Novel developments on cervical length screening and progesterone for preventing preterm birth

Berghella, Vincenzo

doi:10.1111/j.1471-0528.2008.02008.x

Cited by 45 publications

(32 citation statements)

References 34 publications

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“…16,19,28,29,35 They reported that cervical length measurement by transvaginal ultrasonography is an accurate and valid method of measuring the cervix, 35 and may be a useful method of predicting who is at risk for preterm delivery. 16,19 This hypothesis turned out to be true with postconization patients. 28 The cervical length appears to be inversely proportional to the risk of preterm birth.…”

Section: Discussionmentioning

confidence: 99%

“…The mid-trimester cervical length was measured by ultrasonography between 14 to 28 gestational weeks based on previous studies. [16][17][18] Cervical length less than 2.5 cm was considered to be short. 16,19 Each conization specimen consisted of 1 to 3 fragments.…”

Section: Methodsmentioning

confidence: 99%

“…[16][17][18] Cervical length less than 2.5 cm was considered to be short. 16,19 Each conization specimen consisted of 1 to 3 fragments. The volumes of the conization specimen were the sum of all fragments from the pathology report.…”

Section: Methodsmentioning

confidence: 99%

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Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage

et al. 2010

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Objective: This study examined the risk factors for preterm birth and the efficacy of prophylactic cerclage in patients who had undergone cervical conization due to cervical intraepithelial neoplasia before pregnancy. Methods: We reviewed the medical records of all patients who gave live singleton births between May 1996 and April 2009, after having cervical conization. Delivery before 37 gestational weeks was considered as preterm birth. The pregnancy outcomes were analyzed with independent sample t-test, chi-square test, and multiple logistic regression using the SPSS ver. 12.0. Results: Sixty five cases were found. The mean gestational age at delivery was 37 weeks (SD, 3.5). Eighteen patients (27.7%) had preterm delivery. The type of conization, the volume of the specimen, and second trimester cervical length were related to preterm birth (p≤0.001, p=0.019, p≤0.001, respectively). In multivariate analysis, only mid-trimester cervical length was statistically significant for preterm birth (p=0.012; odds ratio, 0.194; confidence interval, 0.055 to 0.693). Six out of 65 patients had undergone prophylactic cerclage, and three (50%) of them had preterm births, while 15 (25%) patients without cerclage had preterm births. Conclusion:The type of conization, the volume of specimen, and second trimester cervical length may be the risk factors for preterm birth in patients who have a prior history of cervical conization. Prophylactic cerclage may not be helpful in preventing preterm birth, therefore more careful consideration should be paid in deciding cerclage after conization during prenatal counseling.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage

et al. 2010

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“…The alignment of collagen varies from one layer to another with inner and outer layer having collagen arranged longitudinally, however middle layer has circumferentially aligned collagen [15,41,42]. As the cervix remodels for birth the cervix softens before the cervical length decreases (after 30 weeks of gestation age) which happens along with change of collagen concentration [43]. The different alignment and concentration of collagen causes the cervix to behave like a heterogeneous medium.…”

Section: Discussionmentioning

confidence: 99%

Using speckle statistics to improve attenuation estimates for cervical assessment

Kumar

Bigelow

2014

The Journal of the Acoustical Society of America

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Quantitative ultrasound parameters like attenuation can be used to observe microchanges in the cervix. To give a better estimate of attenuation we can use speckle properties to classify which attenuation estimates are valid and conform to the theory. For fully developed and only one type of scatterer, Rayleigh distribution models the signal envelope. But in tissues as the number of scatterer type increases and the speckle becomes unresolved Rayleigh model fails. Gamma distribution has been empirically shown to be the best fit among all the distributions. Since more than one scatterer type is present for our work we used a mixture of gamma distributions. EM algorithm was used to find the parameters of the mixture and on basis of that the tissue types were segmented from each other based on the criteria of different scattering properties. Attenuation estimates were then calculated for tissues of the same scattering type only. 67 Women underwent Transvaginal scan and the attenuation estimates were calculated for them after segregation of tissues on scattering basis. Attenuation was seen to decrease as the time of delivery came closer.

