Can transabdominal ultrasound be used as a screening test for short cervical length?

Friedman, Alexander M.; Srinivas, Sindhu K.; Parry, Samuel; Elovitz, Michal A.; Wang, Eileen; Schwartz, Nadav

doi:10.1016/j.ajog.2012.12.021

Cited by 70 publications

(88 citation statements)

References 15 publications

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“…The same group have more recently published data that found that this policy would miss a significant proportion of those with a short cervix 18 . This is also supported by Freidman, et al with a claim that 40% of women that had a TA could avoid a TV assessment but there was a 30% false positive rate and 10% of short cervixes were missed on TA alone 17 . Conflicting datasets included that of the SCOPE study by Stone, et al, and Roh, et al, where the correlation between TA and TV cervical length found the TA to be consistently shorter than the TV approach and so could be used as a screening for the short cervix 15 …”

Section: Discussionmentioning

confidence: 71%

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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Section: Discussionmentioning

confidence: 71%

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Westerway

Pedersen

Hyett

2015

Australas J Ultrason Med

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“…The latter approach was examined in a study of 1,217 women who underwent both transabdominal and transvaginal ultrasonography to measure cervical length. 46 Although an acceptable transabdominal image of the cervix could not be obtained in 6%, a prevoid transabdominal cervical length 35 mm or less had 100% sensitivity to detect transvaginal cervical lengths 20 mm or less with 41% specificity. If replicated in other centers, this approach might safely reduce the need for the time, equipment, and personnel required for transvaginal ultrasonography in as many as 40% of pregnancies.…”

Section: Universal Transabdominal Cervical Ultrasonography To Identifmentioning

confidence: 96%

Identification of Candidates for Progesterone

Iams

2014

Obstetrics &Amp; Gynecology

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Recognition of preterm birth as the major underlying cause of infant mortality in the United States has placed responsibility for prevention in the hands of obstetrician-gynecologists. The advent of effective methods to identify and treat women with increased risk is a major advance that will alter the focus of prenatal care. Adoption of research findings into clinical practice, never an easy task, will be particularly challenging for efforts to reduce the risk of preterm birth. Historical risk factors for preterm birth are numerous and variably defined. Measurement of the length of the cervix with ultrasonography requires unique personnel and facilities. Care algorithms exist but lack the detailed information that comes with experience. This review offers perspective and detail to aid health care practitioners in developing a prematurity prevention strategy appropriate to their practice population.

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“…A full bladder can falsely elongate the TAU CL, and an empty bladder can prevent adequate visualization of the cervical canal. TAU CL measurements have also been shown to overestimate CL in women with a short CL, resulting in underdiagnosis, 9 and accurate TAU CL measurements are unable to be obtained in up to 50% of the women. 10 To date, no published randomized-controlled trials have utilized TAU CL screening to predict sPTB, but several studies have compared TAUCLwithTVUCLscreening(Table2).…”

Section: Tvumentioning

confidence: 97%

“…In the largest study on TAU CL against TVU CL, a prevoid TAU CL of r35 mm was 100% sensitive for a TVU CL of r20 mm. 9 Thus, the utilization of this screening strategy involves performing TVU CL in women with a TAU CL of r35 mm or in whom an adequate TAU CL measurement cannot be obtained. Women with a TAU CL of >35 mm receive routine prenatal care (Fig.…”

Section: Selective Tvu CL Screeningmentioning

confidence: 99%

Cervical Length Screening in Asymptomatic Women at High Risk and Low Risk for Spontaneous Preterm Birth

Orzechowski

Boelig

Berghella

2016

Clinical Obstetrics &Amp; Gynecology

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Cervical length (CL) screening should be offered to singletons because there are interventions for those with a short CL. A transvaginal ultrasound (TVU) is the ''gold standard'' for CL. In singletons with prior spontaneous preterm birth, serial TVU CL screening isrecommended between16and236/7weeks. Universal TVU CL screening between 18 and 24 weeks may be considered for low-risk singletons with the administration of vaginal progesterone for TVU CLr20 mm; alternatively, transabdominal ultrasound CL screening may be considered with reflux to TVU CL screening for a transabdominal ultrasound CL<35 mm or inadequate visualization. CL screening is not recommended in multiples.

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Can transabdominal ultrasound be used as a screening test for short cervical length?

Cited by 70 publications

References 15 publications

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Identification of Candidates for Progesterone

Cervical Length Screening in Asymptomatic Women at High Risk and Low Risk for Spontaneous Preterm Birth

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