Transvaginal Ultrasound Evaluation Research Articles

Role of ultrasound in detection of lymph-node metastasis in gynecological cancer: systematic review and meta-analysis.

To assess the diagnostic performance of transvaginal sonography (TVS) for the preoperative evaluation of lymph-node metastasis in gynecological cancer. This was a systematic review and meta-analysis of studies published between January 1990 and May 2023 evaluating the role of ultrasound in detecting pelvic lymph-node metastasis (index test) in gynecological cancer, using histopathological analysis as the reference standard. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and diagnostic odds ratio were estimated. The literature search identified 2638 citations. Eight studies reporting on a total of 967 women were included. The mean prevalence of pelvic lymph-node metastasis was 24.2% (range, 14.0-65.6%). The risk of bias was low for most domains assessed. Pooled sensitivity, specificity and diagnostic odds ratio of TVS were 41% (95% CI, 26-58%), 98% (95% CI, 93-99%) and 32 (95% CI, 14-72), respectively. High heterogeneity was found between studies for both sensitivity and specificity. TVS showed a high pooled specificity for the detection of pelvic lymph-node metastasis in gynecological cancer, but pooled sensitivity was low. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation.

Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding. Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment. The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site. Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.

Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58

Uterine blood flow assessment by colour Doppler for prediction of malignant endometrial pathologies in women with abnormal uterine bleeding

Introduction: Colour Doppler has emerged as useful adjunct to transvaginal sonography in evaluation of women with AUB. This study was carried out to evaluate the role of measurement of the Resistance index (RI) and Pulsatility index (PI) of the uterine arteries by Colour Doppler sonography to discriminate between benign and malignant endometrial condition in women with abnormal bleeding.Material and Methods: This prospective analytical study was performed to evaluate 70 women (30-60 years) with AUB. Spiral arterioles flow patterns, Resistance index (with 0.81 as cut off) and Pulsatility index (with 1.83 as cut off) of uterine arteries were analysed by colour Doppler after detailed TVS. They were compared with Histopathological report of Endometrial Aspiration biopsy. Results: 10 patients (14.3%) had RI in malignancy range (> 0.81) and 9 patients (12.9%) had PI in malignancy range (< 1.83). Out of these 8 had both RI and PI in malignancy range. Thus 11 cases (15.7%) having either RI/PI or RI and PI both, in malignancy range were considered to be suspected of malignancy. Out of these 11 cases, 5 patients were diagnosed to have Hyperplasia/Malignancy on histopathology. There were no False Negative cases, making the sensitivity 100% and specificity 90.7% of TVS with colour Doppler. For the vascular patterns, both cases of hyperplasia had scattered vessel pattern and all 3 cases of carcinoma had multiple vessel pattern, making the association of vascular pattern with AUB diagnosis significant (p<0.001).Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions. Therefore, it is recommended that CDTU with TVS should be used as screening modality in all AUB patient.

Comparison of transabdominal sonography and transvaginal sonography in evaluation of endometrial thickness in the setting of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a common complaint in women of reproductive age for which they consult their gynecologist and is the direct cause of a significant health-care burden for women. Imaging plays a pivotal role in diagnosing and helping the clinicians choose an appropriate management strategy at the earliest possible juncture, thus relieving patients of their symptoms and preventing complications. This tertiary care hospital-based study aims to assess the role transabdominal sonography in comparison with transvaginal sonography in evaluation of endometrial thickness in the setting of AUB in of in female population of Kancheepuram and West Chennai district of Tamil Nadu. Materials and Methods: It is a prospective study conducted in the Department of Radiology, of a tertiary care hospital in Kancheepuram district of Tamil Nadu, India. One hundred adult females who presented with complaints of abnormal bleeding per vaginum underwent both transabdominal (TAS) and transvaginal ultrasonography (TVS). In addition, they were evaluated for AUB through assessment of endometrial thickness and the presence of other uterine and adnexal pelvic pathologies. Result: The results of the present study show that TVS is superior to TAS in assessing endometrial thickness accurately and has a slightly better role in diagnosing endometrial pathologies such as endometrial polyp, hyperplasia, endometrial carcinoma, and number and location of Submucosal/intramural leiomyomas. Conclusion: TVS is superior to TAS in assessing endometrial thickness accurately and have high sensitivity and accuracy in the diagnosis of pelvic pathologies and determination of the type of pelvic mass was improved significantly when a transvaginal study was performed after TAS in cases of AUB.

