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Soto-Torres EE, Hernandez-Andrade E, Huntley ES, Blackwell SC. Maternal and obstetrical factors associated with short cervical length at midtrimester in women with no history of preterm delivery. J Matern Fetal Neonatal Med 2023; 36:2228448. [PMID: 37385780 DOI: 10.1080/14767058.2023.2228448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
AIM To evaluate associations between maternal characteristics and a short cervix in patients without history of preterm delivery, and to determine if these characteristics can predict the presence of a short cervix. MATERIALS AND METHODS This is a retrospective cohort study that included 18,592 women with singleton pregnancies without history of previous preterm deliveries who underwent universal transvaginal cervical length (TVCL) screening between 18 + 0 and 23 + 6 weeks/days of gestation. A short cervix was defined as a cervical length (CL) ≤25 mm, ≤20 mm, and ≤15 mm. Associations between maternal age, weight, height, body mass index (BMI), previous term deliveries, and history of previous miscarriages, with a short cervix were evaluated using logistic regression models. RESULTS The prevalence of a short cervix in our population was: CL ≤25 mm, 2.2% (n = 403); CL ≤20 mm, 1.2% (n = 224); and CL ≤15 mm, 0.9% (n = 161). Women with BMI >30 and/or previous abortions constituted 45.5% of the total population (8463/18,582). Significant associations with short cervix were observed for women with BMI ≥30, and for women with at least one previous abortion (p < .001). Parous women had a significantly lower association with a short cervix than nulliparous women (p < .001). Maternal age or height were not associated with a short cervix. Prediction of short cervix based on presence of any of the following: BMI ≥ 30 or previous abortions showed sensitivities of 55.8% (≤25 mm), 61.6% (≤20 mm), and 63.4% (≤15 mm) with similar specificity (50.1-54.6%) and likelihood ratio positive (1.2-1.5); and prediction based on BMI ≥ 30 and previous abortions showed sensitivities of 11.1% (≤25 mm), 14.7% (≤20 mm), and 16.7% (≤15 mm) with specificity 93%. CONCLUSIONS Among low risk women for spontaneous preterm delivery, those with a BMI ≥30 and/or previous miscarriages had a significantly increased risk for a short cervix at 18 + 0 and 23 + 6 weeks/days of gestation. Despite these significant associations, screening by maternal risk factors in a low risk population of pregnant women should not be an alternative to mid-trimester universal CL measurement.
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Affiliation(s)
- Eleazar E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Erin S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sean C Blackwell
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Pascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, Espada M, Exacoustos C, Ferrero S, Guerriero S, Hudelist G, Malzoni M, Reid S, Tang S, Tomassetti C, Singh SS, Van den Bosch T, Leonardi M. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:309-327. [PMID: 35229963 DOI: 10.1002/uog.24892] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Pascoal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J M Wessels
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- AIMA Laboratories Inc., Hamilton, Canada
| | - M K Aas-Eng
- Department of Gynecology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Espada
- Department of Obstetrics and Gynaecology, Blue Mountains ANZAC Memorial Hospital, Katoomba, Australia
- Sydney Medical School, Sydney, Australia
| | - C Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Cagliari, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, St John of God Hospital, Vienna, Austria
- Scientific Endometriosis Foundation (SEF), Westerstede, Germany
| | - M Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - S Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, Australia
| | - S Tang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - M Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Sydney Medical School, Sydney, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Soto EE, Hernandez-Andrade E, Huntley ES, Blackwell SC. Implementing a Universal Cervical Length Screening Program in a Large Hospital System, it Takes Some Time to Achieve Consistent Results. Gynecol Obstet Invest 2022; 87:124-132. [PMID: 35354147 DOI: 10.1159/000524361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe changes in the acceptance of transvaginal (TV) cervical length (CL) measurements, and in the variance of CL measurements among operators, after implementation of universal TV-CL measurements at 18+0-23+6 weeks/days of gestation. STUDY DESIGN Retrospective cohort study Participants/Materials, Setting, Methods This study was performed after universal TV-CL screening was implemented at the University of Texas Health Science Center in Houston, Texas, for all women undergoing an anatomy ultrasound (US) between 18 0/6 and 23 6/7 weeks of gestation. Pregnant women carrying singletons without prior history of preterm delivery who underwent anatomy ultrasound evaluation between September 2017 and March 2020 (30 months) were included. The complete study period was divided in five epochs of six months each. Changes in patient's acceptance for the TV scan, in CL distribution, in the prevalence of short cervix defined as ≤15, ≤20, or ≤25 mm, and in the performance of ultrasound operators across the five epochs were evaluated. For this analysis, success rate was defined as the percentage of TV-CL measurements obtained in relation to the number of second trimester anatomy scans. RESULTS A total of 22,207 low risk pregnant women evaluated by 36 trained sonographers were analyzed. Overall, the acceptance for TV-CL measurement was 82.3% (18,289/22,207), increasing from 76.7% in the first epoch to 82.8% (p<0.0001) in the last epoch. The mean CL did not significantly change from 38.6 mm in the first epoch to 38.5 mm in the last epoch (p=0.7); however, the standard deviation decreased from 7.9 mm in the first epoch to 7.04 mm in the last epoch (p=<0.01). The prevalence of a short cervix ≤25 mm was 2.2% (n=399/18,289), ≤20 mm was 1.2% (224/18,289), and ≤15 mm was 0.9% (162/18,289). This prevalence varied only for CL ≤25 mm from 3.02% (88/2,907) in the first epoch to 1.77% (64/3,615) in the last epoch (p=0.0009). There was a variation in CL measurements among operators (mean 3.3 mm). Sonographers with less than one year of experience had a lower success rate for completing TV-CL examinations than more experienced sonographers (80.8% vs. 85.8%; p <0.03). In general 77% (27/35) of operators had a success rate ≥80% for completing TV-SL scans. LIMITATIONS Characteristics of individuals who accepted versus those who declined TV-CL were not compared; CL values were not correlated with clinical outcomes. CONCLUSIONS During the first six months after implementation of a universal cervical length screening program, there was greater variation in CL measurements, lower acceptance for a TV ultrasound, and a higher number of women diagnosed with a CL ≤25 mm, as compared to subsequent epochs. After the first six months, these metrics improved and remained stable. Most operators improved their performance over time; however, there were a few with a low success rate for TV-CL, and others who systematically over or under estimate CL measurements.
