Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Ultrasound Med. 2023 Nov;42(11):2583-2588. doi: 10.1002/jum.16293. Epub 2023 Jun 19.
To assess transvaginal (TV) and transabdominal (TA) cervical length (CL) measurements' variability and patient factors associated with TA CL accuracy. We hypothesized that patient factors would affect the accuracy of TA CL.
This was a prospective cohort study. During anatomy ultrasound, TA and TV CL measurements were obtained, distance from placental edge to internal cervical os assessed, and demographic questionnaires completed. Patients between 18 to 22 weeks and 6 days were included and those <18 year old or with a twin gestation were excluded. TA CL >0.5 cm different from TV length was considered inaccurate.
A total of 530 patients were included. Exactly 18.7% had a prior cesarean, 9.8% a preterm birth, and 2.2% a cervical procedure. Mean age and BMI were 31.1 years and 27.8 kg/m . Median number of living children was one. Median TA and TV CL were 3.42 and 3.53 cm. Exactly 36% (95% CI: 32-40%) of TA CL measurements were inaccurate. CL of 3.4 cm corresponded to a mean difference of zero between TA and TV CL. TA ultrasound had a sensitivity of 25% and a specificity of 98.5% to detect TV CL <2.5 cm. On multivariable analyses, Hispanic ethnicity was associated with inaccurate TA measurement (OR 0.48, 95% CI: 0.24-0.96, P = .04).
On average, TA CL underestimates TV CL when TV CL >3.40 cm and overestimates TV CL when TV CL <3.40 cm. Additional co-variates did not impact accuracy. TA ultrasound has low sensitivity to predict short cervix. Relying solely on TA CL to identify those who need intervention may miss diagnoses. It may be reasonable to develop protocols in which TV CL is used for TA CL <3.4 cm.
评估经阴道（TV）和经腹部（TA）宫颈长度（CL）测量的变异性以及与 TA CL 准确性相关的患者因素。我们假设患者因素会影响 TA CL 的准确性。
这是一项前瞻性队列研究。在解剖超声检查期间，获取 TA 和 TV CL 测量值，评估胎盘边缘到宫颈内口的距离，并完成人口统计学问卷调查。纳入 18 至 22 周 6 天的患者，排除年龄<18 岁或双胎妊娠的患者。TA CL 比 TV 长度相差>0.5cm 被认为不准确。
共纳入 530 例患者。18.7%有剖宫产史，9.8%有早产史，2.2%有宫颈手术史。平均年龄和 BMI 分别为 31.1 岁和 27.8kg/m2。中位数活产子女数为 1 个。TA 和 TV CL 的中位数分别为 3.42cm 和 3.53cm。36%（95%CI：32-40%）的 TA CL 测量值不准确。CL 为 3.4cm 时，TA 和 TV CL 之间的平均差值为零。TA 超声检测 TV CL <2.5cm 的敏感性为 25%，特异性为 98.5%。多变量分析显示，西班牙裔为 TA 测量不准确的相关因素（OR 0.48，95%CI：0.24-0.96，P=0.04）。
当 TV CL >3.40cm 时，TA CL 平均低估 TV CL，当 TV CL <3.40cm 时，TA CL 平均高估 TV CL。其他协变量不影响准确性。TA 超声检测短宫颈的敏感性低。仅依靠 TA CL 来识别需要干预的患者可能会漏诊。制定仅在 TV CL <3.4cm 时使用 TA CL 的方案可能是合理的。