Ovarian Remnant Syndrome Versus Retroperitonealized Ovary: Preoperative Evaluation and Surgical Management

<h3>Study Objective</h3> Our objectives are to compare the definitions of ovarian remnant syndrome and retroperitonealized ovary, present a patient with each condition, describe the preoperative evaluation, and demonstrate the surgical management. <h3>Design</h3> Perioperative evaluation and laparoscopic excision of ovarian remnant syndrome and retroperitonealized ovary. <h3>Setting</h3> Tertiary care center. <h3>Patients or Participants</h3> Reproductive-aged women presenting with pelvic pain and a history of prior pelvic surgery subsequently diagnosed with ovarian remnant syndrome or retroperitonealized ovary. <h3>Interventions</h3> Minimally-invasive retroperitoneal dissection and excision of ovarian remnant or retroperitonealized ovary. <h3>Measurements and Main Results</h3> Ovarian remnant syndrome is the presence of ovarian tissue following an oophorectomy, and retroperitonealized ovary is the presence of ovarian tissue in the retroperitoneum. Patients with a history of pelvic surgery, particularly with extensive retroperitoneal dissection, are at risk for these conditions. Retroperitonealized ovary occurs most frequently following ovarian cystectomy, while ovarian remnant syndrome occurs after oophorectomy. Importantly, ovarian remnant syndrome can usually be anticipated during preoperative evaluation, while retroperitonealized ovary is encountered during the surgery. Patients typically present with chronic pelvic pain. The preoperative workup for patients with suspected retroperitonealized ovary or ovarian remnant syndrome includes a detailed patient history, thorough physical exam, and transvaginal ultrasound evaluation. A follicle-stimulating hormone and estradiol level can evaluate for ovarian function, while a clomiphene provocation test can be used if an ovarian mass is not initially visualized on imaging. Surgical excision is the recommended management option for both conditions. It involves dissection and removal of the ovary from the surrounding structures. In patients with endometriosis, the isolation and removal of the ovarian tissue is typically complicated by dense adhesions to the pelvic sidewall, ureter, and bowel. Complete surgical resection of the ovarian tissue is imperative, as patients are at risk for endometriosis and ovarian cancer. <h3>Conclusion</h3> Both ovarian remnant syndrome and retroperitonealized ovary are potential sequelae of prior pelvic surgery and require surgical resection.

Ovarian volume as an independent marker for metabolic dysfunction in women with suspected androgen excess

To determine whether ovarian volume (OV) alone is an independent marker for metabolic dysfunction in women with suspected androgen excess. Retrospective cohort study. Tertiary academic reproductive endocrinology clinic. Women aged ≥21 years recruited/referred for symptoms related to androgen excess. Transvaginal ovarian ultrasound, physical and medical evaluation, 2-hour 75-g oral glucose tolerance test (oGTT), and blood sampling. Prevalence of hyperandrogenism and metabolic dysfunction. This study included 666 women, of whom 412 (61.9%) and 254 had OVs of >10 and ≤10 mL, respectively. An OV of >10 mL was associated with a higher prevalence of hirsutism (65.1% vs. 51.5%) than an OV of ≤10 mL. Polycystic ovary syndrome by the National Institutes of Health 1990 criteria was found in 67.3% and 51.4% of women with OVs of >10 and ≤10 mL, respectively. Metabolic parameters, including body mass index, waist circumference, and 1-hour insulin levels during the oGTT (odds ratio, 1.98; 95% confidence interval, 1.18-3.31), were significantly higher in women with an OV of >10 mL than in those with an OV of ≤10 mL. An OV of ≤10 mL had a 76.3% negative predictive value for hyperinsulinemia at 1 hour. In women with suspected androgen excess, an OV of >10 mL in at least 1 ovary is not associated with metabolic syndrome but is associated with younger age; an increased body mass index and waist circumference; a higher prevalence of hirsutism, oligoovulation, and polycystic ovary syndrome; and a higher 60-minute insulin level during the oGTT. Overall, an increased OV appears to be a good marker for hyperinsulinemia and hyperandrogenism in women suspected of having an androgen excess disorder.

