Cervical assessment at the routine 23-weeks' scan: problems with transabdominal sonography.

OBJECTIVES: To compare transabdominal and transvaginal sonographic measurements of cervical length in pregnancy and examine the factors that may influence these measurements. METHODS: The study population consisted of 149 women with singleton pregnancies attending for routine ultrasound examination at 23 weeks of gestation. In all women the cervix was successfully visualized by transvaginal sonography and cervical length was measured after emptying of the bladder. This measurement was compared to that obtained by transabdominal sonography. In addition the ability to visualize the cervix transabdominally was examined in relation to body mass index (BMI), bladder volume and cervical length. RESULTS: The percentage of cases in which the cervix could be seen transabdominally increased from 42% for bladder volume of < 50 ml to 73% for volumes > 150 ml, and 13% for cervical length < 20 mm to 51% for lengths > 40 mm. The ability to visualize the cervix was unrelated to BMI. Although there was a significant association between measurements taken transabdominally with those made transvaginally, measurements taken with a full bladder were significantly longer than those with an empty bladder. CONCLUSION: The aim of cervical assessment in pregnancy is to identify women with a short cervix because they are at high risk of preterm delivery. This aim can not be fulfilled by transabdominal sonography. Such a scan fails to visualize the cervix in a high proportion of cases and in particular those with a short cervix. Furthermore, successful visualization requires a full bladder which falsely increases cervical length.     

Is Transabdominal Sonography of the Cervix After Voiding a Reliable Method of Cervical Length Assessment?

Objective. The purpose of this study was to assess the correlation and agreement between transvagi‐nal and transabdominal cervical length measurement after bladder emptying as well as the feasibility of transabdominal sonography in cervical length screening. Methods. This was a prospective cohort study involving 287 participants (14–34 weeks' gestation) from January to December 2003. After voiding, transabdominal and transvaginal cervical length measurements were obtained. The optimal trans‐abdominal technique was established during an unblinded series of transabdominal and transvaginal cervical length measurements (n = 96). The same measurements were obtained in 191 participants under a blinded 2‐sonographer protocol. The transabdominal cervical length cutoff to ensure 100% sensitivity in detecting a short cervix (≤2.5 cm) was determined. Results. There was no difference between mean transabdominal and transvaginal cervical lengths ± SD (3.57 ± 0.74 versus 3.61 ± 0.74 cm; P = .20). The Pearson correlation coefficient was 0.824. The 95% tolerance interval for any paired observation (transabdominal minus transvaginal) was ?0.92 to 0.84 cm. All transvaginal cervical lengths of 2.5 cm or less were associated with paired transabdominal cervical lengths of 3 cm or less. Conclusions. With an optimal sonographic technique, postvoid transabdominal cervical measurement shows a close correlation and agreement with transvaginal assessment and is useful for cervical length screening.     

经阴道彩色多普勒超声检查宫颈纳博特囊肿

目的　应用经阴道彩色多普勒超声 ,分析宫颈纳博特囊肿的声像图表现。方法　用ATL HDI 5 0 0 0型彩色多普勒超声显像仪 ,经腹和经阴道两种方法对比 ,对我院 2 0 0 1年 5月至 2 0 0 2年 4月间妇科患者进行检查 ,注意观测宫颈病变。结果　 182例患者中 ,经腹超声诊断宫颈纳博特囊肿 7例 ,其边界不清 ,结构模糊 ,周边无彩色血流信号显示。经阴道超声诊断宫颈纳博特囊肿 48例 ,91.2 %为直径≤ 6mm的囊性包块 ,其发生位置、大小、形态、结构清晰可辨 ,60 .4%的囊肿周边有较丰富的彩色血流信号显示 ,并探及低速动脉型频谱。结论　经阴道彩色多普勒超声应是诊断宫颈纳博特囊肿的首选方法     

Short cervix detection in pregnant women by transabdominal sonography with post-void technique

Purpose

This study aimed to evaluate the diagnostic properties of transabdominal sonography with the post-void technique for cervical length measurement.

