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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