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
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References
- A new method using vaginal ultrasound and transfundal pressure to evaluate the asymptomatic incompetent cervix.Obstet Gynecol. 1994; 83: 248-252
- Vaginal ultrasonographic assessment of cervical length changes during normal pregnancy.Am J Obstet Gynecol. 1990; 162: 991-993
- Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length.Am J Obstet Gynecol. 1990; 163: 859-867
- Early prediction of preterm delivery by transvaginal ultrasonography.Ultrasound Obstet Gynecol. 1992; 2: 402-409
- Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length.Obstet Gynecol. 1993; 82: 829-832
- Cervical changes throughout pregnancy as assessed by transvaginal sonography.Obstet Gynecol. 1994; 84: 960-964
- The length of the cervix and the risk of spontaneous premature delivery.N Engl J Med. 1996; 334: 567-572
- Cervical incompetence as a continuum: a study of ultrasonographic cervical length and obstetric performance.Am J Obstet Gynecol. 1995; 172: 1097-1106
Article Info
Publication History
Accepted:
November 4,
1996
Received in revised form:
July 10,
1996
Received:
May 13,
1996
Footnotes
☆From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Medicine and Dentistry–Robert Wood Johnson Medical School.
☆☆Reprint requests: Edwin R. Guzman, MD, St. Peter's Medical Center, MOB Fourth Floor, 254 Easton Ave., New Brunswick, NJ 08903-0591.
★0002-9378/97 $5.00 + 0 6/1/79061
Identification
Copyright
© 1997 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
