Mid-Trimester Endovaginal Sonography in Women at High Risk for Spontaneous Preterm Birth

Owen, John; Yost, Nicole P.; Berghella, Vincenzo; Thom, Elizabeth; Swain, Melissa; Dildy, Gary A.; Miodovnik, Menachem; Langer, Oded; Sibai, Bahaeddine M; McNellis, Donald

doi:10.1001/jama.286.11.1340

Cited by 448 publications

(279 citation statements)

References 29 publications

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“…The remaining 14 studies were included in the review. One of the included articles 50 was a secondary analysis of an initial study 31 . Both publications were included in the present analysis as they presented data for different gestational ages of preterm birth.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies have evaluated the use of transvaginal ultrasonography in asymptomatic high-risk women 29,31 , but differences among them exist regarding the cervical length cut-off defined as abnormal, gestational age at which transvaginal ultrasonography was performed and the gestational age at preterm birth. Previous meta-analyses have addressed the use of transvaginal ultrasonography to predict preterm birth in asymptomatic women, including those with singleton and multiple gestations 27,29 , and those presenting with threatened preterm labor 27 -29 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review

Crane

Hutchens

2008

Ultrasound in Obstet & Gyne

232

161

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Objectives To estimate the ability of cervical length measured by transvaginal ultrasonography in asymptomatic high-risk women to predict spontaneous preterm birth. January 1980 and July 2006, using the keywords 'transvaginal ultrasonography' or ('cervix' and ('ultrasound' or 'ultrasonography' or 'sonography')); and ('preterm' or 'premature') and ('delivery' or 'labour/labor' or 'birth') Methods MEDLINE, PubMed, EMBASE and the Cochrane Library were searched for articles published in any language between

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review

Crane

Hutchens

2008

Ultrasound in Obstet & Gyne

232

161

View full text Add to dashboard Cite

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“…Cervical length was measured from the internal to the external cervical os as has been described previously 6 13 If the cervix was significantly curved then the length was measured with trace mode rather than in a straight line 8 . Women were advised to have a full bladder for the TA scan and were then asked to void before the TV assessment.…”

Section: Methodsmentioning

confidence: 99%

“…The cervix lengthens with increasing bladder volume (Figure 1) and as increased transducer pressure is applied 7 . The process of cervical effacement and shortening appears to start at the internal cervical os, leading to funneling that may be revealed by applying fundal pressure 8 . The cervix is dynamic and protocols that standardise measurement recommend making multiple measurements over a five minute period of assessment 6 .…”

Section: Introductionmentioning

confidence: 99%

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Westerway

Pedersen

Hyett

2015

Australas J Ultrason Med

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Objective: To compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length at 16–41 weeks gestation. Methods: TA and TV ultrasound measurements of cervical length were made on 491 pregnancies of 16–41 weeks gestation. Cervical length was measured from internal to external cervical os. Bland‐Altman plots and Wilcoxon signed rank test were used to evaluate differences between TA and TV measurements. Results: The validity of the TA method depended on cervical length. Although the TA method underestimated cervical length by 2.0 mm on average (P < 0.001), Bland Altman plots showed an inverse trend with shorter cervixes. In women with a cervix < 25 mm (n = 30) based on TV scan measurement, TA overestimated cervical length by 12 mm (P < 0.001). The sensitivity and specificity of TA as a test to detect cervical length < 25 mm were 10% (95% CI: 2.1–26%) and 94% (95% CI: 92–96%) respectively; the negative LR was 0.96 (95% CI: 0.84–1.08). The maximum area under the ROC curve would be obtained at a TA cut‐off = 32 mm (to detect a cervix < 25 mm), corresponding to a sensitivity of 77% and a specificity of 58%. Conclusion: TA measurements do not reflect TV assessment accurately, particularly if the cervix is short. At 24–34 weeks, a policy of proceeding to TV scan if TA measurement is < 25 mm will only detect 10% of affected pregnancies and has a poor positive predictive value so is of limited value as a predictive tool for women attending with symptoms and signs of preterm labour > 24 weeks gestation. There is no value in TA assessment of the cervix > 36 weeks.

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“…If a measurement of cervical length is requested (usually because of a risk factor for cervical incompetence), or the cervix appears short on abdominal views, the cervix should be assessed transvaginally with an empty bladder 51 . The operator should aim to obtain a mid‐sagittal view of the cervix demonstrating the hypoechoic cervical canal.…”

Section: Other Structuresmentioning

confidence: 99%

A pictorial guide for the second trimester ultrasound

Bethune

Alibrahim

Davies

et al. 2013

Australas J Ultrason Med

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Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements. Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.

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Mid-Trimester Endovaginal Sonography in Women at High Risk for Spontaneous Preterm Birth

Abstract: Cervical length assessed by endovaginal sonography between 16 weeks' and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts spontaneous preterm birth before 35 weeks' gestation in high-risk women.

Cited by 448 publications

References 29 publications

Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review

Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review

Cervical length measurement: Comparison of transabdominal and transvaginal approach

A pictorial guide for the second trimester ultrasound

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