Biomedical subjects

M S To

Publications and source records attributed to M S To.

9 recordsLinked to original sources

PubMed2006

Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study.

OBJECTIVE: To develop a model for calculating the patient-specific risk of spontaneous early preterm delivery by combining maternal factors and the transvaginal sonographic measurement of cervical length at 22 + 0 to 24 + 6 weeks, and to compare the detection rate of this method to that achieved from screening by cervical length or maternal characteristics alone. METHODS: This was a population-based prospective multicenter study involving 40,995 unselected women with singleton pregnancies attending for routine hospital antenatal care in London, UK. Complete follow-up was obtained from 39,284 (95.8%) cases. The main outcomes were detection rate, false-positive rate and accuracy of predicting spontaneous delivery before 32 weeks' gestation. RESULTS: Spontaneous delivery before 32 weeks occurred in 235 (0.6%) cases. The detection rate of screening for early preterm delivery, at a fixed false-positive rate of 10%, was 38% for maternal factors, 55% for cervical length and 69% for combined testing. There was good agreement between the model estimates and the observed probabilities of preterm delivery. CONCLUSIONS: This study provides a model that can give an accurate patient-specific risk of preterm delivery. The detection rate of screening by a combination of maternal factors and the measurement of cervical length was substantially higher than that of screening by each method alone.

Adolescent↗

PubMed2002

Elective cerclage vs. ultrasound-indicated cerclage in high-risk pregnancies.

OBJECTIVE: To compare pregnancy outcome after elective vs. ultrasound-indicated cervical cerclage in women at high risk of spontaneous mid-trimester loss or early preterm birth. METHODS: This was a retrospective study comparing two management strategies in women with singleton pregnancies who had at least one previous spontaneous delivery at 16-33 weeks of gestation. One group was managed by the placement of an elective cerclage at 12-16 weeks and the other group had transvaginal ultrasound examinations of the cervix at 12-15+6, 16-19+6, and 20-23+6 weeks and cervical cerclage was carried out if the cervical length was 25 mm or less. RESULTS: A total of 90 patients were examined, including 47 that were managed expectantly and 43 treated by elective cerclage. In the expectantly managed group, 59.6% (28/47) required a cervical cerclage. We excluded from further analysis three patients who were lost to follow-up and three because of fetal death or iatrogenic preterm delivery. Miscarriage or spontaneous delivery before 34 weeks' gestation occurred in 14.6% (6/41) of the elective cerclage group, compared with 20.9% (9/43) in the expectantly managed group (chi2 = 0.219, P = 0.640). CONCLUSION: In women at increased risk of spontaneous mid-trimester or early preterm delivery, a policy of sonographic surveillance followed by cervical cerclage in those with a short cervix reduces the need for surgical intervention without significantly increasing adverse pregnancy outcome.

Cerclage, Cervical↗

PubMed2001

Repeatability of measurement of uterine artery pulsatility index using transvaginal color Doppler.

OBJECTIVE: To assess the repeatability of measuring the pulsatility index of the uterine arteries using transvaginal color Doppler at 23 weeks of gestation. PATIENTS AND METHODS: The pulsatility index was measured in 100 women with singleton pregnancies attending for routine transvaginal Doppler examination of the uterine arteries at 23 weeks. To assess the repeatability of different components of variability, six measurements of the uterine artery pulsatility index were made on one of the uterine arteries in each patient. RESULTS: Six measurements of the pulsatility index were successfully measured in all 100 patients, resulting in a total of 600 measurements. The repeatability was unrelated to the pulsatility index. On 95% of occasions the intraobserver, interobserver and waveform tracing repeatability was less than 0.24, 0.27 and 0.14, respectively. CONCLUSIONS: Measurement of the pulsatility index using transvaginal color Doppler is highly reproducible when the examination is carried out by well-trained operators.

Arteries↗

PubMed2001

Cervical length at 22-24 weeks of gestation: comparison of transvaginal and transperineal-translabial ultrasonography.

