Ultrasonographic Assessment Of Cervical Length Research Articles

Value of Transvaginal Ultrasonographic Assessment of Cervical Length in Predicting Duration of Second Trimester Pregnancy Termination

Value of Transvaginal Ultrasonographic Assessment of Cervical Length in Predicting Duration of Second Trimester Pregnancy Termination

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes.

PurposeTo develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model.Materials and MethodsThis retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis.ResultsRisk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2.ConclusionFor women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.

Ultrasonographic assessment of cervical length in pregnancies scheduled for a cesarean delivery: prediction of early spontaneous onset of labor

To investigate whether the cervical length measured by transvaginal ultrasound at 35 to 36 weeks of gestation is predictive of spontaneous early onset of labor in pregnancies scheduled for elective cesarean section (CS). This was a prospective observational study on 167 women scheduled for elective CS at 39 weeks of gestation. The cervical length was measured ultrasonographycally at 35 to 36 weeks of gestation and the pregnancies characteristics were recorded. The presence or absence of spontaneous onset of labor before the time scheduled for elective CS was related to cervical length and pregnancies characteristics. Of the 167 pregnancies enrolled, 25 (14.97%) underwent early spontaneous onset of labor before the time scheduled for the elective CS. The cervical length was significantly shorter in these women when compared with those delivering with an elective CS (21 vs. 30 mm z=5.49 P<0.0001). The presence of ≥2 previous CS as an indicator for elective CS resulted a significant predictor of early onset of labor in univariate analysis (P=0.01). Multivariate logistic regression analysis showed that cervical length (adjusted odds ratio 1.40; 95% confidence interval (CI) 1.22-1.61; P≤0.0001) was the only predictor for the early onset of labor. The area under the receiver-operating characteristics curve for the prediction of early onset of labor was 0.844 (95% CI 0.738-0.950) for cervical length as test variable. Kaplan-Meier analysis demonstrated that a cervical length <24 mm was significantly associated with a short time interval to delivery (log rank test χ2=99,98; P≤0.0001). Cervical length at 35-36 weeks of gestation provides information about the likelihood of spontaneous early onset of labor in pregnancies scheduled for CS and may be useful in individualizing the gestational age for elective CS.

500: Non-invasive prediction of chorioamnionitis in women with preterm premature rupture of membranes

with preterm premature rupture of membranes Kyo Hoon Park, Shi Nae Kim, Eun Ha Jeong, Sung Youn Lee, Aeli Ryu, Kyung Joon Oh Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Obstetrics and Gynecology, Seongnam-si, South Korea OBJECTIVE: To develop a model based on non-invasive clinical and ultrasonographic parameters to predict the probability of subsequent chorioamnionitis in women with preterm premature rupture of membranes (PPROM), and to determine if additional invasive test results improve the prediction of subsequent chorioamnionitis based on the non-invasive model. STUDY DESIGN: Transvaginal ultrasonographic assessment of cervical length was performed and maternal serum C-reactive protein (CRP) and white blood cell (WBC) count were determined immediately after amniocentesis in 106 consecutive women with PPROM at 23 0/7-33 6/7 weeks of gestation. Amniotic fluid (AF) obtained by amniocentesis was cultured and interleukin-6 (IL-6) levels and WBC counts were determined. Outcome measures were histologic and clinical chorioamnionitis. The placentas were examined histologically for presence of chorioamnionitis and women were evaluated for evidence of clinical chorioamnionitis. RESULTS: The non-invasive model (model 1) for prediction of histologic chorioamnionitis included serum C-reactive protein (CRP), gestational age, and parity. The model was shown to have an adequate goodness of fit, and the area under the receiver operating characteristic curve (AUC) was 0.756. When adding AF IL-6, AF culture, and AF WBC as invasive markers to the non-invasive model, serum CRP and parity were excluded from the final model (model 2) as not significant, whereas AF IL-6 and gestational age remained in model 2. No significant difference in AUC was found between models 1 and 2. For the outcome of clinical chorioamnionitis, no parameters studied could be identified to predict women at high risk for its development, although the association with AF culture results was borderline statistically significant (P 0.055). CONCLUSION: In women with PPROM, the non-invasive model based on serum CRP, gestational age, and parity was shown to be moderately predictive of developing histologic chorioamnionitis. However, invasive test results did not add predictive information to the non-invasive model in this setting.