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Affiliation(s)
- Eleazar E Soto
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Erin S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Sean C Blackwell
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
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Collins K, Hamlyn T, Bruxner G, Kothari A. Dangers in the dark: Calling for a safer practice of transvaginal ultrasonography. Australas J Ultrasound Med 2021; 24:5-12. [PMID: 34765410 DOI: 10.1002/ajum.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background The intimate examination is an important component of the assessment of a patient presenting with obstetric or gynaecological concerns. Ultrasound practitioners, like any other medical practitioner, are in a unique and privileged position. During the examination, the sonographers engage in a very close and personal interaction with an individual whom they have likely never met. They are also most likely unfamiliar with their social situation, cultural background, previous experiences with the healthcare profession and more importantly, any history of sexual trauma. It is an extremely sensitive area of practice which places a great deal of responsibility on the clinician to ensure that they not only protect their patient from psychological distress, but also themselves, from the threat of litigation arising from such distress. Aims This paper highlights the current governance requirements for sonographers and makes suggestions to support them in safeguarding their patients and themselves from allegations of unprofessional conduct, until such a regulatory body exists. Materials and Methods A wide-ranging review of the literature exploring the perceptions of female patients regarding intimate sonographic examination was performed using standard search engines. Additionally, grey literature was searched for policy statements and government regulatory documents for guidance on the topic. Results Although much research has been undertaken in this field across diverse cultures and knowledge in this area is ever increasing; however, the guidelines for sonographers appear to be site specific and variable. At present, there is no overarching governance for sonographers, as there is with practitioners registered with the Australian Health Practitioner Regulation Agency. Discussion While there are practice standards for the purposes of Medicare set out by the Diagnostic Imaging Accreditation Scheme, there is no regulatory professional standard that sonographers are held accountable to. This is problematic and has the potential for inadvertent boundary transgression by the practitioner, as there is also no existing framework for management of such incidents in an equitable manner. Conclusion The intimate examination is generally well tolerated; however, there is a subset of the population who are vulnerable to psychological distress arising from the examination. The sonographer must be astute to signs of distress and act in accordance with the intimate examination guidelines set out by AHPRA, for the dual purpose of protecting their patients against harm and also themselves from the threat of litigation.
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Affiliation(s)
- Kelly Collins
- Wesley Hospital Auchenflower Queensland Australia.,University of Queensland St Lucia Queensland Australia
| | - Tina Hamlyn
- Redcliffe Hospital Redcliffe Queensland Australia
| | - George Bruxner
- University of Queensland St Lucia Queensland Australia.,Metro North Mental Health Service Brisbane Queensland Australia
| | - Alka Kothari
- University of Queensland St Lucia Queensland Australia.,Redcliffe Hospital Redcliffe Queensland Australia
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Ginsberg Y, Zipori Y, Khatib N, Schwake D, Goldstein I, Shrim A, Weiner Z, Beloosesky R. It is about time. The advantage of transabdominal cervical length screening. J Matern Fetal Neonatal Med 2020; 35:4797-4802. [PMID: 33345666 DOI: 10.1080/14767058.2020.1864317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Sonographic cervical length (CL) measurement has become a standard practice for identifying women at increased risk for preterm birth. We aimed to assess the time needed for CL measurement during fetal anatomy scan using either transabdominal or transvaginal ultrasound, and to provide a predictive value of the transabdominal CL measurements for reassuring transvaginal CL measurements of more than 25 mm. METHODS In a prospective study we measured CL transabdominally, and transvaginally in all the anatomy scans performed at 18-25 weeks' gestation, from January 2017 until January 2018. CL and the duration of the examination were compared between the two approaches. Adjustments were made for, body mass index, previous cesarean sections and parity. RESULTS Four hundred sixty-eight patients participated in the study. The time needed for the transabdominal CL measurement was significantly lower compare with the transvaginal CL measurement (0.46 ± 0.3 min versus 6.9 ± 1.38 min, p < 0.001). The CL measured transabdominally was significantly shorter than the CL measured transvaginally (36.7 ± 6.7 mm versus 41.9 ± 7.3 mm, respectively p < 0.001). All women with transabdominal CL measurements above 36 mm (64.2% of patients) had a transvaginal CL of more than 25 mm. CONCLUSION Transvaginal measurement of CL is a time-consuming procedure that prolong fetal anomaly scan by 25%. Transabdominal CL measurement of 36 mm is reassuring CL above 25 mm. Transabdominal ultrasound should be used as an initial tool for CL screening. Transvaginal measurements of CL should be reserved for high-risk women, for women with difficulties in demonstrating the cervix abdominally, and for women with transabdominal measurements of less than 36 mm.
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Affiliation(s)
- Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Dalia Schwake
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Israel Goldstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
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6
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Meagher BT, Campos MR, Thornton P, Klima C, Peters TA, Hallberg J, Ulfhager E, O'Brien WD, McFarlin BL. Reasons Why Pregnant Women Participate in Ultrasound Research Involving Transvaginal Scans. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1581-1587. [PMID: 32073680 PMCID: PMC8059443 DOI: 10.1002/jum.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to explore the motivations of pregnant women in participating in an ultrasound study and the acceptability of vaginal ultrasound examinations. METHODS A prospective sample of 270 women were asked one question: "Can you tell me what motivated you to participate in the study?" The data were then analyzed through a qualitative thematic analysis with an inductive approach. In addition to the thematic analysis, quantification of the data was performed to enhance the qualitative result. RESULTS Through the thematic analysis, 5 themes emerged from the responses of the participants: altruism, research, personal experience, personal benefit, and finding out. All responses were relatively short, and some responses included more than one theme. CONCLUSIONS Vaginal ultrasound examinations were acceptable to the participants, and pregnant women had many motivations to participate. Regardless of race, ethnicity, or insurance status, the women in our study were altruistic and curious about our research.
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Affiliation(s)
- Barbara T Meagher
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marissa R Campos
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Patrick Thornton
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carrie Klima
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tara A Peters
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Josefin Hallberg
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - Emma Ulfhager
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - William D O'Brien
- Department of Computer and Electrical Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Barbara L McFarlin
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
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Akintomide AO, Obasi UO. Intimate patient examinations: The awareness, acceptance and practice preference of transvaginal ultrasound scan among women in a South-southern State of Nigeria. J Family Med Prim Care 2019; 8:109-114. [PMID: 30911489 PMCID: PMC6396578 DOI: 10.4103/jfmpc.jfmpc_207_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Transvaginal ultrasound scan (TVS) is a relatively new routine intimate examination in Nigeria carried out only in fertility clinics, specialist radio-diagnostic centres and a few public hospitals. It is a procedure, which many patients find intrusive and may result in anxiety. The gender of the practitioner and the presence of a third person in the room may influence patient's acceptance to undergo the procedure. Centres offering this service do not routinely ask for the patient's opinion, which negates the patient-centred care principle. The aim of this study is to assess women's awareness, acceptance and practice preference of TVS to get their opinion about the preferred gender of sonologist and presence of a third person during the procedure in comparison to other intimate examinations. Materials and Methods It is a questionnaire-based prospective survey involving women referred for various indications to the radiology department of a Navy Hospital in south-southern Nigeria for 1 month. Results We recruited 204 women. Although only 20.6% knew about TVS, 98.5% accepted to undergo TVS. Forty-six percent were indifferent about the gender of the sonologist, while 45% and 9% preferred a female and a male, respectively. About 50.3% wanted a third person in the room during the TVS and majority preferred their husbands (44.7%) to a chaperone (35.8%). Conclusion The awareness of TVS is low, but it enjoys wide acceptance. Patient's preference for practitioner's gender and chaperone use are variable similar to findings from other intimate examinations, so consent should be sought before the procedure.
