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Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(12):647-652
To determine cervical biometry in pregnant women between 18 and 24 weeks of gestation and the ideal mode of measurement of cervical length in cases of curved and straight cervical morphology.
The uterine cervices of 752 low-risk pregnant women were assessed using transvaginal ultrasound in a prospective cross-sectional study. In women with straight uterine cervices, cervical biometry was performed in a continuous manner. In women with curved uterine cervices, the biometry was performed using both the continuous and segmented techniques (in segments joining the cervical os). Polynomial regression models were created to assess the correlation between the cervical length and gestational age. The paired Student t-test was used to comparemeasuring techniques.
The cervical biometry results did not vary significantly with the gestational age and were best represented by linear regression (R2 = 0.0075 with the continuous technique, and R2 = 0.0017 with the segmented technique). Up to the 21st week of gestation, there was a predominance of curved uterine cervix morphology (58.9%), whereas the straight morphology predominated after this gestational age (54.2%). There was a significant difference between the continuous and the segmented measuring methods in all the assessed gestational ages (p < 0.001).
Cervical biometry in pregnant women between 18 and 24 weeks was represented by a linear regression, independently of the measuring mode. The ideal measuring technique was the transvaginal ultrasound performed at a gestational age 21 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(12):647-652
To determine cervical biometry in pregnant women between 18 and 24 weeks of gestation and the ideal mode of measurement of cervical length in cases of curved and straight cervical morphology.
The uterine cervices of 752 low-risk pregnant women were assessed using transvaginal ultrasound in a prospective cross-sectional study. In women with straight uterine cervices, cervical biometry was performed in a continuous manner. In women with curved uterine cervices, the biometry was performed using both the continuous and segmented techniques (in segments joining the cervical os). Polynomial regression models were created to assess the correlation between the cervical length and gestational age. The paired Student t-test was used to comparemeasuring techniques.
The cervical biometry results did not vary significantly with the gestational age and were best represented by linear regression (R2 = 0.0075 with the continuous technique, and R2 = 0.0017 with the segmented technique). Up to the 21st week of gestation, there was a predominance of curved uterine cervix morphology (58.9%), whereas the straight morphology predominated after this gestational age (54.2%). There was a significant difference between the continuous and the segmented measuring methods in all the assessed gestational ages (p < 0.001).
Cervical biometry in pregnant women between 18 and 24 weeks was represented by a linear regression, independently of the measuring mode. The ideal measuring technique was the transvaginal ultrasound performed at a gestational age 21 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(11):664-670
DOI 10.1590/S0100-72032006001100006
PURPOSE: to assess the role of ultrasonographic cervical length in predicting premature labor in patients presenting persistent uterine contractions and intact membranes. METHODS: a prospective observational cohort study was performed in 45 women admitted to our hospital between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation of the cervix was performed once in the women who had completed a course of parenteral tocolysis. The cervical length was obtained according to criteria reported previously. Cervical sonographic findings were not used in diagnosis and management. Outcome variable was the occurrence of preterm delivery (<37 weeks). Statistical analysis consisted of univariate method with the purpose of determining the significant contribution of cervical length to the prediction of preterm delivery. The adopted significance level was 5% (p<0,05) and the confidence interval was 95% (95% CI). RESULTS: the incidence of preterm delivery was 51.11% (23/45). Cervical length was significantly associated with the outcome (p<0.0001). Receiver operating characteristic curve analysis showed that a cervical length of 20 mm was the best cutoff in predicting preterm delivery (sensitivity 86.9%; specificity 81.8%; positive predictive value 83.3%; negative predictive value 85.7%). The calculated area under the curve was 0.91 (95% CI: 0.79-0.97; p<0.0001). CONCLUSIONS: among women with persistent uterine contractions and intact membranes treated for preterm labor, a cervical length of less than 20 mm demonstrated a high likelihood of preterm birth. Transvaginal ultrasound may improve the accuracy of diagnosis in symptomatic women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(11):664-670
