Cervical length at 11–40 weeks: unconditional and conditional longitudinal reference ranges

Papastefanou, Ioannis; Pilalis, Athanasios; Kappou, Dimitra; Souka, Athena P.

doi:10.1111/aogs.13025

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…This is in accordance with a study by Kagan and Sonek 23 , who suggested that a highly curved cervix should be measured in segments to avoid underestimating CL. The slight increase in median CL is in contrast to other longitudinal CL studies 12,13,24,25 ; this might be explained by a higher proportion of very curved cervices in the first trimester. Though the possibility of a systematic overestimation of CL cannot be excluded, this seems unlikely as care was taken to train and appropriately survey CL measurements, especially with respect to correct identification of the internal os.…”

Section: Discussioncontrasting

confidence: 99%

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Transvaginal sonographic cervical length in first and second trimesters in a low‐risk population: a prospective study

Wulff

Rode

Rosthøj

et al. 2018

Ultrasound in Obstet & Gyne

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There is an association between first-trimester CL and risk of short cervix in the second trimester. Once short CL was observed, risk of preterm delivery was greatly increased. However, whether universal CL screening should be implemented in this low-risk population depends on cost-benefit analysis taking into account the low proportions of women with short CL and at risk for preterm delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussioncontrasting

confidence: 99%

“…As found in other studies, median CL did not change markedly from 11 to 24 weeks of gestation in the current study 12,13,24,25 . The slightly shorter median CL in the first trimester compared with the second trimester can most likely be explained by the curved shape of the cervix in the first trimester.…”

Section: Discussionsupporting

confidence: 88%

Transvaginal sonographic cervical length in first and second trimesters in a low‐risk population: a prospective study

Wulff

Rode

Rosthøj

et al. 2018

Ultrasound in Obstet & Gyne

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“…With respect to different techniques to measure the cervix, shorter cervixes when measured by both straight and curve techniques, do not differ substantially. In both techniques, there is a reduction of CL as the pregnancy advances [21,22]. We observed that CL reduces more significantly after 21 weeks, regardless of the technique used for assessment and this pattern is reported in literature.…”

Section: Plos Onesupporting

confidence: 81%

Cervical length distribution among Brazilian pregnant population and risk factors for short cervix: A multicenter cross-sectional study

Marquart

Silva²,

Mol³

et al. 2022

PLoS ONE

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Objective Since there are populational differences and risk factors that influence the cervical length, the aim of the study was to construct a populational curve with measurements of the uterine cervix of pregnant women in the second trimester of pregnancy and to evaluate which variables were related to cervical length (CL) ≤25 mm. Materials and methods This was a multicenter cross-sectional study performed at 17 hospitals in several regions of Brazil. From 2015 to 2019, transvaginal ultrasound scan was performed in women with singleton pregnancies at 18 0/7 to 22 6/7 weeks of gestation to measure the CL. We analyzed CL regarding its distribution and the risk factors for CL ≤25 mm using logistic regression. Results The percentage of CL ≤ 25mm was 6.67%. Shorter cervices, when measured using both straight and curve techniques, showed similar results: range 21.0–25.0 mm in straight versus 22.6–26.0 mm in curve measurement for the 5th percentile. However, the difference between the two techniques became more pronounced after the 75th percentile (range 41.0–42.0 mm straight x 43.6–45.0 mm in curve measurement). The risk factors identified for short cervix were low body mass index (BMI) (OR: 1.81 CI: 1.16–2.82), higher education (OR: 1.39 CI: 1.10–1.75) and personal history ([one prior miscarriage OR: 1.41 CI: 1.11–1.78 and ≥2 prior miscarriages OR: 1.67 CI: 1.24–2.25], preterm birth [OR: 1.70 CI: 1.12–2.59], previous low birth weight <2500 g [OR: 1.70 CI: 1.15–2.50], cervical surgery [OR: 4.33 CI: 2.58–7.27]). By contrast, obesity (OR: 0.64 CI: 0.51–0.82), living with a partner (OR: 0.76 CI: 0.61–0.95) and previous pregnancy (OR: 0.46 CI: 0.37–0.57) decreased the risk of short cervix. Conclusions The CL distribution showed a relatively low percentage of cervix ≤25 mm. There may be populational differences in the CL distribution and this as well as the risk factors for short CL need to be considered when adopting a screening strategy for short cervix.

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“…Most probably, the cervical shortening does not occur until the stress applied by the growing fetus and the myometrial contractions exceeds the biomechanical strength of the cervix. Therefore, the cervical length only changes moderately during the first two trimesters 27–30 . According to this hypothesis, women at risk of preterm birth may experience preterm cervical softening 31 before the preterm cervical shortening; as a result, the CSI may be a valuable biomarker.…”

Section: Discussionmentioning

confidence: 99%

A force‐measuring device combined with ultrasound‐based elastography for assessment of the uterine cervix

Thomsen

Jensen

Leonhard

et al. 2022

Acta Obstet Gynecol Scand

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Introduction In this feasibility study, we hypothesize that the evaluation of cervical biomechanical strength can be improved if cervical length measurement is supplemented with quantitative elastography, which is a technique based on conventional ultrasound elastography combined with a force‐measuring device. Our aims were to: (a) develop a force‐measuring device; (b) introduce a cervical elastography index (CEI) and a cervical strength index (CSI; defined as cervical length × CEI); (c) evaluate how these indexes assess the cervical softening that takes place during normal pregnancy; and (d) how these indexes predict the cervical dilatation time from 4 to 10 cm. Material and methods An electronic force‐measuring device was mounted on the handle of the transvaginal probe, allowing for force measurement when conducting elastography. The study group concerned with normal cervical softening included 44 unselected pregnant women. Outcomes were CEI and CSI at different gestational ages. The study group for labor induction included 26 singleton term pregnant women admitted for labor induction. Outcome was defined as cervical dilatation time from 4 to 10 cm. Elastography measured the changes in mean gray value (intensity) during manual compressions. Region of interest was set within the anterior cervical lip. Results We found that the mean of all variables regarding cervical softening decreased from early to late pregnancy: ie cervical length from 34 to 29 mm, CEI from 0.17 to 0.11 N, and CSI from 5.9 to 3.1 N mm. Moreover, the cervical dilatation time during labor induction was associated with CEI, although not statistically significantly (area under the ROC curve of 0.67), but not with the Bishop score, the cervical length, or the CSI. Conclusions We propose that quantitative elastography based on changes in the intensity of the B‐mode ultrasound recording, in combination with a force‐measuring device on the handle of the vaginal probe, deserves further investigation as an approach for evaluation of cervical biomechanical strength.

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Cervical length at 11–40 weeks: unconditional and conditional longitudinal reference ranges

Cited by 13 publications

References 30 publications

Transvaginal sonographic cervical length in first and second trimesters in a low‐risk population: a prospective study

Transvaginal sonographic cervical length in first and second trimesters in a low‐risk population: a prospective study

Cervical length distribution among Brazilian pregnant population and risk factors for short cervix: A multicenter cross-sectional study

A force‐measuring device combined with ultrasound‐based elastography for assessment of the uterine cervix

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