Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.
J Matern Fetal Neonatal Med. 2022 Dec;35(24):4797-4802. doi: 10.1080/14767058.2020.1864317. Epub 2020 Dec 20.
Sonographic cervical length (CL) measurement has become a standard practice for identifying women at increased risk for preterm birth. We aimed to assess the time needed for CL measurement during fetal anatomy scan using either transabdominal or transvaginal ultrasound, and to provide a predictive value of the transabdominal CL measurements for reassuring transvaginal CL measurements of more than 25 mm.
In a prospective study we measured CL transabdominally, and transvaginally in all the anatomy scans performed at 18-25 weeks' gestation, from January 2017 until January 2018. CL and the duration of the examination were compared between the two approaches. Adjustments were made for, body mass index, previous cesarean sections and parity.
Four hundred sixty-eight patients participated in the study. The time needed for the transabdominal CL measurement was significantly lower compare with the transvaginal CL measurement (0.46 ± 0.3 min versus 6.9 ± 1.38 min, < 0.001). The CL measured transabdominally was significantly shorter than the CL measured transvaginally (36.7 ± 6.7 mm versus 41.9 ± 7.3 mm, respectively < 0.001). All women with transabdominal CL measurements above 36 mm (64.2% of patients) had a transvaginal CL of more than 25 mm.
Transvaginal measurement of CL is a time-consuming procedure that prolong fetal anomaly scan by 25%. Transabdominal CL measurement of 36 mm is reassuring CL above 25 mm. Transabdominal ultrasound should be used as an initial tool for CL screening. Transvaginal measurements of CL should be reserved for high-risk women, for women with difficulties in demonstrating the cervix abdominally, and for women with transabdominal measurements of less than 36 mm.
超声测量宫颈长度（CL）已成为识别早产风险增加的女性的标准方法。本研究旨在评估在胎儿解剖扫描中使用经腹或经阴道超声测量 CL 的时间，并为经阴道 CL 测量值超过 25mm 时经腹 CL 测量值的预测值提供依据。
前瞻性研究纳入 2017 年 1 月至 2018 年 1 月在 18-25 周行胎儿解剖扫描的所有孕妇，分别行经腹和经阴道 CL 测量。比较两种方法的 CL 及检查时间，并对体质量指数、既往剖宫产史和产次进行校正。
共 468 例孕妇纳入研究。与经阴道 CL 测量相比，经腹 CL 测量时间明显缩短（0.46±0.3min 比 6.9±1.38min， <0.001）。经腹 CL 测量值明显短于经阴道 CL 测量值（36.7±6.7mm 比 41.9±7.3mm， <0.001）。所有经腹 CL 测量值大于 36mm（64.2%的患者）的孕妇经阴道 CL 测量值均大于 25mm。
经阴道 CL 测量耗时，使胎儿畸形扫描时间延长 25%。经腹 CL 测量值 36mm 可预测经阴道 CL 测量值大于 25mm。经腹超声应作为 CL 筛查的初始工具。对于经阴道 CL 测量值大于 25mm 的高危孕妇、经腹部难以显示宫颈的孕妇以及经腹 CL 测量值小于 36mm 的孕妇，应保留经阴道 CL 测量。