Methods

This study was a prospective cohort study. The inclusion criteria were pregnant women aged 18–40 years with gestational age of 18–23 completed weeks. Transabdominal sonography with vertical bladder depth of less than 5 cm and transvaginal cervical length measurements were carried out by a single experienced sonographer.

Results

There were 307 eligible pregnant women. The mean age of all subjects was 29.0 years. The mean cervical length obtained through transabdominal and transvaginal measurement was 3.33 and 3.47 cm, respectively. Ten patients (3.3 %) were identified as having a short cervix using transvaginal sonography, and 12 patients (3.9 %) were identified using transabdominal sonography.

Conclusion

Transabdominal sonography with vertical bladder depth of less than 5 cm performed better compared with transvaginal sonography. It may not be necessary to perform transvaginal sonography if transabdominal sonography reveals the cervical length to be more than 2.5 cm.

     

Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section.

OBJECTIVE: To evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term. METHODS: Two independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half-full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut-off of 3.5 mm, by the kappa coefficient. RESULTS: The intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half-full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half-full bladder, respectively. CONCLUSION: The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.     

Reliability and validity of two methods of three-dimensional cervical volume measurement.

OBJECTIVES: To determine if cervical length obtained with three-dimensional ultrasound correlated with the 'true cervical volume' and to evaluate the reliability and validity of transabdominal and transvaginal three-dimensional cervical volume measurement. METHODS: This was a prospective observational study. Three-dimensional cervical volume measurements were made prior to hysterectomy in 28 women. Following hysterectomy the amputated cervical volume was calculated using water displacement. For the assessment of intra- and interobserver reliability, the intraclass correlation coefficient (ICC) was used. The index of concordance between the sonographic cervical volumes and those obtained by the reference standard (true cervical volume) was assessed with the limits of agreement method and the ICC. RESULTS: Transabdominal cervical length and transvaginal cervical length correlated moderately with actual cervical volume; correlation coefficients were 0.64 and 0.57 (P < 0.05), respectively. Intraobserver reliability for both transabdominal and transvaginal cervical volume assessment was good (> 0.75). Interobserver reliability for transvaginal cervical volumes was similarly good (ICC = 0.90). However, for transabdominal measurements the interobserver reliability was poor (ICC = 0.51). The validity of both methods of three-dimensional volume assessment was poor (ICC < 0.75). This was reflected in the wide limits of agreement, which ranged from approximately - 25 mL to + 30 mL. CONCLUSION: The reliability and validity of three-dimensional cervical volume measurement are poor. Clinical introduction of cervical volume measurement should be avoided at this time.     

Early prediction of preterm delivery by transvaginal ultrasonography.

The clinical value of transvaginal ultrasonography in the evaluation of the uterine cervix of pregnant women was studied. Comparison with conventional transabdominal ultrasound in 24 pregnant subjects revealed that transvaginal ultrasound was superior, because the transabdominal technique usually requires a full bladder, which causes deformation and elongation of the cervix. Digital examination showed dilatation of the internal os in only ten (38.5%) of 26 patients in whom it had previously been shown by transvaginal sonography. Transvaginal ultrasonography has the advantage of providing natural and objective information on the cervix. The values of three sonographic signs found transvaginally for predicting preterm delivery were evaluated in a total of 130 at-risk patients and 129 control subjects. Shortening of the cervical length by -1.5 SD or more was associated with an increased risk of preterm delivery (11.3% vs. 2.8%, p < 0.01). A dilated internal os of more than 5 mm before 30 weeks of gestation was associated with preterm delivery more often than an undilated internal os (33.3% vs. 3.5%, p < 0.01). Dynamic changes in the degree of dilatation of the cervical canal which were found in nine women were significantly related with preterm delivery (p < 0.05). But, in the at-risk group, only dilatation of the internal os had a predictive value for preterm birth. From these data, dilatation of the internal os on transvaginal ultrasonography was proved to be an early and important predictor of preterm delivery.     

