spontaneous abortion once at most, and Group C was the primary infertility group. Each patient was followed up by telephone about further pregnancy, miscarriage and live birth for at least 1year. A total of 176 surgical patients were included in this study. Group A, B, and C include 42, 74, and 60 cases, respectively. The postoperative pregnancy rates of the three groups were 71.4, 82.4, and 75.0%; live births rates were 50.0, 74.3, and 71.7%; and spontaneous abortion rates were 21.4, 17.6, and 13.3%. 62 patients had a complete uterine septum and 114 had a partial uterine septum. For patients with complete septate uterus, the preoperative pregnancy rate was 54.84% and the pregnancy rate increased to 85.48% after surgery; and yet the preoperative and postoperative pregnancy rates in patients with partial septate uterus were close (from 71.9 to 72.8%). After uterine septum resection, the pregnancy rate and spontaneous abortion rate in RSA patients were not significantly different from the other two groups, but the live birth rate was still significantly lower. Patients with complete uterine septum may benefit more from surgery. The surgical indications should be carefully and strictly evaluated.

Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI

The aim of this study was to compare the reproductive outcomes between infertile women who underwent hysteroscopic uterine septum resection and those who required a second look hysteroscopy due to residual septum prior to intracytoplasmic sperm injection (ICSI) cycles with selective single ‘Grade A’ embryo transfer (ET). All second look hysteroscopies were performed due to partial remnant septum in a control three dimensional transvaginal ultrasonography (3D TVUSG) after the first hysteroscopic resection. Miscarriage and biochemical pregnancy rates were not different between the groups while clinical pregnancy and live birth rates were significantly higher in Group 2 than in Group 1. Second look hysteroscopic metroplasty performed to restore remnant septum significantly improves live birth rate as well as clinical pregnancy rates while it appears not to alleviate abortion and biochemical pregnancy rates in women undergoing ICSI-ET. IMPACT STATEMENT What is already known on this subject? The effect of hysteroscopic septum resection on reproductive outcomes in IVF treatment in infertile patients with uterine septum is not clearly known. What do the results of this study add? With the selective single ET strategy, complete or partial hysteroscopic correction of the uterine septum before ICSI and subsequent resection of the residual septum with control hysteroscopy significantly increases the live birth rates in the infertile population. What are the implications of these findings for clinical practice and/or further research? In the group of infertile patients with uterine septum, second control hysteroscopy should be performed 1 month later for residual septum or adhesions after hysteroscopic septum resection performed once.

Ultrasound-Guided Hysteroscopic Metroplasty

<h3>Study Objective</h3> This video abstract will demonstrate simultaneous use of pelvic ultrasound and hysteroscopic metroplasty. <h3>Design</h3> N/A. <h3>Setting</h3> The procedure was performed in the operating room under general anesthetic with the patient positioned in the dorsal lithotomy position. Bedside pelvic ultrasound was performed by a skilled assistant. A 2.9mm operative hysteroscope with a 30-degree lens and a bipolar electrosurgery device were selected. Normal saline was used as distention media. <h3>Patients or Participants</h3> The patient was selected based on her history of septate uterus and desire to undergo metroplasty and insertion of levonorgestrel-containing intrauterine system. <h3>Interventions</h3> The procedure performed was ultrasound-guided hysteroscopic resection of uterine septum. <h3>Measurements and Main Results</h3> Ultrasound-guided hysteroscopic resection of uterine septum was demonstrated. <h3>Conclusion</h3> This video demonstrated that simultaneous use of pelvic ultrasound and hysteroscopic metroplasty improves visualization during resection of uterine septum and has been demonstrated to increase the rates of complete resection. It is a useful tool that can be added to hysteroscopic resection of uterine septum.