Transvaginal ultrasound evaluation of the pelvis and symptoms after laparoscopic partial cystectomy for bladder endometriosis

Objective:To evaluate transvaginal sonography (TVS) findings after laparoscopic partial cystectomy for bladder endometriosis and to correlate postsurgical ultrasound findings with symptoms.Material and Methods:A retrospective study including women who underwent laparoscopic partial cystectomy for bladder endometriosis. Within 12 months after surgery, TVS examination was conducted in all patients to evaluate the bladder morphology, and the presence of any postsurgical sonographic findings of the pelvis. Painful symptoms were assessed using a visual analogue scale.Results:A total of 40 women were included. At the follow-up visit, 25 patients were receiving medical treatment while 15 had declined post-surgical therapy and had tried to conceive. The presence of bladder deep-infiltrating endometriosis (DIE) was found in nine (22.5%), fibrotic thickening of the bladder wall was found in 15 (37.5%), and normal bladder morphology was observed in 16 (40%). There was a correlation between anterior adenomyosis and bladder DIE, and fibrotic thickening of the bladder. Patients with TVS signs of bladder DIE and anterior adenomyosis suffered more dysmenorrhea and dysuria than patients with normal bladder.Conclusion:Post-operative TVS can detect the alteration of pelvis and could explain the causes of the persistence of symptoms.

STUDY TO CORRELATE HISTOPATHOLOGICAL FINDINGS WITH ENDOMETRIAL THICKNESS EVALUATED BY TRANSVAGINAL SONOGRAPHY IN POST MENOPAUSAL BLEEDING

almost ninety percent of post-menopausal females with endometrial cancer report a vaginal bleeding experience. Objectives: To nd correlation of radiological and histopathological ndings so that early evaluation of malignancy can be done. Materials And Methods: The Present Study included 50 Patients with abnormal uterine bleeding in postmenopausal women, aged between 45-70 years. All patients were subjected to transvaginal ultrasonographic evaluation of the endometrium and the results were correlated to the histopathological picture of the endometrium after curettage in an attempt to discriminate normal endometrium from abnormal pathological patterns. Results And Analysis: Thirteen patients (26%) had pathological ndings. There was signicant difference in the mean endometrial thickness of nonpathological and abnormal endometrium in postmenopausal patients with P value &lt;0.001**. Among the thirteen patients with pathological ndings eight had endometrial hyperplasia, two had polyp and three had malignancies. Conclusions: It may be concluded that vaginal sonographic measurement of endometrial thickness is an acceptable less invasive alternative to hysteroscopy and D &amp; C and needs to be popularized as rst line investigation in the management of Postmenopausal bleeding in rural population

Transvaginal Ultrasound evaluation of the Cesarean scar: relation between a niche and abnormal uterine bleeding

Transvaginal Ultrasound evaluation of the Cesarean scar: relation between a niche and abnormal uterine bleeding

Transvaginal ultrasound evaluation of the ureter.

ObjectiveIn this video, we present our technique for ureter assessment during pelvic ultrasound examination.MethodsWe used a general electric Voluson E10 (General electric, Wauwatosa, WI, USA) to perform transvaginal ultrasonography. These images were shared after thorough counselling, and obtaining informed consent from the patient. This video was edited using FinalCut ProX® (Apple Inc, Cupertino, CA, USA).ResultsWe systematized this routine after assessing the cervix, uterus, and adnexa. The vaginal probe was slightly removed to focus on the urethra. Next, we approached the hand on the contralateral thigh to the ureter. At this point, the probe was directed to the lateral pelvic wall where the ureteric orifice was found. Then, we raised our hands and perform an internal rotation movement to ascend the ureteral segments until it is related to the iliac vessels.ConclusionThe urinary tract may be involved in gynecological pathologies. Transvaginal ultrasound is an easy, reproducible, and well-tolerated examination that can be used to evaluate the ureters below the pelvic brim.