DOI 10.1590/S0100-72032006001100006
PURPOSE: to assess the role of ultrasonographic cervical length in predicting premature labor in patients presenting persistent uterine contractions and intact membranes. METHODS: a prospective observational cohort study was performed in 45 women admitted to our hospital between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation of the cervix was performed once in the women who had completed a course of parenteral tocolysis. The cervical length was obtained according to criteria reported previously. Cervical sonographic findings were not used in diagnosis and management. Outcome variable was the occurrence of preterm delivery (<37 weeks). Statistical analysis consisted of univariate method with the purpose of determining the significant contribution of cervical length to the prediction of preterm delivery. The adopted significance level was 5% (p<0,05) and the confidence interval was 95% (95% CI). RESULTS: the incidence of preterm delivery was 51.11% (23/45). Cervical length was significantly associated with the outcome (p<0.0001). Receiver operating characteristic curve analysis showed that a cervical length of 20 mm was the best cutoff in predicting preterm delivery (sensitivity 86.9%; specificity 81.8%; positive predictive value 83.3%; negative predictive value 85.7%). The calculated area under the curve was 0.91 (95% CI: 0.79-0.97; p<0.0001). CONCLUSIONS: among women with persistent uterine contractions and intact membranes treated for preterm labor, a cervical length of less than 20 mm demonstrated a high likelihood of preterm birth. Transvaginal ultrasound may improve the accuracy of diagnosis in symptomatic women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(7):397-402
DOI 10.1590/S0100-72032006000700004
PURPOSE: to compare the uterine cervix measurements and funneling obtained by two- and three-dimensional transvaginal sonography during pregnancy. METHODS: a prospective, descriptive study, with group comparison, was carried out between April 2004 and February 2005 in 74 pregnant women, who were between the 19th and 24th week of pregnancy, regardless of risk factors for premature delivery. The ultrasound examination of the cervix was carried out only once in the same patient and by only one observer. The measurements of the cervix by two-dimensional ultrasound were made at the time of the test and by three-dimensional ultrasound at intervals of 7 to 15 days after the two-dimensional ultrasound. The measurements of cervical length, funnel width and length were taken by two-dimensional ultrasound in the sagittal plane and by three-dimensional in the sagittal plane as well as in coronal plane. RESULTS: there was no significant difference between the averages of the measurements of the cervix obtained by two- and three-dimensional ultrasound in the sagittal plane (p=0.23); however, there was a difference in the averages of the measurements of the cervix obtained by two-dimensional ultrasound in sagittal plane and three-dimensional ultrasound in the coronal plane (p=0.009) and between three-dimensional ultrasound in the sagittal and coronal planes (p=0.001). The kappa test (0.86) showed no superiority of either the two-dimensional and three-dimensional ultrasound in the visualization of the cervical funnel. No statistically significant difference was observed between the methods when the average of the measurements of funneling was compared (p>0.05). CONCLUSION: there were differences between two-dimensional and three-dimensional ultrasound of cervical length, only using the coronal plane of the three-dimensional ultrasound.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(7):397-402
DOI 10.1590/S0100-72032006000700004