PROSPECTIVE EVALUATION OF MEDIUM-TERM OUTCOMES OF PATIENTS UNDERGOING HYSTEROSCOPIC UTERINE SEPTUM RESECTION

Objectives: To retrospectively and prospectively investigate the pregnancy outcomes after hysteroscopy (H/S) for septum resection in patients detected to have a uterine septum after presenting with a history of recurrent pregnancy loss (RPL), diagnosis of secondary infertility or primary infertility.&#x0D; Methods: This study included 62 patients with infertility or a history of RPL who underwent hysteroscopic uterine septum resection. Patients who had uterine anomalies other than a uterine septum, such as submucous myoma, endometrial polyp were excluded. Those discharged home with a live infant after a uterine septum operation were compared based on certain variables, those who succeeded and those who failed were categorized into group 1 and group 2, respectively. The two groups were compared with regard to the total number of deliveries before and after the operation, total number of abortions, preterm and term deliveries, delivery methods, control hysterosalpingographies (HSG) and whether they were reoperated.&#x0D; Results: In our study, 25 (40%) patients were primary infertile, 37 (60%) had secondary infertility or a history of RPL. Hysteroscopic septum resection was performed under general anesthesia in 61 and spinal anesthesia in 1 of these patients. Of the patients who were postoperatively discharged home with a live infant, 8 (26.7%) were determined to be primary infertile and 22 (73.3%) to have secondary infertility or a history of RPL. The rate of discharge with a live infant was determined as 76.9% among patients who conceived. The success rate of Group 1 patients, who were secondary infertile or had history of RPL, was significantly higher compared to patients who were primary infertile.&#x0D; Conclusions: Hysteroscopic uterine septum resection is a method with an easy application and high effectiveness. The success of the operation is particularly higher in patients who have a history of RPL or are secondary infertile compared with patients who are primary infertile.

Pregnancy Outcomes Following Hysteroscopic Resection of Uterine Septum: Does the Size Matter?

Study Objective Septate uterus is a common congenital malformation that is usually linked to obstetrical complications. The aim of our study is to compare pregnancy outcomes after hysteroscopic resection (metroplasty) of minor ( Design A retrospective cohort study. Setting A single tertiary affiliated medical center between January 2010 to March 2019. Patients or Participants All women who underwent hysteroscopic resection of uterine septum between 18-45 years old, followed by a documented pregnancy were included. Interventions Septum size was evaluated during operative hysteroscopy by the surgeon. Two groups were defined based on septum size: 1.minor ( Measurements and Main Results During the study period 57 women met inclusion criteria, of them 20 (35%) had a minor septum and 37 (65%) had a major septum. Baseline parameters including maternal age at metroplasty, Body mass index, parity and previous spontaneous abortions were comparable between the groups. The rate of preterm labor before and following uterine septum resection was comparable between the minor and major septum groups [(5/20 vs. 8/37; p=0.764), (3/20 vs. 11/37; p=0.182) respectively], however; decrease rate were observed in the minor group and increased in the major group. Linear regression analysis didn't find septum size to be associated with gestationl a age at delivery (P=-0.26; P=0.15) Conclusion Pregnancy outcomes following uterine metroplasty were comparable between minor and major septum groups. Further studies need to be done in order to strengthen our finding.

1266 Management of Complete Septate Uterus, Duplicated Cervix, and Longitudinal Vaginal Septum

Video Objective Learn the benefit of synchronous laparoscopic and hysteroscopic approach to a complex Mullerian anomaly. Review laparoscopic resection of endometriosis and hysteroscopic resection of complete uterine septum. Setting 19 year old female with complex Mullerian anomaly desiring fertility referred to a minimally invasive gynecologic surgery practice for surgical management. Interventions Diagnostic laparoscopy with resection of endometriosis and hysteroscopic resection of uterine septum. Conclusion A combined laparoscopic and hysteroscopic approach is beneficial when considering surgical management of complex Mullerian anomalies.

