17.05.2015

Cervical length during pregnancy

This study was conducted with objective to assess serial changes of cervical dimensions during pregnancy from mid second trimester till delivery by transvaginal sonography.
The human cervix has been shown to be a dynamic organ through out the gestation, varying markedly in both size and length. Monitoring cervical dimensions during pregnancy helps in the prediction of risk of preterm labor resulting in early diagnosis and institution of preventive therapy such as encirclage, tocolysis and prophylactic steroids.
There are conflicting reports regarding the pattern of cervical changes with advancing gestational age in relation to parity, maternal obesity and ethnicity. This was a prospective randomised longitudinal study involving fifty pregnant women done in the Department of Obstetrics and Gynecology at Dr. The inclusion criterion was singleton live pregnancies regardless of parity and bad obstetrics history. The mean and SD of cervical length and width at each gestational age in women with preterm vs.
Percentile values of cervical length and width at 20, 24, 28, 32, 36 and term gestation are shown in Table 2. Figure 1 represents pattern of change in cervical length and width with increasing gestational age. The linear regression coefficient represents the weekly change in cervical dimensions in cm. This research focuses mainly on a longitudinal study of both cervical length and width during pregnancy using transvaginal sonography.
Serial transvaginal sonographic measurement of cervical dimensions after 20 weeks of gestation in South Indian women. It comprises 50 healthy pregnant women who underwent serial transvaginal ultrasound every four week from 20th week of gestation till delivery.
In general many studies have shown that cervix bears an inverse relation to gestational age in length and direct relation with regard to width.
With patient in lithotomy position, 5 MHz vaginal probe was introduced into the vagina and the length & width of the cervix was measured with the probe placed in the anterior fornix of the vagina.
Percentile values were calculated to construct nomogram of cervical dimensions during pregnancy. Overall, mean cervical lengths decreased while mean cervical widths increased with the gestational age.


It was found that gestational age and body mass index significantly influenced cervical parameters: both length and width, but not the parity. Significant cervical shortening occurred in those who delivered preterm through out the gestation.
It was observed that mean cervical length at any given gestation was longer in patients with BMI > 23, however this was statistically significant only in the beginning (at 20th and 24th week of gestation).
Our charts for cervical length in pregnant population can be used for observing patients at high risk of preterm delivery and for clearly identifying a significant deviation or decline in the percentile for these subjects. Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length.
Ultrasonographic examination of the uterine cervix is better than cervical digital examination as a predictor of the likelihood of premature delivery in patients with preterm labor and intact membranes. Cervical assessment at the routine 23-weeks' scan: problems with transabdominal sonography. Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy. Evaluation of threatened preterm delivery by transvaginal ultrasonographicmeasurement of cervical length. Sonographic evaluation of cervical length in pregnancy: diagnosis and management of preterm cervical effacement in patients at risk for premature delivery. Cervical changes in twin pregnancies observed by transvaginal ultrasound during the latter half of pregnancy: a longitudinal, observational study. Relation of cervical length at 22-24 weeks of gestation to demographic characteristics and obstetric history.
Therefore, the aim of this study was to assess the serial cervical dimensions at 20, 24, 28, 32, 36 and 37+ weeks gestation by transvaginal sonography in a mixed population of nulliparous and parous South Indian women and to establish a reference range for cervical length measurement from mid-pregnancy till delivery. When the difference between the two estimates was more than seven days the first trimester ultrasound result (based on Crown Rump Length - CRL) was used for dating.
The means of the cervical dimensions of all eligible women were compared by Student’s t - test between those with preterm vs.
As statistical analysis showed length had more variation than the width, further graphical interpretation was carried out keeping mainly cervical length in view.
Linear regression analysis showed that the rate of cervical length reduction was significantly higher in preterm delivery group compared to term delivery group (0.65 mm vs.


The acceptability rate among patients is high, more than 90% report none or only mild discomfort or embarrassment during the procedure. Thus we are of the opinion that sonographic cervical length surveillance initiated early in gestation and continued through out the pregnancy may identify the women whose cervices shorten at a higher rate.
Though are there are attempts to monitor serial cervical changes during pregnancy by digital assessment of cervix, it has been flawed by subjectivity and as such pervaginal examination assesses only vaginal portion of the cervix.
They reported that cervical length measurements are higher in those women with high body mass index and they have lower incidence of preterm delivery and concluded that maternal obesity has protective action on preterm incidence. Cervical lengths in women who delivered preterm (< 37 weeks) were significantly shorter compared to term delivery group, but such a difference was not observed with cervical width measurements. Percentile charts were established for cervical length and width from 20th week of pregnancy till delivery. Cervical lengths and widths did not differ significantly between primigravidae and multigravidae. The associations between cervical dimensions and gestational age, parity and body mass index were calculated by multiple linear regression analysis. Multivariate regression analysis was performed to find influence of these factors on cervical length and width measurements.
The same group observed three patterns of cervical length changes; a continuous decrease, an accelerated shortening after approximately 30 gestational weeks and a sudden drop in length in the third trimester. Cervical measurements against gestational age with different classifying factors were plotted using chart tools available in Microsoft excel 2002 and visually assessed for the trend.
The rate of cervical length reduction was significantly higher in preterm delivery group compared to term delivery group (0.65 mm vs. Cervical length decreases gradually through out the gestation where as cervical width increases and these changes are not affected by parity.
The knowledge of pattern of change in cervical length may help in early detection of preterm labour.



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