Nitric oxide metabolite levels and assessment of cervical length in the prediction of preterm delivery among women undergoing symptomatic preterm labor

ObjectiveTo evaluate the diagnostic accuracy of measuring cervical length (CL) in combination with cervical and plasma nitric oxide metabolite (NOx) levels to identify women undergoing preterm labor (PTL) who will deliver preterm. MethodsA hospital-based prospective cohort study of 730 women undergoing spontaneous PTL between 24 and 33weeks+6days of pregnancy was conducted. Measurement of cervical and plasma NOx levels and ultrasonographic assessment of CL were performed to find the best model to predict preterm delivery (PTD). Optimal cut-off values were calculated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis and rank correlation tests were also performed. ResultsCL of 15mm or less, cervical NOx levels greater than 87.6μmol/L, and plasma NOx levels greater than 123μmol/L (P<0.0001) were the only factors significantly associated with PTD within 7days of sampling. This combined model provided high diagnostic accuracy (sensitivity 80.0%; specificity 99.2%). Both cervical and plasma NOx levels were negatively correlated with CL (r=−0.453, P<0.0001 and r=−0.362, P<0.0001, respectively). ConclusionCombined measurement of CL and levels of cervical and plasma NOx could help identify women undergoing symptomatic PTL who are at increased risk of PTD.

Prediction of imminent preterm delivery in women with preterm premature rupture of membranes

To develop a model based on non-invasive clinical parameters to predict the probability of imminent preterm delivery (delivery within 48 h) in women with preterm premature rupture of membranes (PPROM), and to determine if additional invasive test results improve the prediction of imminent delivery based on the non-invasive model. Transvaginal ultrasonographic assessment of cervical length was performed and maternal serum C-reactive protein (CRP) and white blood cell (WBC) count were determined immediately after amniocentesis in 102 consecutive women with PPROM at 23-33+6 weeks. Amniotic fluid (AF) obtained by amniocentesis was cultured and interleukin-6 (IL-6) levels and WBC counts were determined. Serum CRP, cervical length, and gestational age were chosen for the non-invasive model (model 1), which has an area under the curve (AUC) of 0.804. When adding AF IL-6 as an invasive marker to the non-invasive model, serum CRP was excluded from the final model (model 2) as not significant, whereas AF IL-6, cervical length, and gestational age remained in model 2. No significant difference in AUC was found between models 1 and 2. The non-invasive model based on cervical length, gestational age, and serum CRP is highly predictive of imminent delivery in women with PPROM. However, invasive test results did not add predictive information to the non-invasive model in this setting.

Transvaginal ultrasonographic assessment of cervical length following mid-trimester loss of one twin

A 33-year-old woman, G3P0+2, dichorionic, diamniotic twin pregnancy who conceived following IVF treatment presented to the antenatal day assessment unit at 19+1 weeks' gestation with contractions, ...

Transvaginal ultrasonographic measurement of cervical length in predicting intra-amniotic infection and impending preterm delivery in preterm labor: a comparison with amniotic fluid white blood cell count

To determine whether sonographic measurement of cervical length predicts intra-amniotic infection and impending preterm delivery (within 7 days of amniocentesis) in women with preterm labor and intact membranes, and to compare the predictability with that of amniotic fluid (AF) white blood cell (WBC) count. Transvaginal ultrasonographic assessment of cervical length was performed immediately after amniocentesis in 67 consecutive women with preterm labor. AF obtained by amniocentesis was cultured for aerobic and anaerobic bacteria and for Mycoplasmas, and WBC count was determined. Patients with a positive AF culture had a significantly shorter median cervical length, higher median AF WBC count, and lower median gestational age at delivery than did those with a negative AF culture. Multivariate analysis indicated that only the AF WBC count bears a significant relationship with the presence of intra-amniotic infection, whereas only cervical length correlates with impending preterm delivery. Transvaginal sonographic measurements of cervical length are a valuable method for predicting intra-amniotic infection as well as impending preterm delivery in women with preterm labor. However, in comparison with AF WBC, cervical length is less predictive for intra-amniotic infection, whereas cervical length demonstrates better predictability of impending preterm delivery.

