Cervical ultrasonography compared with manual examination as a predictor of preterm delivery☆,☆☆,★
Section snippets
Material and methods
The study was performed from June 1993 to March 1996 at two clinical sites. Patients with the following historic criteria indicating an increased risk of preterm delivery were eligible for inclusion: one or more preterm delivery between 14 and 32 weeks' gestation, mullerian anomaly, two or more voluntary terminations, diethylstilbestrol (DES) exposure, cone biopsy, and Ehlers-Danlos syndrome. Women with multiple gestation, placenta previa, prophylactic cerclage, or a major fetal anomaly were
Results
Of 102 pregnancies entered in the study, 6 were excluded because of induced preterm delivery, leaving 96 pregnancies for analysis. Each patient received an average of 5.5 cervical ultrasonographic and 5.6 manual examinations between 14 and 30 weeks. In 17 of 96 (18%) patients delivery occurred before 35 weeks. Thirty of 96 (31%) underwent tocolysis. Demographic characteristics are presented in Table I.
There was no difference in age, race, parity, health care provider, or history of smoking
Comment
We report the first longitudinal study to demonstrate that measurement of the cervix by ultrasonographic examination is a better predictor of preterm delivery than is measurement by manual examination in patients with risk factors for preterm delivery. Cervical assessment by manual examinations has been the traditional method for the prediction of preterm delivery. With use of l cm cervical length as the cutoff value at 27 to 28 weeks or a Bishop score of 4 between 22 weeks and 27 weeks 6 days
Acknowledgements
We thank Sheila Amand, RDMS, Sue Henry, RDMS, Marianne Candelora, RDMS, Jane Owens, RDMS, Pamela L. Hilpert, MD, PhD, and Jane Hirshberg, RNC, BSN, for their contributions and Greg Maislin, MS, MA, for statistical consulting for the logistic regression analysis.
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From the Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson Universitya and Pennsylvania Hospital,b and the Perinatology Research Branch, National Institute of Child Health and Human Development.c
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Reprint requests: Vincenzo Berghella, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, 834 Chestnut St., Suite 400, Philadelphia, PA 19107.
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