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Affiliation(s)
- Akintunde O Akintomide
- Department of Radiology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Uzoma O Obasi
- Department of Radiology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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9
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Butt K, Crane J, Hutcheon J, Lim K, Nevo O. No 374 - Évaluation systématique de la longueur cervicale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:375-387.e1. [DOI: 10.1016/j.jogc.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Fu A, Weber CE, Gilmore E, Davis AR, Hirsch G, Westhoff CL. A noninferiority randomized controlled trial to compare transabdominal and transvaginal sonography for eligibility assessment prior to medical abortion. Contraception 2018; 98:199-204. [DOI: 10.1016/j.contraception.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/25/2022]
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Panebianco N, Shofer F, O'Conor K, Wihbey T, Mulugeta L, Baston CM, Suzuki E, Alghamdi A, Dean A. Emergency Department Patient Perceptions of Transvaginal Ultrasound for Complications of First-Trimester Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1965-1975. [PMID: 29380893 DOI: 10.1002/jum.14546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/10/2017] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Emergency department (ED) transvaginal ultrasound (US) is underused in clinical practice. This study assessed pregnant women's perceptions of ED transvaginal US in terms of pain, embarrassment, anxiety, and willingness to receive the procedure. Secondary variables include physicians' perceptions of patients' experiences. METHODS Women undergoing US examinations for complications of first-trimester pregnancy were prospectively surveyed before any US and after ED and/or radiology transvaginal US. Patients' and physicians' assessments of pain, embarrassment, and anxiety were measured with visual analog scales (0-100). RESULTS A total of 398 women were enrolled. In the pre-US survey, the median anxiety score was 14 (interquartile range, 3-51), and 96% of patients were willing to have an ED transvaginal US if necessary. Of those who had ED transvaginal US, 96% would agree to have another examination. Patients reported minimal pain/embarrassment, and there was no difference if performed in the ED versus radiology (median pain, 11.5 versus 13; P = .433; median embarrassment, 7 versus 4; P = .345). Of the 48 who had both ED and radiology transvaginal US, 85% thought the ED transvaginal US was worthwhile. Physicians accurately assessed patient's embarrassment and pain (mean differences, 3.5 and -1.9, respectively; P > .25 for both); however, they overestimated them relative to the pelvic examination (mean difference for embarrassment, 12.8; P < .0001; pain, 8.0; P = .01). CONCLUSIONS Pregnant ED patients report low levels of anxiety, pain, and embarrassment, and after ED transvaginal US, 96% would agree to have the examination again. There is no difference in pain/embarrassment between ED and radiology transvaginal US. Emergency department physicians accurately assessed patients' pain and embarrassment with ED transvaginal US but overestimated them compared to the pelvic examination.
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Affiliation(s)
- Nova Panebianco
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Frances Shofer
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Katie O'Conor
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Tristan Wihbey
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lakeisha Mulugeta
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Cameron M Baston
- the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Evan Suzuki
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Adel Alghamdi
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anthony Dean
- Department of Emergency Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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Hermans FJR, Koullali B, van Os MA, van der Ven JEM, Kazemier BM, Woiski MD, Willekes C, Kuiper PN, Roumen FJME, de Groot CM, de Miranda E, Verhoeven C, Haak MC, Pajkrt E, Schuit E, Mol BWJ. Repeated cervical length measurements for the verification of short cervical length. Int J Gynaecol Obstet 2017; 139:318-323. [PMID: 28884811 DOI: 10.1002/ijgo.12321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 09/06/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine if the verification of short cervical length with a repeated measurement improved the identification of patients with short cervical length at increased risk of preterm delivery. METHODS The present secondary analysis analyzed prospective cohort study data from patients with singleton pregnancies without a history of preterm delivery who presented for obstetric care in the Netherlands and delivered between November 18, 2009, and January 1, 2013. Cervical length was measured during standard anomaly scan and a second measurement was performed if the cervical length was 30 mm of shorter. Logistic regression and Cox proportional hazards modeling were used to evaluate associations between cervical length measurements and spontaneous preterm delivery before 37 weeks of pregnancy. RESULTS Cervical length measurements from 12 358 patients were included; 221 (1.8%) had an initial cervical length measurement of 30 mm or shorter. A second cervical length measurement was performed for 167 (75.6%) patients; no differences were identified in the odds of spontaneous preterm delivery when evaluated using the first, second, or a mean of both measurements, regardless of whether cervical length was analyzed as a continuous or dichotomous variable. CONCLUSION Among patients with singleton pregnancies, verification of short cervical length did not improve the identification of short cervical length.
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Affiliation(s)
- Frederik J R Hermans
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, Netherlands
| | - Bouchra Koullali
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, Netherlands
| | - Melanie A van Os
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
| | | | - Brenda M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, Netherlands
| | - Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christine Willekes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Frans J M E Roumen
- Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen, Netherlands
| | - Christianne M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
| | - Esteriek de Miranda
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, Netherlands
| | - Corine Verhoeven
- Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.,Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, Netherlands
| | - Ewoud Schuit
- Julius Center for Healthcare Research and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Okeji MC, Udoh BE, Ihudiebube-Splendor CN, Izge IY, Ekuma KO, Emeter JO. Assessment of women's attitude to and perception of transvaginal sonography in Nigeria. Technol Health Care 2017; 25:797-802. [PMID: 28436409 DOI: 10.3233/thc-170842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. METHODS A Cross-sectional survey was adopted for the study. Subjects were enrolled from one missionary, one government and eight private hospitals. The instruments for data collection were visual analogue scale (VAS), to ascertain patients' pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0-5 (no pain), 6-40 (mild pain), 41-74 (moderate pain), and 75-100 (severe pain). RESULTS The majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. The majority majority of the respondents (63.1%) preferred female sonographers. A majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there was enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. CONCLUSIONS Majority of our respondents had a positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing education.
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Affiliation(s)
- M C Okeji
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - B E Udoh
- Department of Radiography and Radiological Sciences, Faculty of Allied Medical Sciences, University of Calabar, Cross River State, Nigeria
| | - C N Ihudiebube-Splendor
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - I Y Izge
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - K O Ekuma
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - J O Emeter
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
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Okeji MC, Agwuna KK, Ihudiebube-Splendor CN, Izge IY, Ekuma KK, Emeter JO. Transvaginal Sonography: perception and attitude of Nigerian women. BMC WOMENS HEALTH 2017; 17:54. [PMID: 28750613 PMCID: PMC5532778 DOI: 10.1186/s12905-017-0413-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
Background To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. Methods A Cross-sectional survey was adopted for the study. In all, one missionary, one government and eight private hospitals were enlisted. The instruments for data collection were visual analogue scale (VAS), to ascertain patients’ pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0–5 (no pain), 6–40 (mild pain), 41–74 (moderate pain), and 75–100 (severe pain). Results Majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. Also majority of the respondents (63.1%) preferred female sonographers. Majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there were enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. Conclusions Majority of our respondents had positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing academic status.
