A study of short cervix in mid trimester of pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20241431Keywords:
Cervical incompetence, Mid trimester, Preterm delivery, Cervical length, Transvaginal sonography, Internal OSAbstract
ABSTRACT
Background: Preterm birth is truly a global problem. Cervical length is one of the major determinants of preterm births. Diagnosis of cervical insufficiency can be made by history of previous mid trimester loss, on clinical evaluation or sonographically by measuring cervical length or seeing funnelling of OS. The mainstay treatment of cervical insufficiency is the cervical cerclage.
Methods: Present study includes 55 cases of cervical length less than or equal to 2.5 cm on TVS examination between 18 to 22 weeks of gestation of singleton pregnancy was conducted at department of obstetrics and gynaecology at SMT NHL medical municipal hospital, Ahmedabad from July 2022 to December 2023 and shows comparison of rate of full term and preterm deliveries.
Results: Out of 55 patients with cervical incompetence, 22 (40%) patients were diagnosed on examination. Out of 55 patients with cervical incompetence 33 (60%) patients had preterm births and only 19 (35%) patients delivered full term, 3 (5%) had abortions. Present study shows there were 35% full term deliveries, 60% preterm deliveries and 5% had abortion among patients having cervical length less than or equal to 2.5 cm.
Conclusions: Internal OS status of every patient should always be examined by ultrasound between 18 to 22 weeks. Thus, cervical length is very useful in prognostication and prediction of preterm birth. There are highest chances of late preterm in cervical incompetent patients. Our study showed better outcome with OS tightening group compared to conservative group.
Metrics
References
Textbook of obstetrics by Dr J B Sharma, third edition 2022. Chapter: 13 American College of Obstetrician and Gynecologist (ACOG) Early Pregnancy Haemorrhage. Practice Bulletin no. 125. 2019.
http://www.cdc.gov/DES/CONSUMERS/about/: Centers for Disease Control. Available at: http://www.cdc.gov/DES/CONSUMERS/ about/. Accessed on 15 February, 2024.
Mangan CE, Borow L, Burtnett-Rubin MM, Egan V. Giuntoli RL, Mikuta JJ. Pregnancy outcome in 98 women exposed to diethylstilbestrol in utero, their mothers, and unexposed siblings. Obstet Gynecol. 1982:59(3):315-9.
Pillsbury SG, Jr. Reproductive significance of changes in the endometrial cavity associated with exposure in utero to diethylstilbestrol. Am J Obstet Gynecol. 1980;137(2):178-82.
Sandberg EC, Riffle NL, Higdon JV, Getman CE. Pregnancy outcome in women exposed to diethylstilbestrol in utero. Am J Obstet Gynecol. 1981;140(2):194-205.
Kiwi R, Neuman MR, Merkatz IR, Selim MA, Lysikiewicz A. Determination of the elastic properties of the cervix. Obstet. Gynecol. 1988;71(4):568-74.
Page EW. Incompetent internal OS of the cervix causing late abortion and premature labor; technic for surgical repair. Obstet. Gynecol. 1958;12(5):509-15.
Toaff R, Toaff ME, Ballas S, Ophir A. Cervical incompetence: diagnostic and therapeutic aspects. Isr J Med Sci. 1977;13(1):39-49.
Zlatnik FJ, Burmeister LF, Feddersen DA, Brown RC. Radiologic appearance of the upper cervical canal in women with a history of premature delivery. II. Relationship to clinical presentation and to tests of cervical compliance. J Reprod Med. 1989;34(8):525-30.
Bergman P, Svennerud S. Traction test for demonstrating incompetence of the internal os of the cervix. Int J Fertil. 1957;2:163-67.
Leppert PC, Yu SY, Keller S, Cerreta J, Mandl I. Decreased elastic fibers and desmosine content in incompetent cervix. Am J Obstet Gynecol. 1987;157(5):1134-9.
Ians JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334(9):567-72.
Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol. 1998;12(5):312-17.
To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH. Prediction of patient- specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study. Ultrasound Obstet Gynecol. 2006;27(4):362-7.
WHO, Preterm birth 2018. Available at: http://www.who.int/news-room/fact-sheet/detail/Preterm-birth. Accessed on 15 February, 2024.
Nelson L, Dola T, Tran T, Carter M, Luu H, Dola C. Pregnancy outcomes following placement of elective, urgent and emergent cerclage. J Maternal Fetal Neonatal Med. 2009;22(3):263-73.
Guzman ER, Mellon C, Vintzileos AM, Ananth CV, Walters C, Gipson K. Longitudinal assessment of endocervical canal length between 15 and 24 weeks gestation in women at risk for pregnancy loss or preterm birth. Ultrasound Obstet Gynaecol. 1998;92(1):31-7.
Nalini V, Urmila PK, George E, Dasan J, Thomas M. Cervical encerclage- a stitch in time: Analysis of 23 cases. Int J Gynecol Obstetr. 1988;27(3):389-39.
Carvalho MHB, Bittar RE, Brizot ML, Maganha PPS, Borges Da Fonseca ESV, Zugaib M. Cervical length at 11-14 weeks and 22-24 weeks gestation evaluated by transvaginal sonography, and gestational age at delivery. Ultrasound Obstetr Gynecol. 2003;21(2):135-9.
Belotserkovtseva LD, Kovalenko LV, Ivannikov SE, Mirzoeva GT, Petrova TG. Cervical incompetence: Modern Clinical Protocols and Real Practice. Donald School J Ultrasound Obstet Gynecol. 2017;11(3):203-9.
Gahlot K, Singh PP, Pandey K, Sharma H, Gahlot V, Joshi CP. To evaluate efficacy of sonographic cervical length to predict preterm labour. Ann Int Med Den Res. 2016;2(5):OG14-7.
Kaya S, Kayatas S, Boza A, Eroglu M, Api M, et al. Elective cervical cerclage versus no treatment in women with the history of cervical insufficiency: retrospective analysis of pregnancy outcomes. Clin Exp Obstet Gynecol. 2016;43(5):723-6.