OBJECTIVES: To investigate the feasibility of measuring cervical length by transperineal or translabial sonography and compare the measurements obtained by this approach with those obtained transvaginally. METHODS: In 500 women measurement of cervical length by translabial-transperineal sonography was attempted immediately before transvaginal scanning at 22-24 (median 23) weeks of gestation. In the first phase of the study, considered to be the learning period, 200 patients were examined and their results reviewed, before carrying out the second phase in which 300 patients were examined. A comparison was made of the patient acceptability of both techniques. RESULTS: Cervical length was successfully measured transvaginally in all cases. In the first phase of the study cervical length was measured by translabial-transperineal sonography in 84% of the 200 patients but there was poor agreement with measurements obtained transvaginally and the 95% tolerance interval for paired observations was -11.0 mm to 16.1 mm. After audit of results it became apparent that the translabially-transperineally derived images were inadequate in more than half of the cases but in those with adequate paired measurements there was a very good agreement between the two and the 95% tolerance interval for paired observations was -5.8 mm to 5.2 mm. In the second phase of the study special attention was paid towards recording measurements of cervical length only in cases where both the internal and external os were adequately visualized. Successful measurements by translabial-transperineal sonography were obtained in 78% of cases and the 95% tolerance interval for paired observations was -5.8 mm to 6.1 mm. The degree of patient acceptability of the two methods was similar. CONCLUSIONS: The findings of this study suggest that at 22-24 weeks of gestation the cervix can be visualized adequately by translabial-transperineal sonography in about 80% of patients and the measurements of cervical length obtained by this approach are very similar to those obtained by transvaginal sonography.

Adolescent↗

PubMed2001

Prediction of preterm delivery in twins by cervical assessment at 23 weeks.

OBJECTIVE: To establish the relation between cervical length at 23 weeks of gestation in twin pregnancies and risk of spontaneous delivery before 33 weeks. METHODS: Cervical length was measured by transvaginal sonography at 23 (range 22-24) weeks of gestation in 464 twin pregnancies attending for routine antenatal care. In the patients who were managed expectantly the relation between cervical length and the rate of spontaneous delivery before 33 weeks was determined. RESULTS: The cervical length distribution was skewed to the left and the median value was 36 mm. The rate of spontaneous delivery before 33 weeks was inversely related to cervical length at 23 weeks. It increased gradually from about 2.5% at 60 mm, to 5% at 40 mm and 12% at 25 mm, and exponentially below this length to 17% at 20 mm and 80% at 8 mm. Cervical length of 20 mm or less is found in about 8% of the population and this group contained about 40% of women delivering spontaneously before 33 weeks. CONCLUSIONS: In twin pregnancies measurement of cervical length provides useful prediction of risk for spontaneous early preterm delivery.

Adult↗

PubMed2001

Cervical assessment at the routine 23-week scan: standardizing techniques.

OBJECTIVE: To examine the frequency of curvature of the cervix and to establish the degree of curvature with increasing cervical length. To assess the significance of this phenomenon in terms of the classification of patients as high risk for pre-term delivery. METHOD: Cervical length was measured prospectively by transvaginal sonography in 301 women at 23 weeks of gestation. The distance between the internal and external os was measured both as a straight line and also as a curved line along the endocervical canal. In addition, a search of our database was made to identify all women who had undergone cervical assessment as part of a policy of routine screening. In those with cervical length of less than 26 mm the thermal images of the cervix were used to obtain straight and curved measurements. The frequency of curved cervix was calculated and the relationship between the ratio of straight to curved measurement to the curved one was determined. RESULTS: In the prospective study curvature of the cervix was observed in 143 (48%) of the 301 women. Curvature was observed in 51% (135 of 267) with cervical length of 26-55 mm, 25% (8 of 32) with length of 16-25 mm, and none of the two with length of 1-15 mm. The ratio of the straight to the curved measurement decreased with increasing cervical length (r = -0.27, P = 0.001). In the retrospective study curvature of the cervix was found in 72 (15%) of 471 with length of 16-25 mm and in none of the 76 with length of 1-15 mm. CONCLUSION: Cervical length is influenced by the degree of cervical curvature. The disparity of measurements between the internal and external os taken as a straight line or along the cervical canal increases with cervical length. However, this disparity may not have any clinical implications because at short cervical length (less than 16 mm) the cervix appears to be always straight.

Cervix Uteri↗

PubMed2001

Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery.