Curvas de normalidad de la longitud cervical ecográfica según edad gestacional en población española

ObjectiveTo establish gestational age-dependent normal values of ultrasonographic assessment of cervical length in Spanish singleton and twin pregnancies. Subjects and methodsPregnant women undergoing routine ultrasound scans between weeks 12 and 36 at our unit were studied. Transvaginal ultrasound examinations were performed in 285 singleton pregnancies and in 281 twin pregnancies. The mean cervical length and the 5th and 95th percentiles were calculated for each gestational week and curves of normality were obtained. ResultsCervical length progressively decreased with gestational age. At the beginning of the second trimester, the 5th percentile was 25 mm in both singleton and twin pregnancies. In the third trimester, there was a sharp decrease, especially in twin pregnancies, reaching 15 mm in singleton pregnancies and less than 10 mm in twin pregnancies. ConclusionsOur results provide cut-off values for the clinical and investigational use of ultrasound measurement of cervical length. The differences between singleton and twin pregnancies warrant the use of adapted reference curves.

Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage.

The purpose of this study was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting. This was a retrospective analysis of 53 women undergoing cervical cerclage by a maternal-fetal medicine specialist, regardless of indication, and delivering between January 1999 and April 2001. Transvaginal ultrasonographic assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes including gestational age at delivery. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage. Cervical cerclage resulted in a significant increase in cervical length from 2.1 +/- 1.2 cm to 2.9 +/- 0.8 cm after the procedure, P < 0.001; however, this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 +/- 5.6 weeks vs. 36.8 +/- 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P= 0.002. Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery.

Ultrasound-indicated cervical cerclage: Outcome depends on preoperative cervical length and presence of visible membranes at time of cerclage

Objective: The purpose of this study was to assess cases of ultrasound-indicated cervical cerclage and to relate preoperative cervical length, operative findings, postoperative cervical length, and pregnancy outcome to establish the appropriate criteria to offer cervical cerclage. Study Design: A prospective observational study comprised 380 women at high risk of preterm labor who underwent serial transvaginal ultrasonographic assessment of cervical length. Seventy-three women had criteria for and underwent cervical cerclage. Data concerning preoperative cervical length, operative findings, postoperative cervical length, and pregnancy outcome were collected. Statistical analysis was performed with Mann-Whitney and Fisher exact tests. Results: There was a significant increase in median cervical length after cerclage, 15.0 versus 25.0 mm (P <.0001). Preoperative cervical length and postoperative upper cervical length were independently better predictors of outcome than postoperative entire cervical length. Fetal membranes were visible in 18% of cases at the time of suture insertion, which was associated with a significantly worse outcome, regardless of preoperative cervical length. Of those 41 women with a very short preoperative cervical length (≤15 mm), outcome was significantly worse in those women with visible fetal membranes at the time of cerclage compared with those women with no visible fetal membranes at the time of cerclage: median gestational age at delivery, 23 weeks versus 37 weeks 4 days (P =.002); suture insertion to delivery interval, 19 days versus 108 days (P =.0004); and fetal survival rates, 50% versus 86% (P =.03). Conclusion: In a high-risk population that undergoes serial transvaginal ultrasound surveillance of cervical length, the presence of visible fetal membranes at the time of suture insertion, regardless of preoperative cervical length, is associated with a poor outcome. Fetal membranes were not visible in any cases with a preoperative cervical length of >15 mm. These findings lend support to a practice of offering cerclage at or above a cervical length of 15 mm. (Am J Obstet Gynecol 2002;187:445-9.)

