Introduction of a New Index of Cervical Consistency with Transvaginal B-mode Ultrasonography

Hyodo, Hironobu; Aisaka, Kohzo

doi:10.1016/j.ultrasmedbio.2013.01.021

Cited by 2 publications

(7 citation statements)

References 6 publications

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“…Both are determined by a ratio between cervical measurements obtained before and after applying pressure to the cervix with the probe, thereby demonstrating that softer cervices lead to lower GA at delivery. Softer cervices possess greater CLCI and lower CCI as they are inversely correlated . We hypothesized that the mechanical support and cervical edema originated by the pessary would increase cervical consistency.…”

Section: Discussionmentioning

confidence: 99%

“…The variables evaluated in this study were selected after a review of the available literature, with a view to not exceeding 15 min for each vaginal examination. All studied variables had been previously shown to be related to sPTB and pessary or cerclage success …”

Section: Methodsmentioning

confidence: 99%

“…Cervical assessment consisted of obtaining the following 2‐dimensional (2D) and 3D measurements: CL, cervical anterior‐posterior diameter, cervical transverse diameter, A‐UCA, P‐UCA, CCI, CLCI, V, MG and vascular indices such as the vascularization index (VI), flow index (FI) and vascularization‐flow index (VFI). 2D variables were obtained according to the instructions detailed in previous studies . Assessment of V, MG, VI, FI and VFI was made using the 3D power Doppler mode by applying specially designed Virtual Organ Computer‐Aided Analysis (VOCAL) software (GE Healthcare, Kretztechnik).…”

Section: Methodsmentioning

confidence: 99%

“…Sonographic cervical measurements, such as cervical length consistency index (CLCI), cervical consistency index (CCI), anterior uterocervical angle (A‐UCA), posterior uterocervical angle (P‐UCA), cervical volume (V), mean gray value (MG) and cervical vascular indices studied to assess the risk of sPTB showed fair to high predictive capacity in low‐ and high‐risk populations or even in women with a cerclage …”

Section: Introductionmentioning

confidence: 99%

“…4,5 The use of a pessary remains controversial; 6 however, some studies showed that it might prevent sPTB in asymptomatic women with mid-trimester short CL 4 or after arrested threatened preterm labor. 5 Sonographic cervical measurements, such as cervical length consistency index (CLCI), 7 cervical consistency index (CCI), 8 anterior uterocervical angle (A-UCA), 9,10 posterior uterocervical angle (P-UCA), 11 cervical volume (V), 12 mean gray value (MG) and cervical vascular indices 13 studied to assess the risk of sPTB showed fair to high predictive capacity in low-and high-risk populations or even in women with a cerclage. 14 Most of these parameters have not been evaluated in pessary carriers; however, two previous studies assessed the effect on the cervix after pessary placement.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cervical modifications after pessary placement in singleton pregnancies with maternal short cervical length: 2D and 3D ultrasound evaluation

Mendoza

Ribera

Maíz

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The use of a pessary proved to prevent preterm birth in asymptomatic women with mid‐trimester short cervical length (CL); however, the precise mechanisms by which the pessary confers its benefit remain unclear. The aim of this study was to evaluate multiple cervical characteristics assessed by 2‐dimensional and 3‐dimensional ultrasound before and after placement of a cervical pessary to ascertain its mechanism of action. Material and methods In this prospective cohort study, we assessed the cervical characteristics in singleton pregnancies with maternal short CL and compared them with matched reference women with normal CL. The variables evaluated were: CL, uterocervical angles, cervical consistency indices (cervical consistency index and CL consistency index), cervical volume and vascular indices. All variables were re‐assessed immediately after pessary placement and 4‐6 weeks later in all participants. Mann‐Whitney U test was used to assess differences between groups and paired samples t test for comparisons in two different examinations in the same women. The aim of this study was to evaluate multiple cervical ultrasound variables before and after the placement of a cervical pessary and compare the evolution of these variables with a reference group with normal CL to better understand the device's mechanism of action. Results Thirty‐three women with short CL and 24 reference women with normal CL were enrolled. At the time of enrollment, gestational age and maternal baseline characteristics did not differ between groups. Immediately after pessary placement, CL increased, uterocervical angles were narrower and cervical consistency increased significantly. When the magnitude of change in cervical variables was compared over time between the reference group and the study group, median CL had increased in the study group (1.47 mm) but it had shortened in the reference group (−2.56 mm). These inverse trends were statistically significant (P = 0.006). Conclusions Cervical pessary reduces both uterocervical angles and corrects cervical angulation by pushing the cervix up toward the uterus. Maintaining the cervix aligned to the uterine axis leads to reduced cervical tissue stretch, so avoiding further cervical shortening. All these changes were present after pessary placement; however, the clinical implications of these findings remain unknown.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%