Comparison between different methods of sonographic cervical length assessment during pregnancy

El Sayed El Badawy Mohamed Abd Naby Awad, Tamer Mamdouh Abdel Dayem, Ahmed Mohammed Samy El-Agwany


Background: Preterm birth is the presence of uterine contraction of sufficient frequency and intensity to effect progressive effacement and dilatation of cervix prior to term gestation (between 20 and 37 weeks). The objective of this study was to compare between the different methods of assessment of cervical length (Trans abdominal, trans vaginal, and transperineal) during pregnancy as a possible screening of preterm birth.

Methods: Prospective cohort study was performed on 200 cases who attended at Elshat by hospital. At gestational age from 20 to 26 weeks, there was no significant difference regarding demographic data as (maternal age, parity). The route of examination was started according to urinary bladder fullness at admission. Accordingly, the patient was not instructed to void if she had full bladder, rather we started by transabdominal route. If she had empty bladder at the time she presented we started by transperineal then transvaginal route. The four measurements were compared to each other and the difference between them calculated. The selected sample size was found to be 200 pregnant women.

Results: Transvaginal route gave the longest cervical measurements followed by transperineal route then abdominal route (full bladder) and finally tans abdominal route (semi-full bladder). Our results indicate that there is a significant positive correlation among the four methods of measuring cervical length in that gestational age.

Conclusions: Tran-abdominal assessment could be used initially for cervical length screening, considering the maternal and fetal condition. Then, if the need arises, transvaginal sonography could be used. This step by step approach may be more convenient and useful to both patients and physicians for cervical length screening.


Sonography, Cervical length, Pregnancy

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ACOG practice bulletin. Management of preterm labor. Numbre 43. Int J Gynaecol Obestet 2009; 82(1):127-35.

Eden RD, Penka A, Britt DW, Landsberger EJ, Evans MI. Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way. J Maternal Fetal Neonatal Med. 2005;18(4):253-8.

Lykke JA, Paidas MJ, Ross JL. Recurring complication in the second pregnancy. Obstet Gynecol. 2009;113(6):1217-24.

Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous delivery N Engl J Med. 2002;334:567-72.

Heath VCF, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery Ultrasound Obstet Gynecol. 2010;12:312-7.

To MS, Skentou C, Cicero S, Nicolaides KH. Transvaginal and transabdominal ultrasonography of the uterine cervix at 23 weeks of pregnancy: technical aspects I. Ultrasound Obstet Gynecol. 2000;15:292-6.

Podobnik M, Bulic M, Smiljanic N, Bistricki J. Ultrasonography in the detection of cervical incompetency. J Clin Ultrasound. 2000;13:383-91.

Kurtzman JT, Goldsmith LJ, Gall SA, Spinnato JA. Transvaginal versus transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation. Am J Obstet Gynecol. 2011;179:852-7.

Owen J, Neely C, Northen A. Transperineal versus endovaginal ultrasonographic examination of the cervix in the midtrimester: a blinded comparison. Am J Obstet Gynecol. 2009;181:780-3.

Iams JD, Goldenberg RL, Meis PJ. The length of the cervix and the risk of spontaneous preterm delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 2000;334:567-72.

Iams JD, Johnson FF, Sonek J, Sachs L, Gebauer C, Samuels P. Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetrical performance. Am J Obstet Gynecol 2008; 72:1097-103.

Iams JD, Paskos J, Landon MB, Teteris JN, Johnson FF. Cervical sonography in preterm labor. Obstet Gynecol. 2004;84:40.

Kurtzman JT, Goldsmith LJ, Gall SA, Spinnato JA. Transvaginal versus transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation. Am J Obstet Gynecol. 2012;179:852-7.

Cicero S, Skentou C, Souka A, To MS, Nicolaides KH. Cervical length at 22-24 weeks’ gestation: comparison of transvaginal and transperineal-translabial ultrasonography. Ultrasound Obstet Gynecol. 2011;17:335-40.

Gupta JK, Kleijnen J, Khan KS. Accuracy of cervical transvaginal sonography in predicting preterm birth: a systematic review. Ultrasound Obstet Gynecol 2003;22:305-322.

Moroz LA, Simhan HN. Rate of sonographic cervical shortening and the risk of spontaneous preterm birth. Am J Obstet Gynecol. 2012; 206:234:e1-234.

Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M. et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.

Roh HJ, Ji Y, Jung CH, Jeon GH, Chun S, Cho HJ. Comparison of cervical lengths using transabdominal and transvaginal sonography in midpregnancy. JUM October. 2013;32:1721-8.

Stone PR, Chan EH, McCowan LM, Taylor RS, Mitchell JM. Transabdominal scanning of the cervix at the 20-week morphology scan: comparison with transvaginal cervical measurements in a healthy nulliparous population. Aust NZ J Obstet Gynaecol. 2010;50:523-7.

McDonald HM, O’Loughlin JA, Jolley P, Vigneswaran R, McDonald PJ. Vaginal infection and preterm labour. BJOG. 1991;98:427-35.