Ultrasound‐indicated cervical cerclage: operative findings and preoperative cervical length predict outcome

Objectives: To relate preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome in high risk women treated with ultrasound indicated cervical cerclage to establish if it was possible to determine the most appropriate criteria to offer cervical cerclage.Study design: A prospective observational study of 305 high risk women undergoing serial transvaginal ultrasonographic assessment of cervical length during the second trimester. Fifty‐four women met criteria for cerclage (cervical length &lt;15 mm, significant progressive shortening to &lt;25 mm or funneling &gt;50%). Data concerning preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome was collected, and analyzed data is expressed as median values. Statistical analysis was performed using Fisher's exact and Mann–Whitney U‐tests.Results: Gestation at delivery was 37 ± 5 weeks, suture insertion to delivery interval was 115 days and overall fetal survival rate was 85.2%. Median preoperative cervical length was 15.0 mm. Median gestation at suture insertion was 19 ± 5 weeks. There was a significant increase in postoperative cervical length 15.0 vs. 25.0 mm (P &lt; 0.0001). Fetal membranes were visible in 19% of cases at the time of surgery, this occurred in 75, 5, and 0% cases with a cervical length &lt;10, 11–15 and &gt;15 mm, respectively. Overall outcome was considerably worse for those cases with visible membranes at the time of surgery than for those with no visible membranes (gestation at delivery 23 ± 0 vs. 38 ± 2 weeks (P = 0.002), suture insertion to delivery interval 17 vs. 122 days (P &lt; 0.0001), fetal survival rates 50 vs. 93% (P = 0.0005)). This finding was regardless of preoperative cervical length (of all women with preoperative cervical length &lt;15 mm (n = 31) gestation at delivery 25 ± 1 vs. 35 ± 5 (P = 0.008), suture insertion to delivery interval 17 vs. 119 days (P = 0.0005), fetal survival rate 50 vs. 90%).Conclusions: In a high risk population undergoing serial transvaginal ultrasound surveillance of cervical length, regardless of preoperative cervical length, the presence of visible membranes at the time of suture insertion is associated with a poor outcome. Fetal membranes were not visible in any case with a preoperative cervical length &gt;15 mm. These findings support a concept of cervical cerclage at a cervical length of 15 mm.

Ultrasonographic assessment of cervical length in triplet pregnancies

Objective: Our goal was to evaluate the utility of ultrasonographic assessment of cervical length in the management of triplet pregnancies and to compare these measurements with previously reported data for singleton pregnancies. Study Design: The maternal records for all triplet pregnancies managed at the Mayo Medical Center from January 1993–January 1998 were reviewed. Cervical length assessment was undertaken at regular intervals during each pregnancy according to an established real-time transperineal ultrasonographic technique. Presence or absence of cervical funneling was noted at the time of the examination. Obstetric management and outcome data were assessed. Results: Thirty-two triplet pregnancies were managed at our institution between January 1993 and January 1998. Average duration of pregnancy (±SD) was 32.4 ± 2.3 weeks. Progressive cervical shortening was noted with advancing gestational age; average cervical lengths (±SD) were 42.0 ± 5.0 mm at 10 weeks, 37.0 ± 8.0 mm at 20 weeks, 26.0 ± 10.0 mm at 25 weeks, and 21.0 ± 7.0 mm at 30 weeks. Comparison of triplet cervical length measurements with reported data from singleton pregnancies revealed a significant difference between the singleton and triplet data, respectively, at both 24 weeks (35.2 ± 8.3 mm vs 25.0 ± 8.0 mm, P < .001) and 28 weeks (33.7 ± 8.5 mm vs 28.0 ± 11.0 mm, P < .005). Cervical funneling was noted in 3 women with an average of 27 days from onset to delivery. Conclusions: Ultrasonographic assessment of cervical length is a useful adjuvant in the management of the triplet gestation. Triplet cervical length measurements are significantly different from those reported for gestational age–matched singleton pregnancies. Premature cervical shortening and the presence of cervical funneling are harbingers of premature delivery and should necessitate obstetric intervention. (Am J Obstet Gynecol 1999;180:1442-5.)