PURPOSE: to compare the uterine cervix measurements and funneling obtained by two- and three-dimensional transvaginal sonography during pregnancy. METHODS: a prospective, descriptive study, with group comparison, was carried out between April 2004 and February 2005 in 74 pregnant women, who were between the 19th and 24th week of pregnancy, regardless of risk factors for premature delivery. The ultrasound examination of the cervix was carried out only once in the same patient and by only one observer. The measurements of the cervix by two-dimensional ultrasound were made at the time of the test and by three-dimensional ultrasound at intervals of 7 to 15 days after the two-dimensional ultrasound. The measurements of cervical length, funnel width and length were taken by two-dimensional ultrasound in the sagittal plane and by three-dimensional in the sagittal plane as well as in coronal plane. RESULTS: there was no significant difference between the averages of the measurements of the cervix obtained by two- and three-dimensional ultrasound in the sagittal plane (p=0.23); however, there was a difference in the averages of the measurements of the cervix obtained by two-dimensional ultrasound in sagittal plane and three-dimensional ultrasound in the coronal plane (p=0.009) and between three-dimensional ultrasound in the sagittal and coronal planes (p=0.001). The kappa test (0.86) showed no superiority of either the two-dimensional and three-dimensional ultrasound in the visualization of the cervical funnel. No statistically significant difference was observed between the methods when the average of the measurements of funneling was compared (p>0.05). CONCLUSION: there were differences between two-dimensional and three-dimensional ultrasound of cervical length, only using the coronal plane of the three-dimensional ultrasound.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):168-173
DOI 10.1590/S0100-72032005000400002
PURPOSE: to evaluate ophthalmic and retinal central artery Doppler indices during the second and third trimesters of normal pregnancy and to compare the right with left eye Doppler indices of normotensive women. METHODS: a cross-sectional study which evaluated central retinal and ophthalmic artery Doppler velocimetry values of 51 normal pregnant women, in the 20th to 38th week of gestation. The following values were analyzed: pulsatility and resistance indexes (PI, RI), peak systolic and end-diastolic flow velocity (PSV, EDFV) and peak velocity ratio (PVR). The Doppler indices in the right and left eyes were studied by the median. The paired Student's t test was used to confront the right and left eye values and the Pearson linear correlation analysis was performed to study the value changes throughout the gestation, with the level of significance set at 5%. RESULTS: Doppler velocimetry indices of ophthalmic and central retinal arteries (median values) were, respectively: PI=1.83; RI=0.78; PSV=34.20; EDFV=6.80; PVR=0.48 and PI=1.34; RI=0.70; PSV=7.40; EDFV=2.10. There was no significant difference between the right and left side Doppler values. Linear correlation analysis showed no association between the arterial values and pregnancy age. CONCLUSION: the unilateral analysis of ophthalmic and central retinal artery Doppler velocimetry values can be used in systemic maternal disease. There is no significant change in ophthalmic and central retinal artery Doppler velocimetry values throughout normal pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):168-173
DOI 10.1590/S0100-72032005000400002
PURPOSE: to evaluate ophthalmic and retinal central artery Doppler indices during the second and third trimesters of normal pregnancy and to compare the right with left eye Doppler indices of normotensive women. METHODS: a cross-sectional study which evaluated central retinal and ophthalmic artery Doppler velocimetry values of 51 normal pregnant women, in the 20th to 38th week of gestation. The following values were analyzed: pulsatility and resistance indexes (PI, RI), peak systolic and end-diastolic flow velocity (PSV, EDFV) and peak velocity ratio (PVR). The Doppler indices in the right and left eyes were studied by the median. The paired Student's t test was used to confront the right and left eye values and the Pearson linear correlation analysis was performed to study the value changes throughout the gestation, with the level of significance set at 5%. RESULTS: Doppler velocimetry indices of ophthalmic and central retinal arteries (median values) were, respectively: PI=1.83; RI=0.78; PSV=34.20; EDFV=6.80; PVR=0.48 and PI=1.34; RI=0.70; PSV=7.40; EDFV=2.10. There was no significant difference between the right and left side Doppler values. Linear correlation analysis showed no association between the arterial values and pregnancy age. CONCLUSION: the unilateral analysis of ophthalmic and central retinal artery Doppler velocimetry values can be used in systemic maternal disease. There is no significant change in ophthalmic and central retinal artery Doppler velocimetry values throughout normal pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(3):193-200
DOI 10.1590/S0100-72032004000300004