Ten ultrasound endometrial issues

Abnormal uterine bleeding is probably the most frequent gynecological issue that leads women to a consult with a subsequent ultrasound. Transvaginal ultrasonographic evaluation represents the most sensitive method of endometrial evaluation, being more adequate than the transabdominal approach, especially when differentiating the benign lesions from the malignant ones. Transvaginal ultrasound is extremely useful in measurement, morphology and vascularization examination of the uterine cavity, especially the endometrium. We present 10 endometrial issues in which transvaginal ultrasound has proven its utility in the paraclinical evaluation of the patient: endometrial cycle phase, endometrial thickness, endomyometrial junction, endometrial vacuum line, cystic endometrium, endometrial vascularization, endometrial polyp, intracavitary development of leiomyomas, thick endometrium and endometrial cancer.

Saline infusion sonohysterography in endometrial exploration

Contrast substances have been an extremely important addition in the ultrasonographic examination of the female internal genital organs. Saline infusion sonohysterography consists of the transcervical instillation of fluid into the uterine cavity to improve endometrial visualization while performing a transvaginal ultrasound evaluation. Therefore, benign endometrial pathology such as hyperplasia, but most of all focal lesions like polyps, leiomyomas, or adhesions, as well as suspected malignant pathology such as endometrial cancer, can be better assessed during ultrasound examination. Saline infusion sonohysterography is an important tool for avoiding unnecessary biopsies in postmenopausal women with an apparent thicker endometrium; for women of fertile age, saline infusion sonohysterography can be used to select those females who require further therapeutic procedures, especially in infertility, caused by endometrial pathology. Sonohysterography is very well tolerated by patients, has a minimum degree of discomfort, can be performed without hospitalization and can be easily performed at a reduced cost.

331 Correlation between MRI and transvaginal-ultrasound cervical length measurements in pregnancies complicated by twin-twin transfusion syndrome

Twin pregnancies are at high risk of preterm birth, especially when complicated by twin-twin transfusion syndrome (TTS). Pregnancies with TTTS that are candidates for selective fetoscopic laser photocoagulation (SFLP) at our institution undergo transvaginal ultrasound (TVUS) and MRI evaluation of cervical length (CL) to assess preterm birth risk during the perioperative period. There is a paucity of data on accuracy of MRI for cervical length screening in high-risk pregnancies. We sought to investigate the correlation of CL between the two imaging modalities Retrospective cohort study comparing TVUS to MRI measures of CL in pregnancies that underwent SFLP for TTTS at a single center, 4/2010-6/2019. Among 626 pregnancies, data on pre-operative TVUS (n=579), MRI (n=424), and post-op TVUS (n=596) CL measures were available for analysis. Correlation was estimated using Pearson’s coefficient, mean CL measurements were compared with two-tailed paired T-test, and frequency of short cervix detection by the two imaging modalities was compared with chi-square The mean pre-op CL by MRI was an average of 3 mm shorter than the TVUS CL, 39 vs 42mm, respectively (p=0.002). The frequency of short CL ≤25 mm was 39(6.7%) by TVUS and 47(10.8%) by MRI, p=0.0001. CL measures by MRI correlate with TVUS overall (r=0.64); however, the correlation is poor at the shortest cervical lengths (r<0.20), see figure. MRI missed n=2(40%), 3(18.8%), 9(32.1%), and 13(28.9%) of CL cases detected as short by TV US at cut-offs of ≤15, 20, 25 and 28 mm, respectively. Sensitivity analyses excluding or adjusting for cerclage and pessary did not alter these findings Although MRI measurement of CL correlates well with TVUS overall, it performs poorly to accurately detect short cervix. Although prenatal MRI has some fetal anatomic diagnostic advantages over ultrasound, TVUS remains the optimal screening modality for cervical length in pregnancies at high-risk of preterm birthView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Transvaginal ultrasound evaluation of uterine scar in pregnant women with a previous cesarean section