OBJECTIVES: To establish the relationship of cervical length at 23 weeks of gestation to the risk of spontaneous delivery before 33 weeks and to determine the possible additional risk if funneling is present. METHODS: During a 36-month period, 6819 women with singleton pregnancies underwent transvaginal sonographic cervical assessment at 22-24 weeks as a screening test for preterm delivery. The distribution of cervical length and the prevalence of funneling, defined as dilatation of the internal os of > or = 5 mm in width, were established. Women who underwent cervical cerclage, iatrogenic preterm delivery or were lost to follow-up were excluded from further analysis. In the remaining 6334 pregnancies, logistic regression was used to examine the contribution of cervical length and funneling to the risk of spontaneous preterm delivery before 33 weeks. RESULTS: The median cervical length was 36 mm and in 1.6% of cases the length was < or = 15 mm. There was a significant inverse association between cervical length and percentage rate of spontaneous delivery before 33 weeks. Funneling of the internal os was present in about 4% of pregnancies and the prevalence decreased with increasing cervical length from 98% when the length was < or = 15 mm to about 25% for lengths of 16-30 mm and less than 1% at lengths of > 30 mm. The rate of preterm delivery was 6.9% in those with funneling compared to 0.7% in those without funneling (chi2 = 86.7; P < 0.0001). However, logistic regression analysis demonstrated that funneling did not provide a significant additional contribution to cervical length in the prediction of spontaneous delivery before 33 weeks (odds ratio for short cervix = 24.9, Z = 4.43, P < 0.0001; odds ratio for funneling = 1.8, Z = 0.84, P = 0.40). CONCLUSION: In the prediction of preterm delivery, funneling does not provide any significant contribution in addition to cervical length.

Adolescent↗

PubMed2000

Cervical assessment at the routine 23-weeks' scan: problems with transabdominal sonography.

OBJECTIVES: To compare transabdominal and transvaginal sonographic measurements of cervical length in pregnancy and examine the factors that may influence these measurements. METHODS: The study population consisted of 149 women with singleton pregnancies attending for routine ultrasound examination at 23 weeks of gestation. In all women the cervix was successfully visualized by transvaginal sonography and cervical length was measured after emptying of the bladder. This measurement was compared to that obtained by transabdominal sonography. In addition the ability to visualize the cervix transabdominally was examined in relation to body mass index (BMI), bladder volume and cervical length. RESULTS: The percentage of cases in which the cervix could be seen transabdominally increased from 42% for bladder volume of < 50 ml to 73% for volumes > 150 ml, and 13% for cervical length < 20 mm to 51% for lengths > 40 mm. The ability to visualize the cervix was unrelated to BMI. Although there was a significant association between measurements taken transabdominally with those made transvaginally, measurements taken with a full bladder were significantly longer than those with an empty bladder. CONCLUSION: The aim of cervical assessment in pregnancy is to identify women with a short cervix because they are at high risk of preterm delivery. This aim can not be fulfilled by transabdominal sonography. Such a scan fails to visualize the cervix in a high proportion of cases and in particular those with a short cervix. Furthermore, successful visualization requires a full bladder which falsely increases cervical length.

Adult↗

PubMed2000

Cervical length at 23 weeks in triplets: prediction of spontaneous preterm delivery.

OBJECTIVES: To establish the distribution of cervical length at 23 weeks of gestation in triplet pregnancies and to examine the relation to preterm delivery before 33 weeks. METHODS: Cervical length was measured by transvaginal sonography at 23 (range 22-24) weeks of gestation in 43 triplet pregnancies. The distribution of cervical length was determined and the relationship between cervical length and the rate of spontaneous preterm delivery before 33 weeks was calculated. RESULTS: The cervical length distribution was skewed to the left with a median of 34 mm. The rate of spontaneous labor and delivery before 33 weeks increased exponentially with decreasing cervical length at 23 weeks from 8% at 36-48 mm, to 11% at 26-35 mm, 33% at 16-25 mm and 67% at 15 mm or less. Cervical length was < or = 30 mm, < or = 25 mm and < or = 15 mm in 37%, 16% and 8% of cases, respectively, and the corresponding sensitivities in the prediction of spontaneous delivery before 33 weeks were 67%, 50% and 33%. CONCLUSIONS: In triplet pregnancies, measurement of cervical length provides a useful prediction of risk for spontaneous early preterm delivery.

Cervix Uteri↗