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“…The measurement of cervical length provides an accurate prediction of risk for early preterm delivery (4). Transvaginal ultrasound scan (TVS) measurement has become the preferred method and is the only ultrasound technique that has been validated in the prediction of spontaneous preterm birth (5). Although TVS is the method that is generally recommended for assessing cervical length in women at high risk of preterm birth, many women in our culture either decline or are not happy to have a TVS during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Is transabdominal ultrasound scanning of cervical measurement in mid-trimester pregnancy a useful alternative to transvaginal ultrasound scan?

Chaudhury¹,

Ghosh²,

Halder³

et al. 2013

J Turkish German Gynecol Assoc

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Objective: The aim of this study is to assess the correlation between transabdominal and transvaginal ultrasound measurements of the cervix in pregnancy. If transabdominal ultrasound measurement of cervical length is found to provide effective information, it could be used in patient counselling and when making clinical decisions. Material and Methods:One hundred and twenty seven pregnant patients between 18-26 weeks of pregnancy were enrolled in this prospective study for measuring cervical length, both by transabdominal and transvaginal ultrasound scan after bladder emptying. Transabdominal and transvaginal measurements were compared and correlated. Results:In patients with transvaginal ultrasound scan (TVS) cervical length ≤32 mm, TVS cervical length was found to be shorter than by transabdominal ultrasound scan (TAS). Most of these patients needed >3 cm of vertical pocket of urine in the bladder for adequate visualisation of the cervix. In patients with TVS cervical length >32 mm, the TVS measurement of the cervix was longer than the TAS measurement of the cervix. In these patients, the cervix could be seen by TAS when there was either ≤3 cm vertical pocket of urine in the bladder or an empty bladder. Statistical tests showed that there is a significant difference between TAS and TVS cervical measurements and that there is a significant association between these two measurements. Conclusion:Most of the patients needed variable degrees of bladder filling for adequate visualisation of the cervix. Although minimal bladder filling does not influence TAS measurements of cervical length, moderate fullness of the bladder does cause an apparent increase in TAS measurements of cervical length. If the cervical length is ≥30 mm by TAS, regardless of urine content in the bladder, the patient can be assured vis a vis their risk of preterm labour as far as cervical length is concerned. However, in patients with TAS cervical measurement <30 mm and where the bladder needed a moderate amount of urine for adequate visualisation of the cervix, TVS cervical measurement may be close to the critical value of 25 mm. These patients need to be counselled and offered TVS for better assessment of cervical length. (J Turkish-German Gynecol Assoc 2013; 14: 225-9) Key words: Cervical length, transabdominal sonography, transvaginal sonography Received: 10 July, 2013 Accepted: Sonuç:Hastaların çoğunda serviksin yeterli görüntülenmesi için çe-şitli derecelerde mesane dolumu gerekliydi. Minimal mesane dolumunun servikal uzunluk TAS ölçümlerini etkilememesine rağmen, mesanenin orta derece dolgunluğu servikal uzunluk TAS ölçümlerin-de belirgin bir artışa neden olmaktadır. Servikal uzunluk TAS ile ≥30 mm ise, mesanedeki idrar içeriğine bakmaksızın, servikal uzunluk söz konusu olduğu sürece hastanın erken doğum riski ile karşı karşıya olduğundan emin olunabilir. Bununla birlikte, TAS serviks ölçü-mü <30 mm olan hastalarda ve serviksin yeterli görüntülenmesi için mesanede orta derecede idrar miktar gerekli olduğunda, TVS servikal ölçümü 25 ...

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Novel developments on cervical length screening and progesterone for preventing preterm birth

Cited by 45 publications

References 34 publications

Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage

Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage

Using speckle statistics to improve attenuation estimates for cervical assessment

Is transabdominal ultrasound scanning of cervical measurement in mid-trimester pregnancy a useful alternative to transvaginal ultrasound scan?

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