Transvaginal ultrasound evaluation of uterine scar in pregnant women with a previous cesarean section

Hysteroscopic and ultrasonographic evaluation of ulipristal acetate treatment for symptomatic myomas in premenopausal women: a prospective study

Objective This study aimed to analyze the effects of a six-month therapy with ulipristal acetate (UPA) on myoma size and endometrial thickness in premenopausal women. Material and methods Seventy-four women undergoing conservative therapy with UPA were enrolled for this study. All women underwent transvaginal ultrasound evaluation to assess the endometrial thickness, and the number and size of myomas at the beginning and after six months. Hysteroscopy and biopsy were performed after six months, if necessary. Results After six months of treatment, sonographic examination showed a statistically significant (p < .05) reduction of the size of the largest myoma (56.3 ± 5.1 vs. 31.7 ± 10.1 mm) and a statistically significant (p < .05) increase in endometrial thickness (5.9 ± 2.1 vs. 9.7 ± 3.4 mm). Twenty-two patients with endometrial thickness >10 mm or nonhomogeneous pattern and ten patients with metrorrhagia underwent hysteroscopy: the most frequent finding was the combination of endometrial hypotrophy, floating surface, and chicken-wire vascular pattern aspect (14 cases, 43.7%). Histologic findings showed no case of complex hyperplasia. Conclusion UPA is a safe, effective and assured method to decrease symptoms, reduce the need for surgery in premenopausal women suitable for the treatment.

VP57.03: Transvaginal ultrasound evaluation of cervix as a tool in predicting successful labour induction in term pregnancies: systematic review and meta‐analysis

The study aims to determine diagnostic value of transvaginal ultrasound cervical evaluation in labour induction outcome in term pregnancies, review of published studies on pre-induction ultrasound cervix evaluation compared to Bishop score and to recognise factors in cervical evaluation that is sensitive and specific in predicting labour induction outcome. Published articles from Cochrane, PubMed/MEDLINE, Medscape, Herdin and Googlescholar were searched to find eligible studies from January 2000 up to present. Key words used are "transvaginal ultrasonography", "induction of labour", "cervical assessment" and "cervical length". Full articles obtained and studied for content, data extraction and analysis. Eligible studies are observational prospective studies that evaluated pre-induction transvaginal ultrasound cervical assessment to predict successful labour induction in term pregnancies and those comparing ultrasound cervical evaluation and Bishop score. Studies with patients already in labour were excluded, as well as narrative systematic reviews, retrospective design and case reports. A total of five published literatures were included. The analysis of pooled data demonstrated that there is no significant difference in transvaginal cervical length measurement and Bishop score in predicting successful labour induction in term pregnancies using the fixed effects (Z = 1.39; p = 0.16) models. Comparing Bishop score and cervical length, it can be seen that those data coming from Bishop score were highly favourable. However, when tested for significance at 0.05 level, it yielded a value of 1.39. This is lower than the z-value of 1.96 at 0.05 level. The review proved there is no significant difference in transvaginal cervical length measurement and Bishop score in predicting successful labour induction in term pregnancies. However, cervical length measurement as well as Bishop score yielded successful labour induction with mean cut-off values of <3cm & score of >/ = 4, respectively.

Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial Thickness for the Prediction of Preterm Labor in Twins Gestations. Observational Study

Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and recently lower uterine segment myometrial thickness had been used for this purpose. Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies. Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm group and full-term group. Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT ≥4. among patients who delivered at full term, 50 patients (96.2%) had LUS-MT ≥4.26 and 19 patients (43.2%) had LUS-MT <4.26. The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %, specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %. Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to be investigated.

Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial Thickness for the Prediction of Preterm Labor in Twins Gestations. Observational Study

Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and recently lower uterine segment myometrial thickness had been used for this purpose. Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies. Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm group and full-term group. Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT ≥4. among patients who delivered at full term, 50 patients (96.2%) had LUS-MT ≥4.26 and 19 patients (43.2%) had LUS-MT <4.26. The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %, specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %. Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to be investigated.

Prediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkers

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers n cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk, In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL25mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL 25mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women