Ultrasonic Assessment of Cervix in “At Risk” Patients

Abstract

One hundred and fifteen women were considered to be at risk of cervical incompetence, judging from their previous history. They were scanned serially from the first trimester to 32 weeks of gestation. Of the 115, 75 women were found to have defective cervix, as assessed on the basis of its length, its overall width and the width of the cervical canal at the level of the internal cervical os, and herniation of the amniotic membrane, with or without fetal parts, into the cervical canal. Sixteen of the 75 women with ultrasonically diagnosed cervical incompetence aborted, 40 needed cervical cerclage, 24 gave birth premature (24 to 34 weeks). Of the 115 women, 40 did not have ultrasonic evidence of cervical incompetence and only one patient gave birth at 36 weeks' gestation, while 39 patients gave birth between 37 and 42 weeks. These 40 women would have had cervical cerclage on the basis of clinical history alone. Ultrasound is an objective method of diagnosing the incompetent cervix and also helps to avoid unnecessary cerclage operations on the basis of history alone.

Emergency Cervical Cerclage: Relation between Its Success, Preoperative Serum Level of C-Reactive Protein and WBC Count, and Degree of Cervical Dilatation

“…Although no randomized controlled studies on the efficacy of emergency cerclage during midtrimester are available, the present and previous results suggest that some women have benefited from cerclage [2][3][4][5][6][7][8]. However, it has not been determined which patients will benefit from emergency cerclage.…”

“…As suggested by previous studies [2][3][4][5][6][7][8], pregnancy is unlikely to be prolonged in the presence of chorioamnionitis. In fact, chorioamnionitis may lead to premature delivery.…”

“…Although the placement of Minakami/Matsubara/Izumi/Kosuge/ Watanabe/Iwasaki/Sato a cerclage under such unfavorable circumstances is less successful than when the procedure is performed prophylactically, studies have reported fetal salvage rates ranging from 47 to 91% in selected and unselected cases [2][3][4][5][6][7][8]. These studies have usually excluded patients with clinical chorioamnionitis [2][3][4][5][6][7][8]. However, clinical chorioamnionitis is not well defined.…”

“…The strong association between infection within the vagina and uterus and premature birth suggests that microbial factors play an important role in a large percentage of previously unexplained preterm births [9][10][11]. Therefore, subclinical chorioamnionitis may have been present in patients who benefited from emergency cervical cerclage [2][3][4][5][6][7][8].…”

A clinical study on ultrasonographic measurement of cervical length at 18-24 weeks of gestation and pregnancy outcome

“…4 Since the clinical digital examination and cervical scoring and biochemical tests have very low sensitivity and specificity therefore these are almost of no use in clinical practice. 5,7 Over the last two decades the measurement of fetal fibronectin levels from cervico-vaginal secretions and cervical changes diagnosed by TVS have emerged as a promising prediction of preterm birth. 8 It is now universally accepted that the shorter the cervical length, the greater is the risk of spontaneous pre-term labour.…”