Advertisement

The natural history of a positive response to transfundal pressure in women at risk for cervical incompetence

      Abstract

      OBJECTIVE: Our purpose was to observe the evolution of the endocervical canal length in women at risk for cervical incompetence after a positive response to transfundal pressure.
      STUDY DESIGN: Ten women at risk for cervical incompetence had a midtrimester cervical evaluation with transvaginal ultrasonography and transfundal pressure. With a transvaginal probe, the endocervical canal length was first measured. Transfundal pressure was then applied and the endocervical canal length was remeasured. All patients had a positive response to transfundal pressure as defined by a decrease in endocervical canal length after application of transfundal pressure. At the initial evaluation the digital examination of the cervix had revealed a closed and long cervix in all 10 cases. In 9 of the 10 patients repeat examinations were performed until the endocervical canal length progressively shortened to <10 mm or the digital examination revealed a dilated cervix. The endocervical canal lengths after application of transfundal pressure from the first and last examination were compared. One patient was lost to follow-up, but the obstetric outcome was available.
      RESULTS: The median time interval between the first and final examination was 7 (2 to 20) days in 9 of the patients. The median (range) gestational age at the first and final examination was 19.0 (15 to 22) weeks (n = 10) and 20.5 (18 to 24) weeks (n = 9), respectively. There was significant shortening of the endocervical canal length from the first to the last examination; 12.2 (4 to 20) mm (n = 10) versus 0.0 (0 to 9.5) mm (n = 9), p = 0.008. Six patients had membranes at the external cervical os before application of transfundal pressure at the last examination. The one patient lost to ultrasonographic follow-up had a pregnancy loss at 23 weeks of gestation, 6 weeks after a positive response to transfundal pressure.
      CONCLUSION: In patients at risk for cervical incompetence, shortening of the endocervical canal length in response to transfundal pressure requires treatment with a cervical cerclage because it is associated with progressive cervical changes over 1 to 3 weeks. (Am J Obstet Gynecol 1997;176:634-8.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Guzman ER
        • Rosenberg JC
        • Houlihan C
        • Ivan J
        • Waldron R
        • Knuppel R
        A new method using vaginal ultrasound and transfundal pressure to evaluate the asymptomatic incompetent cervix.
        Obstet Gynecol. 1994; 83: 248-252
        • Kushnir O
        • Vigil D
        • Izquierdo L
        • Schiff M
        • Curet L
        Vaginal ultrasonographic assessment of cervical length changes during normal pregnancy.
        Am J Obstet Gynecol. 1990; 162: 991-993
        • Anderson HF
        • Nugent CE
        • Wanty S
        • Hayashi RH
        Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length.
        Am J Obstet Gynecol. 1990; 163: 859-867
        • Okitsu O
        • Mimura T
        • Nakayama T
        • Aono T
        Early prediction of preterm delivery by transvaginal ultrasonography.
        Ultrasound Obstet Gynecol. 1992; 2: 402-409
        • Murakawa H
        • Utumi T
        • Hasegawa I
        • Tanaka K
        • Fuzimori R
        Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length.
        Obstet Gynecol. 1993; 82: 829-832
        • Zorzoli A
        • Soliani A
        • Perra M
        • Caravelli E
        • Galimberti A
        • Nicolini U
        Cervical changes throughout pregnancy as assessed by transvaginal sonography.
        Obstet Gynecol. 1994; 84: 960-964
        • Iams JD
        • Goldenberg JL
        • Meis PJ
        • Mercer BM
        • Moawad A
        • Das A
        • et al.
        The length of the cervix and the risk of spontaneous premature delivery.
        N Engl J Med. 1996; 334: 567-572
        • Iams JD
        • Johnson FF
        • Sonek J
        • Sachs L
        • Gebauer S
        • Samuels P
        Cervical incompetence as a continuum: a study of ultrasonographic cervical length and obstetric performance.
        Am J Obstet Gynecol. 1995; 172: 1097-1106