Document Detail


Predictive value of two-dimensional and three-dimensional multiplanar ultrasound evaluation of the cervix in preterm labor.
MedLine Citation:
PMID:  12854923     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the predictive value of conventional two-dimensional ultrasound measurement of cervical length and three-dimensional multiplanar volume assessment of the cervix for delivery at < 37 weeks of gestation among patients with preterm labor. MATERIALS AND METHODS: This preliminary prospective study was conducted in 28 patients hospitalized for preterm labor between 24(+0) and 33(+6) weeks of gestation, defined by regular and painful uterine contractions (at least two per 10 min), intact membranes and a cervical length of < or = 26 mm measured by two-dimensional transvaginal ultrasonography at admission with a Voluson 530 (Kretz, France) machine using a 7.5-MHz transvaginal transducer. The cervical volume was then assessed by the three-dimensional triplan technique. It was automatically calculated after drawing of the cervix outlines in mid-sagittal and median axial plane images. As the border between the cervix and the lower uterine segment is virtual, it was defined by a perpendicular line to the line joining the external os and the internal os. The result of the latter measurement was not disclosed to the obstetric team. The primary outcome was the rate of deliveries at < 37 weeks. We constructed a receiver operator characteristic (ROC) curve to determine the optimal cut-off point of the cervical volume, to predict preterm delivery. RESULTS: Sixteen (57%) patients delivered at < 37 weeks. Mean (+/- SD) gestational ages at admission and delivery were 28.2 (+/- 3.2) weeks and 35.9 (+/- 4.1) weeks, respectively. Mean cervical length and volume at admission were 20.1 (+/- 9.9) mm and 23.1 (+/- 14.6) mm3, respectively. The ROC curve showed that the optimal cut-off point was 20 mm3. The predictive values of cervical length and of cervical volume on delivery at < 37 weeks were: sensitivity, 87.5% (14/16) and 75% (12/16); specificity, 50% (6/12) and 75% (9/12); positive predictive value, 70% (14/20) and 80% (12/15); negative predictive value, 75% (6/8) and 69.2% (9/13), respectively. CONCLUSIONS: The three-dimensional multiplanar volume assessment of the cervix probably increases the positive predictive value of cervical ultrasonography in predicting preterm delivery. Screening high-risk women could be achieved by conventional two-dimensional transvaginal ultrasound and the diagnosis of true preterm labor may be improved by three-dimensional multiplanar transvaginal ultrasound assessment of the cervix.
Authors:
P Rozenberg; A Rafii; M V Sénat; A Dujardin; J Rapon; Y Ville
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  13     ISSN:  1476-7058     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-07-11     Completed Date:  2003-07-25     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  237-41     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Versailles-St Quentin University, Poissy, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cervix Uteri / ultrasonography*
Female
Gestational Age
Humans
Obstetric Labor, Premature / ultrasonography*
Pregnancy
Prospective Studies
ROC Curve

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