Pregnancy outcomes in viable pregnancies with a septate uterus compared with viable pregnancies after hysteroscopic uterine septum resection

Septate uterus is one of the more common Müllerian anomalies and is the anomaly most amenable to surgical correction. It is currently uncertain if hysteroscopic septum resection reduces the incidence of adverse pregnancy outcomes. The purpose of this study was to compare pregnancy outcomes in women who had reached at least 20 weeks gestation with those women with a uterine septum and those women who had undergone septum resection before pregnancy. Retrospective cohort study of women with a history of uterine septum who were cared for by a large maternal-fetal medicine practice from 2005-2018. We included women with singleton pregnancies at >20 weeks gestation. Baseline characteristics and pregnancy outcomes were compared between women with a history of a hysteroscopic uterine septum resection and women with an unresected septum. Regression analysis was performed to control for differences in baseline characteristics. The analysis was repeated in nulliparous women only. A total of 109 women (163 pregnancies) were included. In the entire population, pregnancy outcomes did not differ between the groups, aside from a higher rate of cesarean delivery in the resected septum group. In the 63 nulliparous women, septum resection was associated with later gestational ages at delivery (39.1 vs 37 weeks; P=.030), decreased preterm birth <37 weeks gestation (4.5% vs 31.6%; adjusted odds ratio, 0.154; 95% confidence interval, 0.027-0.877), and an increased incidence of cesarean delivery in women who attempted vaginal delivery (30.6% vs 0%; P=.012). There was no difference in the rates of small for gestational age, preeclampsia, blood transfusion, retained placenta, or morbidly adherent placenta. In nulliparous women with viable pregnancies, hysteroscopic resection of a uterine septum is associated with a decreased incidence of preterm birth and an increased incidence of cesarean delivery. These findings need to be confirmed in a well-designed randomized trial before uterine septum resection is recommended routinely.

Is IVF/ICSI [corrected] an Independent Risk Factor for Spontaneous Preterm Birth in Singletons? A Population-Based Cohort Study.

The aim of our study was to explore the risk factors for very preterm (gestation under 32 weeks) and moderate preterm birth (gestation weeks 32-36 6/7) in singleton pregnancies in a national retrospective cohort study. We also wanted to establish whether IVF/ICSI is an independent risk factor for preterm birth after adjusting for already known confounders. We used data for 267 718 singleton births from 2002-2015 from the National Perinatal Information System of Slovenia, containing data on woman, pregnancy, birth, the postpartum period, and the neonate for each mother–infant pair. Mode of conception, maternal age, education, BMI, parity, smoking, history of cervical excision procedure, history of hysteroscopic resection of uterine septum, presence of other congenital uterine malformations, bleeding in pregnancy, preeclampsia or HELLP and maternal heart, and pulmonary or renal illness were included in the analyses. Unadjusted OR for very preterm birth after IVF-ICSI was 2.8 and for moderate preterm birth was 1.7. After adjusting for known confounders, the OR was still significantly elevated (1.6 and 1.3, respectively). Risk factors for very preterm birth with OR higher than 2.4 were history of cervical excision procedure, resection of uterine septum, operation or having other congenital uterine malformations, and bleeding in pregnancy. Risk factors for very preterm birth with OR between 1.4 and 2.1 were age >35 years, being underweight or obese, not having professional education, smoking, first birth, preeclampsia/HELLP, and IVF/ICSI. Risk factors for moderate preterm birth with OR higher than 2.4 were history of cold knife conization and other congenital uterine malformations. We found that even after adjustment, IVF/ICSI represents a single risk factor for early and late preterm birth even after adjustment with other risks such as maternal age, smoking, or a history of invasive procedures for either cervical intraepithelial neoplasia or infertility treatment.

Comparative analysis of intrauterine device placement or estrogen therapy to patients after hysteroscopic uterine septum resection