PURPOSE: to verify the prevalence of two sonographic findings, the cervical gland area (CGA) feature and the cervical length of less than 20 mm, and to compare these with the risk for premature delivery in pregnant women between 21 and 24 weeks' gestation. METHOD: this was a prospective, cross-sectional study in which 361 women were consecutively examined by transvaginal ultrasonography. Müllerian or other malformations, multiple gestations, fetal death, olygo- or polyhydramnios, marginal placenta previa, and conization, cerclage, amputation or other surgical procedures in the cervix, prior to or during pregnancy, were exclusion criteria. After the abdominal ultrasonographic morphological examination, we used transvaginal ultrasonography to measure the cervical length and to observe the presence of hyper- or hypoechoic area next to the endocervical canal, a feature characteristic of endocervical epithelium glands which is called CGA (cervical gland area). Qualitative variables are expressed as absolute and relative frequency. Quantitative variables are expressed as mean, median, standard deviation, minimum, and maximum values. Association between qualitative variables was detected by the c² test or by the Fisher exact test. For each variable, the relative risk and the 95% confidence interval (CI) were calculated. Logistic regression analysis was used to calculate the predictive values for premature delivery. Significance level was 95% (alpha = 5%), with descriptive (p) values equal or lower than 0.05 considered significant. RESULTS: spontaneous preterm delivery occurred in 5.0% of the patients. Cervical length was up to 20 mm in 3.3% of all studied patients and in 27.8% of those who delivered spontaneously before the end of the pregnancy. Absence of the CGA was detected in 2.8% of all patients and in 44.4% of the women who eventually developed spontaneous preterm labor. There was a statistically significant association of absence of CGA with short cervical length (p<0.001). Absence of CGA was strongly associated with spontaneous preterm delivery (relative risk of 28.57, 95% CI 14.40-56.68). CONCLUSION: the absent CGA feature is a new morphological ultrasonographic parameter that is useful in the prediction of spontaneous preterm delivery in single gestations. Our results show that the parameter can be used as an indicator of risk for premature delivery, to be confirmed by future research.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(3):193-200
DOI 10.1590/S0100-72032004000300004
PURPOSE: to verify the prevalence of two sonographic findings, the cervical gland area (CGA) feature and the cervical length of less than 20 mm, and to compare these with the risk for premature delivery in pregnant women between 21 and 24 weeks' gestation. METHOD: this was a prospective, cross-sectional study in which 361 women were consecutively examined by transvaginal ultrasonography. Müllerian or other malformations, multiple gestations, fetal death, olygo- or polyhydramnios, marginal placenta previa, and conization, cerclage, amputation or other surgical procedures in the cervix, prior to or during pregnancy, were exclusion criteria. After the abdominal ultrasonographic morphological examination, we used transvaginal ultrasonography to measure the cervical length and to observe the presence of hyper- or hypoechoic area next to the endocervical canal, a feature characteristic of endocervical epithelium glands which is called CGA (cervical gland area). Qualitative variables are expressed as absolute and relative frequency. Quantitative variables are expressed as mean, median, standard deviation, minimum, and maximum values. Association between qualitative variables was detected by the c² test or by the Fisher exact test. For each variable, the relative risk and the 95% confidence interval (CI) were calculated. Logistic regression analysis was used to calculate the predictive values for premature delivery. Significance level was 95% (alpha = 5%), with descriptive (p) values equal or lower than 0.05 considered significant. RESULTS: spontaneous preterm delivery occurred in 5.0% of the patients. Cervical length was up to 20 mm in 3.3% of all studied patients and in 27.8% of those who delivered spontaneously before the end of the pregnancy. Absence of the CGA was detected in 2.8% of all patients and in 44.4% of the women who eventually developed spontaneous preterm labor. There was a statistically significant association of absence of CGA with short cervical length (p<0.001). Absence of CGA was strongly associated with spontaneous preterm delivery (relative risk of 28.57, 95% CI 14.40-56.68). CONCLUSION: the absent CGA feature is a new morphological ultrasonographic parameter that is useful in the prediction of spontaneous preterm delivery in single gestations. Our results show that the parameter can be used as an indicator of risk for premature delivery, to be confirmed by future research.
