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#Grand Rounds

Transabdominal vs Transvaginal Ultrasound for Cervical Length

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BACKGROUND AND PURPOSE:

  • Jayakumaran et al. (AJOG, 2019) studied a transabdominal ultrasound program vs reflex transvaginal ultrasound program for the assessment of cervical length in a low risk population

METHODS:

  • Cross-sectional study
  • Participants
    • Singleton pregnancies
    • Between 16w0d and 23w6d
    • No risk factors for spontaneous preterm birth
  • Study design
    • Preexposure period (June to December 2016)
      • Universal transabdominal cervical length (TACL) screening program was performed without a protocol for reflex transvaginal scanning
    • Postexposure period (June to December 2017)
      • Routine TACL was performed with reflex transvaginal cervical length (TVCL) ultrasound scans if (1) TACL cervical measurement <30 mm or (2) transabdominal views limited
  • Primary outcome
    • The proportion of reflex TVCL ultrasound scans
  • Secondary outcomes
    • The number of TACL studies <30 mm
    • Various obstetric outcomes
  • Reproducibility studies (6 sonographers)

RESULTS:

  • 616 patients in the preexposure group | 669 patients in the post exposure group
  • Overall demographics were similar between groups except for a small difference in BMI between the groups (P<.001)
    • Preexposure median: 28.6 kg/m2
    • Postexposure median: 25.8 kg/m2
  • 16 women in postexposure group had reflex transvaginal ultrasound
    • 9 scans were performed because of TACL <30 mm
    • 7 scans were due to poor visualization of TACL landmarks
  • The percentage of cervical length <25cm was less than expected from the literature (0.3%)
  • Secondary outcomes
    • There were no differences between groups
  • Reproducibility
    • Intraclass correlation coefficients for TACL measurements: 0.15 (95% confidence interval, 0.04–0.45; <0.5 considered poor)
    • Within-subject variance for TACL measurements: 0.11 (95% confidence interval, 0.10–0.13)

CONCLUSION:

  • TACL limited the number of women who received transvaginal scans
  • Similar to previous studies, inter- and intrarater agreement was poor for TACL
  • The authors state

…we urge providers to consider the possibility that the primary benefit of universal TACL screening is the avoidance of transvaginal scanning rather than the identification of high-risk patients.

Learn More – Primary Sources:

Transvaginal ultrasound is superior to transabdominal ultrasound in the identification of a short cervix

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Related ObG Topics:

Cervical Cerclage – Professional Recommendations
Does Shortened Midtrimester Cervical Length Predict Preterm Birth?
Does Vaginal Progesterone Improve Birth Outcomes for Mothers with Short Cervix?
Does Cervical Length Actually Predict Preterm Birth?

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