Whether the implement of Intrauterine Device (IUD) and/or Estrogen Replacement Therapy (ERT) is required for preventing intrauterine adhesion after transcervical hysteroscopic resection of uterine septum (TCRS) remains unclear, here, we report a retrospective cohort analysis of the outcomes of patients who had received different treatments after TCRS. Among the 223 cases received TCRS and/or postoperative treatments, the group A, B and C received TCRS at periods 2002-2007, 2007-2009 and 2009-2011 respectively. The group A of 74 patients was placed IUD for 2~3 months after operation. Group B of 63 patients was given ERT treatment for 2~3 cycles. Group C of 86 patients received neither IUD nor ERT. All of the patients were checked hysteroscopically for uterine cavity adhesions during the period of the third to the seventh days after the second menstruation. All pregnancies occurring during the observation period were recorded. The TCRS succeeded for all patients. None of them needed a twostage operation. Cavity membrane adhesion of uterine cavity formed in 3 cases, 2 cases and 2 cases in the groups A, B, C respectively. 194 of 223 patients got pregnant within one year after TCRS. 160 children had been delivered successfully. The live birth rate was 71.7% (160/223). The abortion rates after operation were 10 cases, 7 cases and 9 cases in A, B, C group respectively. Statistical analysis showed no significant differences in uterine adhesion, pregnancy rate, abortion frequency, live birth rate and the rate of cesarean section among the three groups. However, the postoperational cost of group C was significantly lower than that of groups A and B. In short, neither postoperational IUD placement, nor estrogen therapy, nor the combination of IUD and ERT demonstrated any discernible clinical benefits to the patients in preventing intrauterine adhesions and facilitating pregnancy after TCRS.

Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report

Abstract Uterine rupture is a catastrophic obstetrical emergency with unpleasant maternal and fetal outcomes. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 32 weeks of gestation in a 28-year-old woman with previous history of hysteroscopic resection of uterine septum after development of acute abdomen. Repair of anterior uterine wall longitudinal tear was performed through emergency laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent UR in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures.

Recurrent large uterine fundal dehiscence during cesarean section after hysteroscopic uterine septum resection with uterine perforation

Abstract Septum resection using hysterescopy is safe, rapid and efective, but some late complication of it may be seen as uterine rupture or dehiscence of uterine wall during pregnancy due to myometrial damage. We present a case of recurrent large uterine fundal dehiscence conscecutive to cesarean section in a patient who had previously undergone a uterine septum resection. The patient was a 35-year-old who presented at 39 weeks of gestation (Gravida 2, Parity 1) and was admitted for an elective cesarean section. Her reproductive history included a septum resection which resulted in uterine perforation, and one previous cesarean section in which a large fundal defect was found and repaired. Then the examination had shown an aproximately 5 cm large uterine fundus defect including all three layers of uterus which had been repaired. Perforation or excessively deep incision of uterine fundus during hysteroscopic metroplasty may cause chronic weakness of the uterine wall especially at fundal localization. Our case was an incidental uterine wall dehiscence during cesarean section. Patients with an uterine septum resection history should be followed up carefully for uterine rupture during pregnancy.

Cervical assessment in women with hysteroscopic uterine septum resection: a retrospective cohort study

Objective: To estimate whether cervical length measured by transvaginal ultrasonography in women with a history of hysteroscopic uterine septum resection predicts spontaneous preterm birth <35 weeks’ gestation.Methods: This retrospective cohort study compared women who had undergone hysteroscopic metroplasty, and were subsequently pregnant with singleton gestations delivered January 2003 to December 2012, to a low-risk control group. Transvaginal ultrasonographic cervical lengths were measured 16–30 weeks’ gestation. The primary outcome was spontaneous preterm birth <35 weeks’ gestation and the primary exposure variable of interest was cervical length.Results: Women with a uterine septum resected (N = 24) had a shorter cervical length (2.90 cm) than the low-risk control group (N = 141, 4.31 cm, p < 0.0001); and were more likely to have a cervical length <3.0 cm (41.7% versus 1.4%, p < 0.0001), <2.5 cm (33.3% versus 0%, p < 0.0001), <2.0 cm (16.7% versus 0%, p < 0.0001) and <1.5 cm (12.5% versus 0%, p = 0.003). Women with septum resected were more likely to receive corticosteroids (33.3% versus 11.3%, p = 0.010), but were not more likely to have a spontaneous preterm birth <35 weeks (4.2% versus 0.7%, p = 0.27). There were no differences noted in secondary outcomes including neonatal morbidity.Conclusion: Pregnant women with a history of a hysteroscopic uterine septum resection have shorter cervical lengths than low-risk controls but may not be at a higher risk of spontaneous preterm birth <35 weeks’ gestation. Further research with a larger sample size is needed to evaluate this group of women to determine if transvaginal ultrasonographic cervical length assessment is of benefit.