Reference range for cervical length throughout pregnancy: non‐parametric LMS‐based model applied to a large sample

Salomon, L. J.; Díaz-García, César; Bernard, Jean‐Pierre; Ville, Y.

doi:10.1002/uog.6332

Cited by 94 publications

(94 citation statements)

References 30 publications

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“…, 15 Intra‐observer variability was low (3.5%) confirming previous reports that TV measurements are reproducible 6 . The data show that cervical length is not normally distributed; in line with the previous observations of Solomon, et al 22 While the cervix appears to have stable length < 24 weeks, there is then a gradual reduction in cervical length of approximately 1mm per week gestation thereafter; these cross‐sectional data are consistent with previous longitudinal assessment, showing a decay rate of 0.5 mm / week gestation 23 . There have been some reports that multiple measures of cervical length may be useful in defining an excessive rate of cervical decay from 16 weeks, that is predictive of preterm labour 24 .…”

Section: Discussionsupporting

confidence: 90%

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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: Discussionsupporting

confidence: 90%

“…Measures of cervical length appeared non‐Gaussian (in accordance with Salomon, et al) even after logarithmic transformation 22 . Consequently, the distributions of cervical length measurements were compared by the non‐parametric Wilcoxon sign‐rank test.…”

Section: Discussionmentioning

confidence: 58%

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Westerway

Pedersen

Hyett

2015

Australas J Ultrason Med

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“…, 12 A cervix that is less than 25 mm may be indicative of preterm birth 1 . A cervical length < 25 mm before 28 weeks gestation is abnormal and associated with a higher incidence of PTB, women with a cervical length < 25 mm and contractions have twice the incidence of PTB than women with a cervical length < 25 mm but no contractions 11 …”

Section: Introductionmentioning

confidence: 99%

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

O'Hara

Zelesco²,

Sun

2013

Australas J Ultrason Med

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Introduction: Preterm birth is the leading cause of neonatal morbidity and mortality not attributable to congenital anomalies or aneuploidy. It has been shown that a shortened cervix is a powerful indicator of preterm births in women with singleton and twin gestations – the shorter the cervical length, the higher the risk of spontaneous preterm birth. Ultrasound measurements of the cervix are a more accurate way of determining cervical length (CL) than using a digital method. Background: There are three approaches that may be used to perform ultrasound measurements of the cervix; these are the transabdominal (TA), transperineal (TP) and the transvaginal (TV) approach. The TV approach is considered to be the gold standard. In women who are considered to be at a high risk of preterm birth it is now recommended that the cervix is measured at the mid‐trimester ultrasound using the TV ultrasound approach. For women considered to be at a historical low risk the TV scan is not recommended, however it has been found that many women who deliver a preterm baby have no known risk factors. Conclusion: There is contradictory evidence in the literature with regard to the correlation between TA, TP and TV measurements. This article provides an overview of these three approaches with a focus on the clinical value for the assessment of the maternal cervix.

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“…За 50 лет трансабдоминальный сер-кляж остается редкой операцией, его использу-ют как «крайнюю» меру у женщин с выражен-ными анатомическими дефектами шейки матки, при которых невозможен трансвагинальный подход и/или предыдущие традиционные швы были неудачны [35]. Также возможными пока-заниями для данного серкляжа являются состо-яния после высокой конизации шейки матки или трахелэктомии.…”

Section: трансабдоминальный серкляжunclassified

“…Согласно шкале L.J. Salomon длина шейки матки менее 25 мм является основным диагностическим критерием диагноза ИЦН, у пациенток с таким параметром чрезвычайно высок риск прежде-временного прерывания беременности [35]. Длина шейки матки зависит от срока геста-ции.…”

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Selection of the method for correction of cervical incompetence

et al. 2017

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■ Истмико-цервикальная недостаточность (ИЦН) является одной из важных проблем современного акушерства.Перед практикующим акушером-гинекологом стоит сложная задача своевременной диагностики, выбора метода коррекции, сроков наложения и удаления серкляжа. Проблема несостоятельности шейки матки при беремен-ности известна с XIX в., но еще в XI в. выдающийся ученый Абу Али Ибн Сина (Авиценна) писал об этой пато-логии. Согласно классическому определению ИЦН -это размягчение, расширение и укорочение шейки матки до 37-й недели гестации при отсутствии угрозы прерывания. Для ИЦН характерна неспособность женщины доносить беременность до доношенного срока из-за функционального или структурного дефекта шейки матки. На настоящее время не существует объективных диагностических тестов для выявления пациенток высоко-го риска развития ИЦН ни до и ни во время беременности. Высокой диагностической значимостью во время беременности обладает трансвагинальное ультразвуковое исследование шейки матки. Разработанная ультра-звуковая шкала L.J. Salomon позволяет оценить длину шейки матки в зависимости от срока гестации и сделать врачу правильный выбор для коррекции короткой шейки. Выбор метода коррекции ИЦН зависит от клиниче-ской ситуации, анамнеза, сроков гестации, числа плодов, данных цервикометрии, гинекологического осмотра, угрозы прерывания беременности, опыта врача. Существует два основных метода коррекции ИЦН: консерва-тивный и хирургический. К хирургическим методам относятся трансвагинальный и трансабдоминальный сер-кляж, а к консервативным -соблюдение постельного режима, токолитическая, гормональная терапия, приме-нение акушерского пессария. Установка акушерских пессариев является перспективным безопасным простым методом лечения и профилактики ИЦН и угрозы прерывания беременности во II и III триместрах. Стратегия широкого использования пессариев у беременных из групп высокого риска позволяет снизить частоту прежде-временных родов и улучшить перинатальные исходы.■ Ключевые слова: истмико-цервикальная недостаточность (ИЦН); серкляж; трансвагинальный серкляж; трансабдоминальный серкляж; акушерский пессарий Arabin; трансвагинальное УЗИ; преждевременные роды. ■ Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy d...

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Reference range for cervical length throughout pregnancy: non‐parametric LMS‐based model applied to a large sample

Abstract: Conclusion

Cited by 94 publications

References 30 publications

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Cervical length measurement: Comparison of transabdominal and transvaginal approach

Cervical length for predicting preterm birth and a comparison of ultrasonic measurement techniques

Selection of the method for correction of cervical incompetence

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