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ORIGINAL RESEARCH
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Comparison of Ultrasonographic Transabdominal and Transvaginal Measurements in Second Trimester Cervical Length Screening: Reliability of Transabdominal Measurement: A Prospective Study
Received: 27 Jan 2025 | Received in revised form: 10 Apr 2025
Accepted: 18 Apr 2025 | Available online: 16 Jun 2025
JCOG. 2025;35(2):74-80
DOI: 10.5336/jcog.2025-108846
Article Language: EN
Article Language: EN
Copyright Ⓒ 2025 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
To investigate the reliability of transabdominal ultrasonography (TAUS), which can be used as an alternative to transvaginal ultrasonography (TVUS), which is a gold standard method in cervical length measurement. The study also aimed to determine the cut-off values for TAUS that can predict the short cervix detected in TVUS. Material and Methods: The prospective study included 204 pregnant women. The cervical lengths (CL) of the patients were measured using TAUS and TVUS. The sensitivity, specificity, positive predictive value, and negative predictive values of the measurement methods were calculated. The TVUS CL threshold value used to define the short cervix was determined as <25 mm. Results: TAUS bladder-full CL measurements were statistically and significantly higher than bladder-empty TAUS measurements. A positive correlation was detected between the TVUS and TAUS CL measurements. The sensitivity of the TAUS bladder-full method was found to be 25% in detecting the short cervix with a specificity of 99.5%. The sensitivity of the TAUS bladder-empty method was found to be 50% with a specificity of 99.5%. The cut-off values for TVUS short cervix prediction were found to be 28 mm for TAUS bladder empty and 32 mm for TAUS bladder full. Conclusion: We recommend that TAUS be performed first in low-risk patients regarding preterm birth. When the CL is measured as 32 mm with a full bladder and 28 mm with an empty bladder in TAUS measurements, we should suspect a short CL and evaluate it with TVUS.
To investigate the reliability of transabdominal ultrasonography (TAUS), which can be used as an alternative to transvaginal ultrasonography (TVUS), which is a gold standard method in cervical length measurement. The study also aimed to determine the cut-off values for TAUS that can predict the short cervix detected in TVUS. Material and Methods: The prospective study included 204 pregnant women. The cervical lengths (CL) of the patients were measured using TAUS and TVUS. The sensitivity, specificity, positive predictive value, and negative predictive values of the measurement methods were calculated. The TVUS CL threshold value used to define the short cervix was determined as <25 mm. Results: TAUS bladder-full CL measurements were statistically and significantly higher than bladder-empty TAUS measurements. A positive correlation was detected between the TVUS and TAUS CL measurements. The sensitivity of the TAUS bladder-full method was found to be 25% in detecting the short cervix with a specificity of 99.5%. The sensitivity of the TAUS bladder-empty method was found to be 50% with a specificity of 99.5%. The cut-off values for TVUS short cervix prediction were found to be 28 mm for TAUS bladder empty and 32 mm for TAUS bladder full. Conclusion: We recommend that TAUS be performed first in low-risk patients regarding preterm birth. When the CL is measured as 32 mm with a full bladder and 28 mm with an empty bladder in TAUS measurements, we should suspect a short CL and evaluate it with TVUS.
KEYWORDS: Cervical length screening; risk of preterm birth; short cervix; transvaginal ultrasonography; transabdominal ultrasonography
REFERENCES:
- Rumack CM, Wilson SR, Charboneau W, Levine D. Diagnostic Ultrasound. 4th ed. Philadelphia: Elsevier Mosby; 2011.
- Chandiramani M, Shennan AH. Premature cervical change and the use of cervical cerclage. Fetal and Maternal Medicine Review. 2007;18(1):25-52. [Link]
- Lim K, Butt K, Crane JM; Diagnostic Imaging Committee; Family Physicians Advisory Committee; Maternal Fetal Medicine Committee. SOGC Clinical Practice Guideline. Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies. J Obstet Gynaecol Can. 2011;33(5):486-99. [PubMed]
- Marren AJ, Mogra R, Pedersen LH, Walter M, Ogle RF, Hyett JA. Ultrasound assessment of cervical length at 18-21 weeks' gestation in an Australian obstetric population: comparison of transabdominal and transvaginal approaches. Aust N Z J Obstet Gynaecol. 2014;54(3):250-5. [Crossref] [PubMed]
- Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O'Brien JM, Cetingoz E, et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol. 2012;206(2):124.e1-19. [Crossref] [PubMed] [PMC]
- Campbell S. Universal cervical-length screening and vaginal progesterone prevents early preterm births, reduces neonatal morbidity and is cost saving: nothing is no longer an option. Ultrasound Obstet Gynecol. 2011;38(1):1-9. [PubMed]
- Moroz LA, Simhan HN. Rate of sonographic cervical shortening and the risk of spontaneous preterm birth. Am J Obstet Gynecol. 2012;206(3):234.e1-5. [Crossref] [PubMed]
- Peng CR, Chen CP, Wang KG, Wang LK, Chen CY, Chen YY. The reliability of transabdominal cervical length measurement in a low-risk obstetric population: comparison with transvaginal measurement. Taiwan J Obstet Gynecol. 2015;54(2):167-71. [Crossref] [PubMed]
- Hernandez-Andrade E, Romero R, Ahn H, Hussein Y, Yeo L, Korzeniewski SJ, et al. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. J Matern Fetal Neonatal Med. 2012;25(9):1682-9. [Crossref] [PubMed] [PMC]
- Berghella V, Saccone G. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 2019;9(9):CD007235. [Crossref] [PubMed] [PMC]
- O'Hara S, Zelesco M, Sun Z. A comparison of ultrasonic measurement techniques for the maternal cervix in the second trimester. Australas J Ultrasound Med. 2015;18(3):118-23. [Crossref] [PubMed] [PMC]
- Cho HJ, Roh HJ. Correlation between cervical lengths measured by transabdominal and transvaginal sonography for predicting preterm birth. J Ultrasound Med. 2016;35(3):537-44. [Crossref] [PubMed]
- Nambiar JM, Pai MV, Reddy A, Kumar P. Can transabdominal scan predict a short cervix by transvaginal scan? Obstet Gynecol Int. 2017;2017:3035718. [Crossref] [PubMed] [PMC]
- Westerway SC, Pedersen LH, Hyett J. Cervical length measurement: comparison of transabdominal and transvaginal approach. Australas J Ultrasound Med. 2015;18(1):19-26. [Crossref] [PubMed] [PMC]
- Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org; McIntosh J, Feltovich H, Berghella V, Manuck T. The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention. Am J Obstet Gynecol. 2016;215(3):B2-7. [Crossref] [PubMed]
- Wongkanha L, Sudjai D, Puttanavijarn L. Correlation of transabdominal and transvaginal sonography for the assessment of uterocervical angle at 16-24 weeks' gestation. J Obstet Gynaecol. 2020;40(5):654-8. [Crossref] [PubMed]
- Pedretti MK, Kazemier BM, Dickinson JE, Mol BW. Implementing universal cervical length screening in asymptomatic women with singleton pregnancies: challenges and opportunities. Aust N Z J Obstet Gynaecol. 2017;57(2):221-7. [Crossref] [PubMed]
- Pedretti MK, Nathan EA, Doherty DA, Dickinson JE. Consistency in the transabdominal ultrasound measurement of cervical length in mid-pregnancy. Australas J Ultrasound Med. 2022;25(3):127-36. [Crossref] [PubMed] [PMC]
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