1 Centre for Maternal Fetal Medicine, Mater Health Services,. South Brisbane, QLD, Australia ; 2 Obstetrics and. Gynaeclogy, University of Queensland, Brisbane ...
23rd World Congress on Ultrasound in Obstetrics and Gynecology OP10.08 Effect of cervical cerclage on labor course and obstetric outcome S. Kim, J. Shin Obstetrics and Gynecology, Holy Family Hospital of Catholic University, Kyungido, Republic of Korea Objectives: To evaluate the effects of cervical cerclage on labor course and obstetric outcome. Methods: We evaluated cervical status through ultrasound of Accuvix (Samsung Medicine, Korea). We compared labor course, total labor duration, and obstetric complications in 127 women who received cervical cerclage with 254 controls, retrospectovely. Results: There was no significant difference in the duration of the first stage of labor (477 ± 576 vs. 373 ± 437 minutes, p = 0.075) or the second stage of labor (18 ± 17 vs. 20 ± 19 minutes, p = 0.287) between the 2 groups. In the multivariate analysis, women in the cerclage group were found to be significantly more likely to have a prolonged latent phase (odds ratio [OR], 2.802; 95% confidence interval [CI], 1.103-7.120; p = 0.030), cervical laceration (OR, 15.984; 95% CI, 3.169-80.624; p = 0.001), and treatment with tocolytics (OR, 2.580; 95% CI, 1.217-5.468; p = 0.013) than the control group. No significant difference was noted in Cesarean delivery rate. Conclusions: Cervical cerclage is more likely to be associated with a prolonged latent phase and minor obstetric complications, but not with a difference in the total duration of labor or increased Cesarean delivery rate. Dysfunctional labor and perinatal outcome by cervical cerclage P value of adjusted OR prolonged latent phase 0.030 arrest of dilatation 0.123 cervical laceration 0.001 postpartum bleeding 0.371 Cesarean delivery 0.185 tocolytics 0.013
Supporting information can be found in the online version of this abstract
OP11: ULTRASOUND ASSESSMENT OF PRETERM AND TERM LABOUR OP11.01 Does the presence of obvious cervical mucous affect the determination of the internal os and the cervical length measurement? J. Thomas1,2 , S. Petersen1,2 , S. Connard1 , N. Brown1 , K. Nolan1 , G. Gardener1,2 1
Centre for Maternal Fetal Medicine, Mater Health Services, South Brisbane, QLD, Australia ; 2 Obstetrics and Gynaeclogy, University of Queensland, Brisbane, QLD, Australia Objectives: Cervical length measurement by transvaginal scanning (TVS) is considered as a universal screening test for preterm labour at the 18 to 20 week scan. As TVS is more widely used variations in cervices imaged will become more common. The exact technique to measure the cervix when there is obvious mucous has not been described. We wanted to determine this and elucidate practices nationally. Methods: We selected all transvaginal cervical assessment upto 24 weeks from our Viewpoint database over 5 years. We compared the reported cervical length, the cervical length with mucous and without mucous and the pregnancy outcomes. An online survey of reporting on 11 cervical images with obvious mucous and funnelling by
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Short oral presentation abstracts
Australian sonologist and sonographers was performed to determine practice. Results: The overall incidence of cervices with obvious mucous was low. When cervical mucous is excluded, cervical length is lesser than when mucous is included. From the online survey, when the images showed funnelling or cervical mucous there was little agreement regarding the cervix being open or closed and the location of the internal os. Conclusions: The incidence of cervices with obvious mucous at cervical assessment upto 24 weeks is low. However there was a low consensus among Australian obstetric sonologists and sonographers with regards to the location of the internal os and consequently the cervical length measurement when there is obvious mucous or funnelling seen in the cervix. We propose clarifications regarding the location of the internal os and a modification to the current methodology of cervical length measurements when there is excess mucous.
Supporting information can be found in the online version of this abstract
OP11.02 3D evaluation of the cervix during pregnancy: the relationship between cervical volume and preterm delivery T. D. Shipp1,2 , S. Little1 , N. A. Smith1 1 OB/GYN, Brigham & Women’s Hospital, Boston, MA, USA; 2 Diagnostic Ultrasound Associates, P.C., Brookline, MA, USA
Objectives: Preterm labor is poorly predicted by 2D assessment of the gravid uterine cervix. Prior studies evaluating 3D volumes of the cervix and preterm labor are constrained by the lack of a clear definition of the border between the cervix and lower uterine segment. Methods: 3D cervical volumes were collected prospectively over a 14 months. Women were included if they had transvaginalss sonography between 16 and 32 weeks gestation. Demographic characteristics and pregnancy histories were ascertained by questionnaire. A nested case–control study of singletons was performed. Cases delivered prior to 35 weeks after preterm labor or preterm premature rupture of membranes, and controls delivered after 37 weeks and were matched 2:1 by gestational age at the time of the ultrasound. The 3D volume calculations were performed using the VOCAL Sphere application with an initial volume set to 100 cm3. Groups were compared using Mann Whitney U and Fisher exact test as appropriate. Results: Of the 372 patients who had 3D volume data acquisition of the cervix, 13 (3.5%) delivered preterm. Of these, 6 were singletons. Age, body mass index (BMI), % multiparous, and history of cervical surgery or preterm birth did not differ between women delivering term or preterm. Median cervical length by 2D transvaginal ultrasound did not differ between the 2 groups (31mm (95% 13–37) vs 33 mm (95% 30–36), p = 0.81). Median cervical volume for those delivering preterm was significantly less than in those who delivered at term (40.2 cm3 (95% 35.8-46.8) vs. 56.9 cm3 (95% 52.6-59.7) p = 0.035.) The odds of preterm birth for those with high cervical volume (>50% of the median) compared with those with low volume (
