Transabdominal and transvaginal endosonography: Evaluation of the cervix and lower uterine segment in pregnancy

Brown, James E.; Thieme, Gary A.; Shah, Dinesh; Fleischer, Arthur C.; Boehm, Frank H.

doi:10.1016/s0002-9378(86)80006-0

Cited by 63 publications

(25 citation statements)

References 4 publications

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“…Indeed ample evidence in the literature supports the reliability of sonographic evaluation of cervical shortening as measured by cervical length in assessment of preterm cervix. 9 These previous studies confirm the sensitivity of sonography in cervical length measurement and the strong association between premature cervical length shortening and clinical preterm labour in high risk population. However, these large series fail to provide sonographic evaluation of cervical length for normal term pregnancy, or to evaluate cervical length alteration in asymptomatic group.…”

Section: Introductionsupporting

confidence: 76%

Cervical length by ultrasound as a predictor of preterm labour

Begum

Behera

2014

Int J Reprod Contracept Obstet Gynecol

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Section: Introductionsupporting

confidence: 76%

Cervical length by ultrasound as a predictor of preterm labour

Begum

Behera

2014

Int J Reprod Contracept Obstet Gynecol

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“…Several studies have compared TA and TV approaches to cervical assessment but their findings are inconsistent. [16][17][18][19][20][21][22][23] Attempting TA assessment postvoid appears to give better TA-TV measurement correlation, but the cervix cannot be visualised transabdominally in >40% of cases; and in >80% of cases with a short cervix (<20 mm in closed length). 11,19 Several groups have examined a strategy of using TA assessment as a baseline, proceeding to a TV scan if the cervix could either not be visualised or was short; between 57 and 60% of women still needed to have a TV scan and 85% of cervices deemed short by TV assessment would have been missed if they had solely been screened with a TA approach.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound assessment of cervical length at 18–21 weeks' gestation in an Australian obstetric population: Comparison of transabdominal and transvaginal approaches

Marren

Mogra

Pedersen

et al. 2014

Aust NZ J Obst Gynaeco

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Background: Using a fixed cut-off of ≤25 mm, ultrasound assessment of cervical length during the 18-23 week anomaly scan has been shown to identify approximately 50% of pregnancies that would deliver prior to 34 weeks. Aim: To determine whether a policy of reverting to transvaginal cervical assessment only if the cervix appears short (≤25 mm) on transabdominal assessment affects the efficiency of screening. Methods: Women with a singleton pregnancy that presented for a routine anomaly scan had their cervical length assessed transabdominally, initially with the maternal bladder full (TABF) and then empty (TABE). Cervical length was then assessed transvaginally (TV). Results: One hundred and ninety-eight women agreed to participate in the study. Identification of the internal and external cervical os was possible during TABF, TABE and TV sonography in 97.0, 82.8 and 100%, respectively. Compared with TV sonography, TABF overestimates cervical length (6.1 mm difference in median values; P < 0.01). There was no significant difference between TV and TABE. However, TABE assessment was not possible in one in six women. If TABF sonography was to be used as a screening tool and using ≤25 mm as the critical cut-off, the sensitivity and specificity was 15.4 and 93.2%, respectively. Conclusion: This study has shown that assessment of cervical length using a TA approach is only routinely possible when the bladder is full. However, measurements are significantly overestimated. Therefore, we feel that TV assessment of cervical length is the preferred method of reliable cervical assessment. As such, all women should be offered a TV assessment of cervical length at the time of the fetal anomaly ultrasound as a screening test for preterm birth.

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“…TVS has been reported as a useful tool in the folStructural characteristics of the cervix such as the internal and external os, cervical canal, low-up of pregnant women at risk for cervical incompetance (Figure 2). 3 Monitoring cervical dy- namics may identify early changes necessitating cerclage procedures, or may prevent unnecessary intervention. Areas of increased echogenicity or hypoechoic areas with an irregular outline may signify changes compatible with cervical carcinoma (Figure 3).…”

mentioning

confidence: 99%

The uterus: A new look with transvaginal sonography

Lewit

Thaler

Rottem

1990

J of Clinical Ultrasound

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Targeted scanning of the uterus and its adjacent structures is made possible by high-resolution transvaginal sonography. A systematic approach is applied so that the normal anatomy and abnormal processes in the various uterine components can be visualized. By adopting this method we detected various pathologies in the cervix, endometrium, myometrium, and in the uterine vessels and ligaments. Cervical pathology included inflammatory processes, cysts, malignant lesions, and incompetence during pregnancy. By scanning the endometrium, a reflection of the hormonal status of the patient under both normal (e.g., the menstrual cycle) and abnormal conditions may be obtained. More sinister lesions, such as endometrial hyperplasia and carcinoma, can be suspected based on the sonographic appearance of the endometrium. In hydatiform mole, a typical sonographic picture directs the sonographer to the diagnosis. Uterine fibroids are the most common lesion of the corpus uteri, and are readily detected by transvaginal sonography, including any degenerative changes that may complicate this condition. Changes in uterine size, particularly when accompanied by profuse intracavitary fluid, should raise the suspicion of a malignant process. Intracavitary fluid may also be associated with inflammatory lesions (e.g., tuberculosis). Congenital uterine anomalies may be diagnosed and defined by this method. Uterine ligaments are best visualized in the presence of fluid in the pelvis. Intraligamentary masses can be also be detected and defined. Finally, the main vessels supplying the uterus can be visualized, both in pregnant and nonpregnant patients. Using a transvaginal image-directed Doppler system, flow velocity profiles can be obtained from these vessels and form the basis for defining abnormalities in uterine perfusion.

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Transabdominal and transvaginal endosonography: Evaluation of the cervix and lower uterine segment in pregnancy

Cited by 63 publications

References 4 publications

Cervical length by ultrasound as a predictor of preterm labour

Cervical length by ultrasound as a predictor of preterm labour

Ultrasound assessment of cervical length at 18–21 weeks' gestation in an Australian obstetric population: Comparison of transabdominal and transvaginal approaches

The uterus: A new look with transvaginal sonography

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