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Affiliation(s)
- Mark C Okeji
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria.
| | - Kennedy K Agwuna
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Chika N Ihudiebube-Splendor
- Department of Radiation Medicine, Faculty of Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
| | - Iliyasu Y Izge
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Kelechi K Ekuma
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Jennifer O Emeter
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
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Khalifeh A, Berghella V. Not transabdominal! Am J Obstet Gynecol 2016; 215:739-744.e1. [PMID: 27889000 DOI: 10.1016/j.ajog.2016.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 06/19/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Preterm birth remains a major cause of perinatal morbidity and mortality. A short cervix is strongly associated with spontaneous preterm birth. Professional organizations support cervical length screening for singleton gestations with a prior spontaneous preterm birth and second-trimester cervical length measurements between 16-24 weeks. All interventions used to decrease the risk of preterm birth in women with a short cervix are based on clinical trials that used transvaginal cervical length measurement, but transabdominal ultrasound has been shown to correlate well with transvaginal measurement in some observational studies. Transvaginal cervical length measurement is more accurate and more reliably obtained than the transabdominal approach. Conversely, transabdominal ultrasound could have the advantage of ease of implementation and, in general, is perceived by patients to be associated with less discomfort. Currently, there is no randomized clinical study that compares head-to-head the effectiveness of transvaginal vs transabdominal ultrasound for preterm birth risk screening. This point/counterpoint article summarizes the pros and cons of the 2 ultrasound approaches and debates whether transvaginal ultrasound should be used exclusively or if transabdominal ultrasound can be incorporated in cervical length screening for prevention of preterm birth.
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Affiliation(s)
- Adeeb Khalifeh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Khalifeh A, Berghella V. Universal cervical length screening in singleton gestations without a previous preterm birth: ten reasons why it should be implemented. Am J Obstet Gynecol 2016; 214:603.e1-5. [PMID: 26707072 DOI: 10.1016/j.ajog.2015.12.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 11/15/2022]
Abstract
A short cervix is associated strongly with preterm birth. Pharmacologic intervention with vaginal progesterone in women with a singleton pregnancy and a short cervix in the second trimester decreases the incidence of preterm birth. We explore the evidence that universal cervical length screening in women with a singleton pregnancy meets the criteria for an effective screening test for preterm birth prevention, driving it towards becoming routinely offered in prenatal care.
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Affiliation(s)
- Adeeb Khalifeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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Koullali B, Oudijk MA, Nijman TAJ, Mol BWJ, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med 2016; 21:80-8. [PMID: 26906339 DOI: 10.1016/j.siny.2016.01.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers.
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Affiliation(s)
- B Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - T A J Nijman
- Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands
| | - B W J Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
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Laursen CB, Sloth E, Lassen AT, Davidsen JR, Lambrechtsen J, Henriksen DP, Madsen PH, Rasmussen F. Does point-of-care ultrasonography cause discomfort in patients admitted with respiratory symptoms? Scand J Trauma Resusc Emerg Med 2015; 23:46. [PMID: 26071404 PMCID: PMC4465167 DOI: 10.1186/s13049-015-0127-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/29/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study aimed to assess the patient-rated level of discomfort during point-of-care ultrasonography (POCUS) of the heart, lungs and deep veins in a population of patients admitted to an ED with respiratory symptoms and to what extent the patients would accept being assessed by the use of POCUS if they had to be examined for possible disease. METHODS A questionnaire-based observational study was conducted in an ED. Inclusion criteria were one or more of the following: respiratory rate > 20/min, oxygen saturation < 95 %, oxygen therapy initiated, dyspnoea, cough or chest pain. Patients were examined by the use of POCUS of the heart, lungs and deep veins. Patient-rated level of discomfort and acceptance were assessed using a standardised questionnaire. RESULTS The median duration of the sonographic examinations was 12 min (IQR 11-13, range 9-23). The median patient-rated level of discomfort for all three types of POCUS was 1 (IQR 1-1, range 1-8) on a scale from 1 to 10. All but one patient (99.6 % (95 % CI: 98.9-100 %)), would accept being examined by the use of POCUS as a part of routine ED diagnostics. CONCLUSIONS The patient-rated level of discomfort during POCUS of the heart, lungs and deep veins is very low and the vast majority of patients would accept being assessed by the use of POCUS if the patients once again had to be examined for possible disease.
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Affiliation(s)
- Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Erik Sloth
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Skejby, Denmark.
| | | | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Jess Lambrechtsen
- Department of Medicine, Odense University Hospital, Svendborg, Denmark.
| | | | | | - Finn Rasmussen
- Department of Allergy and Respiratory Medicine, Near East University Hospital, Mersin 10, Nicosia North Cyprus, Turkey.
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Iliodromiti S, Anderson RA, Nelson SM. Technical and performance characteristics of anti-Müllerian hormone and antral follicle count as biomarkers of ovarian response. Hum Reprod Update 2014; 21:698-710. [PMID: 25489055 DOI: 10.1093/humupd/dmu062] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/07/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stratified (individualized) medicine has been recognized as a key priority for policy makers and healthcare providers. The main principle of individualized care depends on utilizing patients' characteristics and biomarkers to predict prognosis, tailor intended treatment and predict treatment outcomes. In reproductive medicine a wide variety of biomarkers have been proposed as predictors of ovarian response; of these, anti-Müllerian hormone (AMH) and antral follicle count (AFC) are purported as exhibiting the most favourable analytical and performance characteristics. Previously AFC and AMH have been considered essentially interchangeable; however, recent trial data have questioned this postulation. The aim of this review is to present an analysis of the strengths and weaknesses of these biomarkers as predictors of ovarian response, using both physiological and technical perspectives. METHODS We have conducted a systematic search of the most recent (to May 2014) relevant literature and summarized the existing evidence. Articles written in a language other than English without an available English translation were excluded. RESULTS Both AMH values and AFC can be influenced by comparable technical, physiological and exogenous factors. AMH displays some variation within and between cycles, consistent with its physiological role in follicle development, and there are growing data on the impact of pharmacological treatments and pathological conditions but cycle-independent measurement is appropriate for clinical purposes. A range of issues with manual AMH assays may be resolving with the development of fully automated assays. Despite described standardization of its measurement technique, AFC is subject to marked inter- and intra-operator variability and the effects of external influences are likely to be comparable. Outwith some highly specialist centres, the intracyclic variation in AFC requires its measurement between Day 2 and 4 of the cycle. Observational studies suggest comparable performance characteristics for AMH and AFC in predicting poor and high ovarian response, but recent RCTs suggest markedly better performance for AMH. CONCLUSIONS The performance characteristics of both AMH and AFC for the prediction of ovarian response to exogenous gonadotrophins have been inflated by single site observational cohorts, resulting in the viewpoint that AMH and AFC exhibit equivalent performance characteristics. Large scale multicentre RCTs, with centralized assay performance, have demonstrated that AMH is substantially the more accurate and robust biomarker, probably reflecting difficulties with standardization of AFC determination. While AFC retains some advantages, particularly immediacy and accessibility, international standardization of AMH combined with a stable automated assay is likely to enhance its performance as the biomarker of choice in predicting the ovarian response in assisted conception.
