Abstract
Objective Our purpose was to compare various noninvasive stress techniques for their ability
to elicit ultrasonographic cervical changes and to determine their efficacy in detecting
ultrasonographic cervical incompetence. Study design Eighty-nine patients at risk for pregnancy loss and preterm birth underwent ultrasonographic
evaluation of the cervix at least twice between 15 and 24 weeks of gestation. With
use of a transvaginal probe, the funnel width, funnel length, and endocervical canal
length were measured in millimeters with the patient in the supine position. These
measurements were repeated after three stress tests: transfundal pressure, coughing,
and standing. The difference between the baseline measurements and those obtained
after the stress tests were determined. A positive response to stress was defined
as any decrease in endocervical canal length accompanied by an increase in funnel
width and length. Improvement was defined by any increase in endocervical canal length
accompanied by a decrease in funnel width and length. Cervical incompetence was defined
as the presence of progressive cervical changes on ultrasonographic examinations with
final endocervical canal length measurements below 26 mm. Results are reported as
median (range). Results: The number of positive cervical responses to transfundal pressure (19%, 17/89) was
significantly greater than to coughing (3.3%, 3/89) and standing (9.0%, 8/89). The
status of the cervix improved with standing in three cases, whereas this was not seen
with transfundal pressure or coughing. There was no case where there was a positive
response to standing or coughing and not to transfundal pressure. When the changes
in funnel width and length and endocervical canal length as a result of transfundal
pressure and standing in the 17 cases that responded to transfundal pressure, transfundal
pressure resulted in a significantly greater increase in funnel width and length and
a decrease in endocervical canal length. The efficacy of transfundal pressure in detecting
the cervix that had subsequent progressive changes on ultrasonography was as follows:
sensitivity 83.3%, specificity 97.2%, and positive and negative predictive values
88.2% and 95.8%, respectively. The efficacy of coughing was sensitivity 16.7%, specificity
100%, and positive and negative predictive values 100% and 85.5%, respectively. The
efficacy of standing was sensitivity 33.3%, specificity 97.2%, and positive and negative
predictive values 75% and 85.2%, respectively. Similar results were obtained when
the analysis was confined to 37 patients who had a prior history of a midtrimester
miscarriage. Conclusion: Transfundal pressure was the most effective technique in eliciting cervical changes
during the active assessment of the cervix during pregnancy and the most sensitive
in detecting the cervix that had progressive second-trimester cervical shortening
during pregnancy, compared with coughing or standing position.
Keywords
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Article Info
Publication History
Accepted:
April 28,
1997
Received in revised form:
February 25,
1997
Received:
December 26,
1996
Footnotes
☆From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, St. Peter's Medical Center.
☆☆Reprints not available from the authors.
★0002-9378/97 $5.00 + 0 6/1/82915
Identification
Copyright
© 1997 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
