Stone Julie, House Michael
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA.
Am J Obstet Gynecol MFM. 2023 Apr;5(4):100881. doi: 10.1016/j.ajogmf.2023.100881. Epub 2023 Jan 29.
An abnormally soft cervix could contribute to the pathophysiology of cervical shortening and cervical insufficiency. Multiple techniques to measure cervical softness have been developed but none are used routinely in clinical practice. A clinically acceptable technique to measure cervical softness could improve identification of patients at risk for cervix-related preterm birth.
This study aimed to measure cervical softness in patients with cervical insufficiency and in normal controls using a novel, aspiration-based device. We hypothesized that the cervix is softer in patients with cervical insufficiency.
This was a cross-sectional study of patients presenting for cerclage at a single academic medical center. Cervical softness was measured using a noninvasive, aspiration-based device placed on the anterior lip of the cervix during a speculum examination. The device measured the aspiration pressure required to displace cervical tissue to a predefined deformation level. Stiff tissue required increased aspiration pressure, whereas soft tissue required lower pressure values. Cerclage patients were subdivided into 3 groups, namely history-indicated, ultrasound-indicated, and examination-indicated cerclage. Controls were healthy volunteers between 12+0 weeks and 23+6 weeks of gestation without a history of cervical insufficiency and were matched by gestational age to the patients in the cerclage groups. Women with a cerclage in place, multiple gestations, active genital infection, or previous cervical excision procedures were excluded. Delivery information was subsequently recorded as well.
Data from 133 women were analyzed; of those, 54 patients were in the cerclage group (23 history-indicated, 12 ultrasound-indicated, and 19 examination-indicated participants) and 79 were controls (40 in the first trimester and 39 in the second trimester groups). Patients who presented for ultrasound-indicated cerclage had significantly softer cervices (median; interquartile range) than second trimester controls (62 mbar; 50.5-114 vs 81 mbar; 75-101; P=.042). The difference in cervical softness was not significantly different between the history-indicated and examination-indicated cerclage groups and their respective control groups.
Patients presenting for ultrasound-indicated cerclage had significantly softer cervices than normal controls as measured by an aspiration-based device. Quantitative measurement of cervical softness with the aspiration-based device is a promising technique for objective measurement of cervical softness during pregnancy.
宫颈异常柔软可能与宫颈缩短和宫颈机能不全的病理生理过程有关。目前已开发出多种测量宫颈柔软度的技术，但在临床实践中均未常规使用。一种临床可接受的测量宫颈柔软度的技术可能会改善对宫颈相关早产风险患者的识别。
本研究旨在使用一种新型的基于抽吸的装置测量宫颈机能不全患者和正常对照者的宫颈柔软度。我们假设宫颈机能不全患者的宫颈更柔软。
这是一项在单一学术医疗中心对接受宫颈环扎术的患者进行的横断面研究。在阴道镜检查期间，使用一种非侵入性的基于抽吸的装置放置在宫颈前唇来测量宫颈柔软度。该装置测量将宫颈组织移位到预定义变形水平所需的抽吸压力。硬组织需要更高的抽吸压力，而软组织需要更低的压力值。宫颈环扎术患者被分为3组，即病史指征性、超声指征性和检查指征性宫颈环扎术。对照组为妊娠12 + 0周和23 + 6周之间无宫颈机能不全病史的健康志愿者，并按孕周与宫颈环扎术组患者匹配。排除已进行宫颈环扎术、多胎妊娠、活动性生殖器感染或既往有宫颈切除手术的妇女。随后记录分娩信息。
分析了133名女性的数据；其中，54例患者在宫颈环扎术组（23例病史指征性、12例超声指征性和19例检查指征性参与者），79例为对照组（40例在孕早期组和39例在孕中期组）。接受超声指征性宫颈环扎术的患者的宫颈明显比孕中期对照组更柔软（中位数；四分位间距）（62毫巴；50.5 - 114对81毫巴；75 - 101；P = 0.042）。病史指征性和检查指征性宫颈环扎术组与其各自对照组之间的宫颈柔软度差异无统计学意义。
通过基于抽吸的装置测量，接受超声指征性宫颈环扎术的患者的宫颈明显比正常对照者更柔软。使用基于抽吸的装置对宫颈柔软度进行定量测量是一种在孕期客观测量宫颈柔软度的有前景的技术。