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Affiliation(s)
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow G31 2ER, UK
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Miller ES, Grobman WA. Cost-effectiveness of transabdominal ultrasound for cervical length screening for preterm birth prevention. Am J Obstet Gynecol 2013; 209:546.e1-6. [PMID: 23954533 DOI: 10.1016/j.ajog.2013.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Transabdominal ultrasound (TAUS) cervical length (CL) screening has been proposed as an alternative to universal transvaginal screening to identify women at an increased risk of preterm birth. We sought to identify whether and under what circumstances TAUS would be cost-effective. STUDY DESIGN This is a decision analytic model designed to compare an initial TAUS CL screening approach with universal transvaginal screening in a hypothetical cohort of women with a singleton pregnancy. Cost, probability, and utility estimates were derived from the existing literature. RESULTS Under baseline assumptions, universal transvaginal was the dominant strategy. In comparison to TAUS, universal transvaginal CL screening reduced preterm birth by 0.03%, reduced costs by $1.2 million and increased quality-adjusted life years by 70 per 100,000 women. Although robust to many changes in many estimates, the model was sensitive to the cost of a transvaginal ultrasound, the prevalence of a short cervix and the test characteristics (ie, sensitivity and specificity) of a TAUS screening examination for short CL. CONCLUSION Compared with an initial TAUS screen, universal transvaginal ultrasound was a more cost-effective strategy under most assumptions. Optimizing TAUS testing characteristics or applying a transabdominal screening strategy in lower risk populations may yield an initial TAUS to be cost-effective.
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Bora SA, Kirk E, Bourne T. Do women with pain and bleeding in early pregnancy require a vaginal speculum examination as part of their assessment? Gynecol Obstet Invest 2013; 77:29-34. [PMID: 24217155 DOI: 10.1159/000355923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/21/2013] [Indexed: 11/19/2022]
Abstract
AIMS To investigate whether a vaginal speculum examination (VSE) prior to a transvaginal scan (TVS) alters the diagnosis or management of women who complain of bleeding in early pregnancy. METHODS A prospective study. Women were asked to describe their bleeding as heavy, moderate or light and to consent to VSE prior to TVS. TVS was performed to obtain a final diagnosis of pregnancy outcome. RESULTS 221 consecutive women were included in the study. In 14.5% (n = 32) complaining of heavy bleeding, blood was seen in all but two VSE and 84% (n = 27) had a miscarriage diagnosed by TVS. Products of conception were removed in 18.8% (n = 6), but this did not alter the subsequent immediate management of any cases. 65.2% (n = 144) of women complained of light bleeding, blood was seen on VSE in 53% (n = 77). Of these women, 25% (n = 19) of those where blood was seen had a miscarriage, compared to 6% (n = 4) of women where blood was not seen. A cervical ectropion was visualised in 11.7% (n = 26) and 2.3% (n = 5) had a cervical polyp. No other clinically significant pathology was detected. CONCLUSION The amount of bleeding reported by women in early pregnancy relates well with VSE findings. Performing a VSE did not alter the subsequent management of these patients. This study demonstrates that routine objective assessment of blood by a clinician performing VSE prior to a TVS is unnecessary.
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Gentry-Maharaj A, Sharma A, Burnell M, Ryan A, Amso NN, Seif MW, Turner G, Brunell C, Fletcher G, Rangar R, Fallowfield L, Campbell S, Jacobs I, Menon U. Acceptance of transvaginal sonography by postmenopausal women participating in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:73-79. [PMID: 22791597 DOI: 10.1002/uog.12262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess pain and overall experience of transvaginal sonography (TVS) in asymptomatic postmenopausal women. METHODS In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), 50 639 postmenopausal women were randomized to undergo annual TVS at 13 trial centers in England, Wales and Northern Ireland. Together with the appointment letter for their annual scan, a random sample of 150 women per center was sent a detailed 48-item postal questionnaire regarding the screening experience. It included a specific question about pain using a score of 0-5, where 5 was severe pain and 3 was discomfort. To assess factors that might affect a woman's reported pain experience, the pain score was regressed on age, hormone replacement therapy use, body mass index, a history of hysterectomy, prolonged scanning time, ovarian visualization, scan result, sonographer's visualization rates and opinion of the women regarding the sonographer who performed the scan. RESULTS Between 7 July and 9 September 2009, 1950 randomly chosen women (150 per regional center) were sent the questionnaire. Of the 800 (41.0%) who returned the questionnaire, 651 could be linked to their TVS appointment. One-hundred and fifty-two (23.3%) women reported pain/discomfort (score 3-5) during TVS and 473 (72.7%) reported no discomfort (score 0-2). Only 23 (3.5%) women reported experiencing moderate/severe pain. Increasing discomfort/pain was independently associated with a history of hysterectomy and participant's reporting of prolonged scan time. Women who experienced pain on TVS were less compliant (odds ratio = 0.87) with the following year's scan compared with those who did not experience pain. CONCLUSIONS The majority of postmenopausal women found TVS acceptable. Pain influenced compliance and correlated with women's perception of increased scanning time and previous hysterectomy.
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Affiliation(s)
- A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, London, UK.
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Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol 2012; 206:376-86. [PMID: 22542113 DOI: 10.1016/j.ajog.2012.03.010] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We sought to provide evidence-based guidelines for using progestogens for the prevention of preterm birth (PTB). METHODS Relevant documents, in particular randomized trials, were identified using PubMed (US National Library of Medicine, 1983 through February 2012) publications, written in English, which evaluate the effectiveness of progestogens for prevention of PTB. Progestogens evaluated were, in particular, vaginal progesterone and 17-alpha-hydroxy-progesterone caproate. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Data were evaluated according to population studied, with separate analyses for singleton vs multiple gestations, prior PTB, or short transvaginal ultrasound cervical length (CL), and combinations of these factors. Consistent with US Preventive Task Force suggestions, references were evaluated for quality based on the highest level of evidence, and recommendations were graded. RESULTS AND RECOMMENDATIONS Summary of randomized studies indicates that in women with singleton gestations, no prior PTB, and short CL ≤ 20 mm at ≤ 24 weeks, vaginal progesterone, either 90-mg gel or 200-mg suppository, is associated with reduction in PTB and perinatal morbidity and mortality, and can be offered in these cases. The issue of universal CL screening of singleton gestations without prior PTB for the prevention of PTB remains an object of debate. CL screening in singleton gestations without prior PTB cannot yet be universally mandated. Nonetheless, implementation of such a screening strategy can be viewed as reasonable, and can be considered by individual practitioners, following strict guidelines. In singleton gestations with prior PTB 20-36 6/7 weeks, 17-alpha-hydroxy-progesterone caproate 250 mg intramuscularly weekly, preferably starting at 16-20 weeks until 36 weeks, is recommended. In these women with prior PTB, if the transvaginal ultrasound CL shortens to < 25 mm at < 24 weeks, cervical cerclage may be offered. Progestogens have not been associated with prevention of PTB in women who have in the current pregnancy multiple gestations, preterm labor, or preterm premature rupture of membranes. There is insufficient evidence to recommend the use of progestogens in women with any of these risk factors, with or without a short CL.