经直肠经阴道超声在提高膀胱肿瘤超声显示率中的价值

目的探讨应用经直肠、经阴道超声检查在提高膀胱肿瘤超声显示率中的价值。方法对42例经膀胱镜检、手术病理证实的膀胱肿瘤的经腹超声与经直肠/阴道超声检查结果进行对比分析。结果经腹超声、经直肠/阴道超声检查膀胱肿瘤的显示率分别为83.3%(35/42)、97.6%(41/42),P<0.05,二者有显著性差异。经腹超声漏诊7例中,经阴道/直肠超声显示6例,P<0.05,二者有显著性差异。结论经直肠、经阴道超声能弥补经腹超声检查的不足,提高膀胱肿瘤超声诊断显示率。     

宫颈机能不全的经阴道超声诊断价值评价

目的:评价经阴道超声检查对宫颈机能不全的诊断价值。方法:分析25例宫颈机能不全患者非孕期及孕16~18周宫颈长度并与同时期健康孕妇相对照。结果:CIC患者非孕期宫颈长度及孕1~18周的宫颈长度低于均健康对照组。结论:经阴道超声检查宫颈长度对评估CIC具有一定价值。     

经阴道超声诊断早期异位妊娠的临床价值

目的探讨经阴道超声诊断早期异位妊娠的临床效果及应用价值。方法回顾性分析85例早期异位妊娠患者的一般资料,所有患者均经腹部与经阴道超声检查,主要观察患者的子宫及双附件区,并将检查结果与临床病理对照,比较两种检查方法的诊断符合率。结果 85例早期异位妊娠患者经住院手术及病理检查结果证实,术前经阴道超声检查诊断符合率明显高于术前经腹部超声检查,差异具有统计学意义(χ2=43.92,P<0.01)。结论经阴道超声诊断早期异位妊娠效果明显优于经腹部超声,诊断符合率较好,能够更好地为患者提供治疗方案,改善患者的病情及预后,提高患者的生活质量,具有较高的临床应用价值,为诊断早期异位妊娠的首选方法。     

经阴道三维彩色多普勒诊断早期宫颈癌

目的：探讨经阴道三维彩超检查诊断早期宫颈癌（Ⅰb期~Ⅱa期）的应用价值。方法：对96例早期宫颈癌患者和其他150例患者作经阴道三维彩超检查,并与手术、病理结果对照分析。结果：在96例早期宫颈癌患者中,Ⅰb1期67例,Ⅰb2期18例,Ⅱa期11例,其中鳞癌73例,腺癌19例,腺鳞癌4例。肿块大小：5mm×6mm×9mm~32mm×35mm×46mm。在150例对照组中,子宫颈正常组50例,宫颈肌瘤23例,宫颈粘膜下子宫肌瘤16例,颈管息肉11例,宫颈子宫内膜异位囊肿23例,宫颈纳氏囊肿27例。经阴道三维彩超显示宫颈癌宫颈肿块处血管形态分布可分成4型。早期宫颈癌三维阴道彩超诊断符合率为86.5%。结论：经阴道三维彩超能显示宫颈及宫旁组织的立体图像,宫颈处显示的4种血管形态分布对鉴别宫颈肿瘤的良恶性质有较高价值。     

经腹部超声联合经阴道超声检查诊断妇产科急腹症

目的：探讨经腹部超声联合经阴道超声检查在妇产科急腹症诊断中的价值。方法：选择2013年1月～2016年6月经本院临床及病理确诊的妇产科急腹症患者110例为对象,所有患者均采用经腹部超声联合经阴道超声检查,比较超声检查诊断结果与临床病理诊断结果的符合率,并分析各类急腹症的超声影像表现。结果：经腹部超声联合经阴道超声检查诊断妇产科急腹症的符合率97.27%(107/110),与临床病理结果比较差异无统计学意义(P＞0.05);诊断异位妊娠的符合率96.77%(30/31),诊断宫内孕流产的符合率94.44%(17/18),诊断卵巢囊肿破裂的符合率93.33%(14/15),诊断急性盆腔炎、卵巢肿瘤蒂扭转、子宫内膜异位症、胎盘早剥的符合率均为100%(23/23、10/10、8/8、5/5),与临床病理结果比较差异无统计学意义(P＞0.05)。结论：经腹部超声联合经阴道超声检查在诊断妇产科急腹症中,与临床病理结果的符合率高,是一种可行的方案。     

