Comparative evaluation of the length of the cervix by digital and ultrasonographic examination in the second trimester of pregnancy

Hebbar, Shripad and Koirala, Samjhana (2006) Comparative evaluation of the length of the cervix by digital and ultrasonographic examination in the second trimester of pregnancy. Malaysian Journal of Obstetrics & Gynaecology, 8 (11). pp. 46-61.

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Abstract

OBJECTIVE: To evaluate the cervical length in the second trimester by digital, transabdominal and transvaginal ultrasonography; to find the agreement between measurements and to decide which one accurately predicts preterm labour. METHOD: Two hundred pregnant women were enrolled in this prospective study. Each woman underwent digital assessment and ultrasound examination (both transabdominal and transvaginal) of cervix at 18 – 22 weeks of gestation. Agreements between the measurements were assessed by using methods described by Bland and Altman. The best cut-off points were decided for each parameter using ROC curve analysis. Sensitivity, specificity, positive predictive value and negative predictive values of these cut-off values were compared to decide which parameter predicts preterm delivery with maximum accuracy. RESULT: Neither digital nor transabdominal method correlate well with transvaginal ultrasonography. Digital assessment of cervix underestimated transvaginally measured cervical length by 0.65 cm; where as transabdominal ultrasound overestimated the same by 0.75 cm. Transvaginal ultrasonographic cervical length measurements of term and preterm deliveries showed a statistically significant difference (P < 0.01), but no significant differences were found in digital and transabdominal measurements (P > 0.05). At a cut-off point of 2.5 cm, transvaginal cervical length showed sensitivity, specificity, positive predictive value and negative predictive values of 77%, 95%, 56% and 98% respectively and was far superior to other two methods of assessment. CONCLUSION: Neither digital assessment nor transabdominal ultrasonography should substitute transvaginal cervical ultrasonography for assessment of cervical length in the second trimester for prediction of spontaneous preterm delivery.

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