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Atalabi OM, Morhason-Bello IO, Adekanmi AJ, Marinho AO, Adedokun BO, Kalejaiye AO, Sogo K, Gbadamosi SA. Transvaginal ultrasonography: a survey of the acceptability and its predictors among a native African women population. Int J Womens Health 2012; 4:1-6. [PMID: 22312194 PMCID: PMC3271809 DOI: 10.2147/ijwh.s23533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women. Method A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software. Results The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery. Conclusion The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.
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Affiliation(s)
- Omolola M Atalabi
- Department of Radiology, College of Medicine/University College Hospital, University of Ibadan, Ibadan
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Ierullo AM, Fernandez S, Palacio M, Gratacos E, Hernandez-Andrade E. Cervical blood perfusion assessed using power Doppler-derived estimation of fractional moving blood volume: a reproducibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:57-61. [PMID: 21584885 DOI: 10.1002/uog.8974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the reproducibility of estimation of power Doppler-derived fractional moving blood volume (FMBV) in the uterine cervix of women with uncomplicated pregnancies. METHODS Two experienced operators evaluated 30 uncomplicated singleton pregnancies at 20-24 weeks of gestation. The PDU box was positioned in a mid-sagittal view of the cervix, including the internal os and external os, in the same plane as that in which cervical length is measured. Two consecutive examinations were performed by each operator, in each of which the cervical length was measured and five consecutive good-quality images with PDU information were obtained. The region of interest (ROI) (cervix) was delineated offline and FMBV, which expresses the percentage of blood occupying the ROI, was calculated with purpose-designed software. Intra- and interobserver intraclass correlation coefficients (ICCs) and mean differences with 95% limits of agreement (LOA) were calculated. RESULTS The median gestational age at examination was 22 + 0 weeks. Measurements (median ± SD) obtained for cervical length and FMBV were as follows: Operator A: 37 ± 7.4 mm and 8.11 ± 2.9%; Operator B: 37.5 ± 9.3 mm and 7.9 ± 3.3%, respectively. The intra- and interobserver ICCs for FMBV were 0.88 (95% CI, 0.75-0.94) and 0.82 (95% CI, 0.64-0.94), respectively. There was a mean difference in FMBV measurement between operators of - 0.2 ± 1.75% (95% LOA, - 3.7 to 3.2%). CONCLUSIONS Reproducible assessment of cervical blood perfusion through estimation of FMBV can be achieved while cervical length is being measured.
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Affiliation(s)
- A M Ierullo
- Department of Maternal-Fetal Medicine, ICGON, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Song JE, Lee KY, Kim MY, Jun HA. Cervical funneling after cerclage in cervical incompetence as a predictor of pregnancy outcome. J Matern Fetal Neonatal Med 2011; 25:147-50. [PMID: 21463213 DOI: 10.3109/14767058.2011.565835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate whether cervical funneling influences pregnancy outcome in women with short cervical length (CL) after cerclage, and to identify funneling parameters associated with pregnancy outcome. METHODS Medical records of women identified to have a short CL with or without funneling after cerclage were reviewed. Women with short CL as well as funneling were defined as cases (Funneling group), and those with short CL but no funneling were the controls (No Funneling group). We compared perinatal outcome between the two groups and analyzed the relationships between funneling parameters and pregnancy outcome. RESULTS Seventy-two patients were included in this study; 39 women with short CL and funneling and 33 with short CL and no funneling. The mean gestational age at delivery of the Funneling group was 33.7 weeks, as compared to 36.5 weeks for the NoFunneling group (p < 0.001). We found a significant inverse association of funneling depth as well as volume with pregnancy outcome (p < 0.001, and p = 0.005, respectively). However, funneling width was not associated with pregnancy outcome (p = 0.49). CONCLUSIONS Funneling depth and volume may be useful predictors of pregnancy outcome after cerclage.
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Affiliation(s)
- Ji-Eun Song
- Department of Obstetrics and Gynecology, Hallym University, Seoul, Republic of Korea
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Benoist G, Chéret-Benoist A, Beucher G, Dreyfus M. [Bleeding in the first trimester of pregnancy: diagnostic approach and therapeutic management]. J Gynecol Obstet Hum Reprod 2010; 39:F33-F39. [PMID: 20362403 DOI: 10.1016/j.jgyn.2010.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 05/29/2023]
Affiliation(s)
- G Benoist
- hôpital Georges-Clemenceau, CHU de Caen, France.
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Abstract
The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part of the uterus begins to show changes weeks before eventual birth. Only transvaginal ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The shortest best cervical length (CL) is the most effective measurement for clinical use. Proper technique is paramount for accurate results. The risk of PTB increases with ever shorter CL (<25 mm). Other factors that must be carefully considered when using CL for prediction of PTB are number of fetuses, risk factors for PTB, and gestational age at screening.
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Affiliation(s)
- Maria Teresa Mella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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30
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Bottomley C, Bourne T. Diagnosing miscarriage. Best Pract Res Clin Obstet Gynaecol 2009; 23:463-77. [DOI: 10.1016/j.bpobgyn.2009.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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Kirk E, Condous G, Bourne T. Pregnancies of unknown location. Best Pract Res Clin Obstet Gynaecol 2009; 23:493-9. [DOI: 10.1016/j.bpobgyn.2009.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 01/16/2009] [Indexed: 10/20/2022]
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Kirk E, Bourne T. Diagnosis of ectopic pregnancy with ultrasound. Best Pract Res Clin Obstet Gynaecol 2009; 23:501-8. [PMID: 19356985 DOI: 10.1016/j.bpobgyn.2008.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 12/15/2008] [Indexed: 01/10/2023]
Abstract
Transvaginal sonography (TVS) is now the imaging modality of choice for the diagnosis of ectopic pregnancy with overall reported sensitivities of>90%. Specific sonographic criteria exist for the diagnosis of tubal and non-tubal pregnancies including cervical and caesarean section scar pregnancies. Diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intra-uterine pregnancy. This chapter discusses the specific criteria used for the diagnosis of ectopic pregnancy and examines the literature assessing the accuracy of ultrasound as a diagnostic tool.
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Affiliation(s)
- Emma Kirk
- Whittington Hospital, Magdala Avenue, London, UK.
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Berghella V. Novel developments on cervical length screening and progesterone for preventing preterm birth. BJOG 2009; 116:182-7. [PMID: 19076950 DOI: 10.1111/j.1471-0528.2008.02008.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cervical length (CL) measured by transvaginal ultrasound is an effective screening test for the prevention of preterm birth (PTB). The criteria for an effective screening test are all met by CL. It studies an important condition (PTB); it is safe and acceptable by >99% of women; it recognises an early asymptomatic phase that precedes PTB by many weeks; it has a well-described technique, is reproducible, is predictive of PTB in all populations studies so far; and, perhaps most importantly, it has been shown that 'early' treatment is effective in prevention. These two interventions, effective only in specific populations, are ultrasound-indicated cerclage and vaginal progesterone.