经腹部超声联合经阴道超声诊断血管前置的临床价值

目的探讨经腹部超声联合经阴道超声在产前诊断血管前置中的临床价值。 方法回顾性分析2018年1月至2019年12月在首都医科大学附属北京妇产医院因临床疑诊血管前置而行剖宫产手术的病例54例。以术后胎盘检查结果为"金标准"，对产前经腹部超声联合经阴道超声的检查结果进行分析，应用四格表计算得出其诊断血管前置的敏感度、特异度、阳性预测值、阴性预测值和准确性。 结果54例患者中，经腹部超声联合经阴道超声诊断血管前置47例，其中误诊3例，漏诊2例；5例因临床出血疑似诊断而手术，联合超声及术后证实均无血管前置。经腹部超声联合经阴道超声诊断血管前置的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为95.7%（44/46）、62.5%（5/8）、93.6%（44/47）、71.4%（5/7）和90.1%（49/54）。 结论经腹部超声联合经阴道超声可为产前诊断血管前置提供更多的诊断信息和依据，减少干扰因素，具有良好的诊断效能，值得临床推广应用。     

Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?

OBJECTIVE: To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. METHODS: Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. RESULTS: One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4-5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 +/- 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 +/- 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 +/- 2.9 weeks. CONCLUSION: A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age.     

Ultrasonographic characteristics and cystoscopic correlates of bladder wall invasion by endophytic cervical cancer.

OBJECTIVES: To present the ultrasonographic findings and explore cystoscopic correlates of endophytic cervical cancer invading the bladder wall. METHODS: We retrospectively reviewed the imaging files in 19 cases of cervical cancer, comprising six cases of endophytic lesions invading the bladder wall (study group) and 13 cases of endo- or exophytic, clinical stage IB1 lesions without bladder wall invasion (controls). Bladder wall infiltration or invasion was confirmed by cystoscopic biopsy or surgical findings or both. All 19 patients had undergone transvaginal ultrasound examination to evaluate the cervix and lower urinary tract. The main measures included tumor volume of the primary cervical neoplasm, tumor protuberance, mobility of the cervix over the lower bladder wall, continuity of the endopelvic fascia and echogenicity and morphological texture of the bladder wall and its thickness. RESULTS: A tumor protuberance emerging from the cervicocorporeal junction and invading the bladder in the supratrigonal area was seen in the study group but not in the controls. Disruption of the endopelvic fascia, a thickened bladder wall, changes in the bladder mucosa and interruption of the entire bladder wall were ultrasonographic characteristics demonstrating the sequential stages of bladder wall invasion. The morphological changes in the bladder wall on ultrasound examination were categorized into four stages. Based on the morphological classification, two of the six patients in the study group belonged to stage I, one to stage II, one to stage III and two to stage IV of bladder wall invasion. CONCLUSIONS: In cervical cancer, transvaginal ultrasonography helps to explore sequential changes seen in bladder wall invasion, information that is not as readily available from cystoscopic examination.     

