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Am J Perinatol 2021; 38(12): 1303-1307
DOI: 10.1055/s-0040-1712950
Original Article

Ultrasonographic Transabdominal Measurement of Uterine Cervical Length for the Prediction of a Midtrimester Short Cervix

Paul Guerby 
1   Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec–Université Laval, Quebec, Canada
,
Annie Beaudoin
1   Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec–Université Laval, Quebec, Canada
,
Geneviève Marcoux
1   Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec–Université Laval, Quebec, Canada
,
Mario Girard
1   Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec–Université Laval, Quebec, Canada
,
Jean-Charles Pasquier
2   Department of Obstetrics and Gynecology, Université de Sherbrooke, Faculté de médecine et des sciences de la santé 3001, Sherbrooke, Quebec, Canada
,
Emmanuel Bujold 
1   Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec–Université Laval, Quebec, Canada
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
› Author Affiliations Funding This study was funded by Jeanne et Jean-Louis Lévesque Perinatal Research Chair—Université Laval.
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Abstract

Objective This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester.

Study Design We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed.

Results A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: −6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95–0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%.

Conclusion Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm.

Key Points

  • Cervical length (CL) measurement with transabdominal (TA) ultrasound is feasible in most cases and is strongly correlated with CL measured with transvaginal (TV) ultrasound.

  • Using a cut-off of 30 mm for TA ultrasound as a first-step screening of short cervix in nulliparous women, three-quarter of TV ultrasound could have been avoided.

  • Use of TA CL screening could alleviate some of the logistical challenges of universal TV CL screening.

Keywords

cervical length screening - transabdominal ultrasound - preterm birth prediction - short cervix


Publication History

Received: 03 February 2020

Accepted: 24 April 2020

Article published online:
10 June 2020

© 2020. Thieme. All rights reserved.

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