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Affiliation(s)
- V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Bottomley C, Bourne T. Dating and growth in the first trimester. Best Pract Res Clin Obstet Gynaecol 2009; 23:439-52. [PMID: 19282247 DOI: 10.1016/j.bpobgyn.2009.01.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/20/2009] [Indexed: 11/16/2022]
Abstract
Measurement of embryonic or foetal size using the greatest length of the embryo or foetal crown rump length can be used to accurately determine the gestational age of a normal first trimester pregnancy to within three to five days. Transvaginal ultrasound scan can be used to measure the size of an embryo and gestation sac earlier than transabdominal ultrasound. The original Robinson curve used for dating pregnancies is still valid in most cases. Ultrasound dating in the first trimester is now recommended for all women with spontaneous pregnancies, even those with certain menstrual dates. First trimester growth in normal pregnancy is not uniform and is influenced by both maternal and foetal factors. Early foetal growth restriction is demonstrated in many pregnancies that subsequently end in first trimester miscarriage and is also demonstrated in fetuses with triploidy, trisomy 18 and possibly trisomy 13. Pregnancies which are small at the 11-14 week ultrasound scan appear to be at risk of later intrauterine growth restriction, preeclampsia and preterm delivery. Cross-sectional and serial measurement of foetal growth in the first trimester may be helpful in predicting both miscarriage and adverse late pregnancy outcomes.
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Tayal VS, Crean CA, Norton HJ, Schulz CJ, Bacalis KN, Bliss S. Prospective comparative trial of endovaginal sonographic bimanual examination versus traditional digital bimanual examination in nonpregnant women with lower abdominal pain with regard to body mass index classification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1171-1177. [PMID: 18645075 DOI: 10.7863/jum.2008.27.8.1171] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We hypothesized that a sonographic bimanual examination (SBME) would improve confidence in the pelvic examination in adult nonpregnant women with lower abdominal conditions compared to a traditional digital bimanual examination (DBME). METHODS In a prospective comparative study at an urban regional emergency department, an ultrasound-trained group of emergency clinicians performed both an SBME and a DBME on 30 women who required a DBME as part of their evaluation. Patients were divided into 3 groups based on their body mass index (BMI) weight class. Inclusion criteria included lower abdominal pain, age between 18 and 55 years, hemodynamic stability, and BMI of greater than 18.5. Exclusion criteria included pregnancy, hysterectomy, oophorectomy, and recent vaginal surgery. The patient's sequence of examinations was randomized and then performed by a different member of the study group. Examiners assessed their confidence (0%-100%) in 11 components of the pelvic examination. RESULTS There were higher scores for the SBME compared to the DBME in the overall composite score, cervical position, uterine size, uterine position, uterine tenderness, ovarian size, ovarian tenderness, and presence of an adnexal mass (P < .05), whereas cervical motion tenderness, cervical os opening, and rectovaginal tenderness did not show significant differences. Across BMI classes, the SBME produced high composite and individual examination scores among all examination criteria. In contrast, the DBME revealed significant differences for uterine size, uterine alignment, uterine tenderness, ovarian size, and ovarian tenderness across BMI classes (P < .05). CONCLUSIONS The SBME provides improved confidence in overall and key aspects of the pelvic examination across BMI classes compared to the DBME.
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Affiliation(s)
- Vivek S Tayal
- Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA.
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Berghella V, Owen J, MacPherson C, Yost N, Swain M, Dildy GA, Miodovnik M, Langer O, Sibai B. Natural History of Cervical Funneling in Women at High Risk for Spontaneous Preterm Birth. Obstet Gynecol 2007; 109:863-9. [PMID: 17400847 DOI: 10.1097/01.aog.0000258276.64005.ce] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the natural history of funneling in the second trimester by transvaginal ultrasonograms and whether funneling increases the risk of spontaneous birth. METHODS Secondary analysis of a blinded, multi-center observational study of women with at least one prior spontaneous preterm birth at 16.0-31.9 weeks who subsequently carried singleton gestations. Cervical length, funneling (membrane prolapse greater than or equal to 5 mm), funnel shape, and dynamic changes were recorded at 16-18 weeks, and then every 2 weeks until 23.9 weeks. Managing obstetricians were blinded to the ultrasonography results. The primary outcome was gestational age at delivery. RESULTS Five hundred ninety scans were performed in 183 women, of which 60 (33%) had funneling observed on at least one of the serial evaluations. These 60 women delivered at an earlier gestational age at delivery than the 123 women without funneling (31.7+/-7.9 weeks compared with 36.9+/-4.4 weeks; P<.001). In the 60 women with funneling on at least one evaluation, the progression over time of internal os cervical anatomy from a "T" to a "V" to a "U" shape was associated with earlier gestational age at delivery, whereas resolution of "V" shape funnels was associated with term delivery. Women with a shortened cervical length less than 25 mm (n=60) had a similar gestational age at birth with or without funneling (30.6+/-8.0 weeks compared with 31.9+/-6.6 weeks; P=.59). After controlling for the shortest observed cervical length, largest funnel percent was not a significant independent risk factor. CONCLUSION The natural history of second-trimester funneling has significant variability and a significant association with earlier gestational age at delivery. As an independent finding, funneling does not add appreciably to the risk of early gestational age at delivery associated with a shortened cervical length. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Abstract
PURPOSE OF REVIEW To present a summary of the literature and most recent advances in the clinical use of cervical length for the prediction of preterm birth. RECENT FINDINGS Cervical length is predictive of preterm birth in all populations studied, including asymptomatic women with prior cone biopsy, mullerian anomalies, or multiple dilation and evacuations. While cervical length remains the most predictive measurement, funneling may add to its predictive value in certain populations. In terms of interventions aimed at preventing preterm birth once a short cervical length has been identified in asymptomatic women, recent data from a meta-analysis of all trials published so far point to the benefit of ultrasound-indicated cerclage in women with both a prior preterm birth and a cervical length less than 25 mm. Other interventions for a short cervical length such as progesterone and indomethacin are promising, but deserve further study before clinical recommendations can be made. In women with symptomatic preterm labor, a recent trial has shown that knowledge of cervical length (and fetal fibronectin) may be beneficial both in terms of time to triage and reduction of preterm birth. SUMMARY Transvaginal ultrasound cervical length used as a screening tool for prediction and prevention of preterm birth can significantly improve the health outcomes of pregnant patients and their babies.
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Affiliation(s)
- Jacqueline Grimes-Dennis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvannia 19107, USA
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Sawyer E, Jurkovic D. Ultrasonography in the Diagnosis and Management of Abnormal Early Pregnancy. Clin Obstet Gynecol 2007; 50:31-54. [PMID: 17304023 DOI: 10.1097/grf.0b013e31802f71db] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The demand for ultrasound in early pregnancy has been increasing steadily, and is now a routine investigation for most women within the first trimester of their pregnancy. It is a safe investigation which provides reassurance, charts normal development, and identifies women with abnormal or high risk pregnancies. Transvaginal ultrasound has revolutionized the diagnosis of early pregnancy as it can detect a pregnancy at an earlier stage, whether it is normal and therefore reassuring, or abnormal and require intervention. Ultrasound is also a useful tool to aid decisions regarding management of abnormal pregnancy, such as ectopic pregnancy or miscarriage. This chapter looks at the important role ultrasound plays in the diagnosis and management of abnormal pregnancy.
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Affiliation(s)
- Emma Sawyer
- Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London
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Abstract
Irregular vaginal bleeding is a common symptom of women seeking gynecologic care. Etiologies of irregular vaginal bleeding can be classified into the following categories: pregnancy related (retained products of conception, threatened or missed abortion, or ectopic pregnancy), hormonal (disorders of ovulation, menopause, or hormonal contraceptive use), structural (polyps, myomas, or arteriovenous malformation), neoplasm (endometrial cancer), and infection (endometritis). After the history and physical examination, the initial evaluation of irregular vaginal bleeding has traditionally involved an endometrial biopsy. Transvaginal ultrasound has revolutionized the evaluation of the gynecologic ultrasound examination by providing a minimally invasive means to determine the etiology for the bleeding. Transvaginal ultrasound assessment of the endometrial cavity allows treatment to be tailored to the specific cause of irregular vaginal bleeding, thus saving women time, money, and exposure to unnecessary interventions. The purpose of this article is to give the clinician critical information regarding the capabilities of ultrasound to evaluate women with irregular vaginal bleeding.
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40
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Olive EC, Roberts CL, Nassar N, Algert CS. Test characteristics of placental location screening by transabdominal ultrasound at 18-20 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:944-9. [PMID: 17121427 DOI: 10.1002/uog.3873] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine the test characteristics of a second-trimester transabdominal fetal anomaly scan in screening for placenta previa. PATIENTS AND METHODS This was a case-control study carried out at a tertiary obstetric hospital involving 54 women (0.5% of the total number booked for antenatal care and delivery at the center) with clinically significant placenta previa at the time of delivery, and 168 randomly selected controls who attended for antenatal care and delivery in 2000-2003. Sensitivity, specificity and false positive rate of the placenta-os measurement in the second-trimester transabdominal fetal anomaly scan for identification of clinically significant placenta previa were assessed. RESULTS Women with placenta previa at delivery had significantly different second-trimester placenta-os measurements from those of controls (P < 0.0001). For women with placenta previa, the mean (standard deviation) placenta-os measurement was -0.96 cm (1.95) vs. 4.15 cm (1.77) for controls (P < 0.0001). Using the anomaly scan as a screening test for placenta previa with a placenta-os measurement cut-off point of < or = 2 cm, all cases of placenta previa should be identified, but 11.1% (95% CI, 7.1-14.8) of women without placenta previa would have false positive results. At cut-off points of 3 cm and 1.5 cm the false positive rates were 25.7% (95% CI, 18.8-30.2%) and 6.6% (95% CI, 3.8-9.6%), respectively, but at 1.5 cm 3.8% of cases would be missed. CONCLUSIONS The second-trimester transabdominal fetal anomaly scan is a useful screening test for placenta previa. However, because of false positives among the much larger population of women without placenta previa, we estimate that with a cut-off point of < or =2 cm, 23 women would have to be followed up to confirm one true placenta previa.
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Affiliation(s)
- E C Olive
- Centre for Perinatal Health Services Research, School of Public Health, University of Sydney, Australia.
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Holst RM, Jacobsson B, Hagberg H, Wennerholm UB. Cervical length in women in preterm labor with intact membranes: relationship to intra-amniotic inflammation/microbial invasion, cervical inflammation and preterm delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:768-74. [PMID: 17042035 DOI: 10.1002/uog.3837] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Intra-amniotic infection, diagnosed by microbial invasion of the amniotic cavity (MIAC) and/or the presence of intra-amniotic inflammation (IAI), is related to adverse perinatal outcome in women with preterm labor. Due to the subclinical nature of IAI, a correct diagnosis depends on amniocentesis, which is an invasive method not performed as a clinical routine. The aim of this study was to evaluate if cervical length measured by transvaginal sonography could assist in the identification of women at high risk for IAI. METHODS Cervical length was assessed by transvaginal sonography in 87 women with singleton pregnancies in preterm labor (<34 weeks of gestation). Cervical (n=87) and amniotic (n=55) fluids were collected. Polymerase chain reactions for Ureaplasma urealyticum and Mycoplasma hominis, and culture for aerobic and anaerobic bacteria, were performed. Interleukin (IL)-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay. RESULTS IAI was present in 25/55 (45%) of the patients presenting with preterm labor who underwent amniocentesis. Women with IAI had a significantly shorter cervical length (median, 10 (range, 0-34) mm) than had those without IAI (median, 21 (range, 11-43) mm) (P<0.0001). Receiver-operating characteristics curve analysis showed that a cervical length (cut-off of 15 mm) predicted IAI (relative risk, 3.6; CI, 1.9-10.0) with a sensitivity of 72%, specificity of 83%, positive predictive value of 78% and negative predictive value of 78%. Cervical length was also significantly associated with preterm birth up to 7 days from sampling and at <or=34 weeks. CONCLUSION Cervical length assessed by transvaginal sonography predicts IAI as well as preterm birth and could thereby be a useful clinical tool in the management of patients in preterm labor.
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Affiliation(s)
- R-M Holst
- Perinatal Center, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, Sahlgrenska University Hospital/East, Göteborg, Sweden.
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Berghella V, Ness A, Bega G, Berghella M. Cervical Sonography in Women with Symptoms of Preterm Labor. Obstet Gynecol Clin North Am 2005; 32:383-96. [PMID: 16125039 DOI: 10.1016/j.ogc.2005.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the last few years, ultrasound of the cervix during pregnancy has been the focus of much research. Significant advances have been made in its technique and in understanding the proper role of this procedure in several clinical settings. This article reviews the evidence for the clinical role of transvaginal cervical assessment in women with symptoms of preterm labor.
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Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
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43
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Kew FM, Whittaker VJ, Cruickshank DJ. Preconceptions versus experience of transvaginal ultrasonography in older women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:572-574. [PMID: 15386605 DOI: 10.1002/uog.1710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine whether women find that having a transvaginal ultrasound scan is better or worse than they had expected. METHODS Fifty-four consecutive women in an ovarian cancer screening trial filled in linked questionnaires before and after having a transvaginal ultrasound scan. RESULTS The women found that having a transvaginal scan was less painful (P = 0.003) and less embarrassing (P = 0.001) than they had expected. They found it less uncomfortable than expected in comparison to having mammography (P = 0.013) or a cervical smear (P = 0.004). CONCLUSIONS Women attending for a transvaginal scan can be reassured that it will not be as painful or embarrassing as they fear, and that it is not as uncomfortable as having mammography or a cervical smear.
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Affiliation(s)
- F M Kew
- Department of Gynaecological Oncology, James Cook University Hospital, University of Teesside, Middlesbrough, UK.
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