膀胱容量对经腹超声评估胎盘下缘与宫颈内口距离的影响

目的 研究膀胱容量对经腹超声观察胎盘下缘与宫颈内口距离的影响.方法 136例正常单胎妊娠孕妇,孕周18 ～27周末,于不同膀胱容量下测量同一孕妇胎盘下缘与宫颈内口的曲线距离,0～50 ml为d1组、50 ～150ml为d2组、150～ 250 ml为d3组.并根据胎盘覆盖区域的不同,将其分为前壁、后壁、侧壁三型.结果 同一孕妇不同膀胱容量下,经腹超声评估胎盘下缘与宫颈内口的距离具有差异性（P＜0.01）,且这种距离变化与胎盘覆盖位置无关（P＞0.05）.随着膀胱容量的增加,胎盘下缘与宫颈内口的距离缩短.相对于d1组,膀胱容量在d2、d3组范围时,距离变化95％单侧上界值为31.67 mm和50.70mm.结论 经腹超声观察胎盘下缘与宫颈内口距离的可信度有赖于膀胱容量,应在超声检查中引起重视.     

阴道联合腹部超声在异位妊娠诊断中的应用价值

目的:探讨阴道联合腹部超声在异位妊娠诊断中的应用价值。方法:本研究选取2017年1月—2019年11月我院收治的经手术确诊的100例异位妊娠患者,所有患者术前经腹部及经阴道超声检查,比较两种检查结果。结果:经阴道超声检查对异位妊娠检出率显著高于腹部超声检查(P<0.05);腹部联合阴道超声检查对异位妊娠检出率显著高于腹部或经阴道单独超声检查(P<0.05),且误诊率及漏诊率显著低于腹部或经阴道单独超声检查(P<0.05);经阴道超声检查对异位妊娠典型影像学表现检出率显著高于腹部超声检查(P<0.05),腹部联合阴道超声检查对异位妊娠典型影像学表现检出率均显著高于腹部或经阴道单独超声检查(P<0.05)。结论:阴道联合腹部超声提升异位妊娠检出率,可推广应用。     

Cervical length for prediction of preterm birth in women with multiple prior induced abortions.

OBJECTIVE: To determine whether transvaginal sonographic cervical length predicts preterm birth in women with multiple prior induced abortions. METHODS: This was a retrospective cohort study using the Thomas Jefferson University Prematurity Database. Patients with a singleton pregnancy and a history of more than one induced abortion were identified. Exclusion criteria were cerclage and indicated preterm birth. Subjects were followed with transvaginal ultrasound measurement of the cervix between 14 and 24 weeks' gestation and grouped into those with and those without a short cervix; a cervical length of < 25 mm was considered short. The primary outcome was spontaneous preterm birth at < 35 weeks. RESULTS: Fifteen of the 65 (23%) women with more than one induced abortion included in the study had a short cervix. The demographics and risk factors were similar between those with and those without a short cervix. The overall incidence of preterm birth was 21.5% (14/65); in women with a short cervix the incidence was 47% (7/15) and in women without a short cervix it was 14% (7/50). The sensitivity, specificity and positive and negative predictive values of a short cervix in the prediction of preterm birth were 50%, 84%, 47% and 86%, respectively. The relative risk of a short cervix for spontaneous preterm birth was 3.3 (95% CI, 1.4-7.4). CONCLUSION: A cervical length of < 25 mm on transvaginal ultrasound is predictive of preterm birth in women with more than one prior induced abortion. Women with multiple prior induced abortions and a short cervix have a 3.3-fold greater chance of spontaneous preterm birth compared with those with a cervical length of > or = 25mm.     

Sonographic depiction of postmenopausal endometrium with transabdominal and transvaginal scanning.

The thickness of the endometrium was measured in postmenopausal women by both the transvaginal and transabdominal ultrasound approaches in two separate groups of patients. The first group consisted of 90 women who received a transabdominal scan of the endometrium before dilatation and curettage or hysterectomy for either postmenopausal bleeding or uterine prolapse. The second group consisted of 111 women who underwent a transvaginal scan of the endometrium for similar postmenopausal conditions.Both methods suggested that an endometrial thickness of 5 mm may be used as a cut-off level in the conservative management of patients with postmenopausal bleeding or in a screening program for endometrial carcinoma.Patient acceptance and image quality were better in the group examined transvaginally. The proximity of the transvaginal probe to the endometrium, in the absence of a full bladder compressing the endometrium, revealed a unique group of patients with atrophic endometrium but thick endometrial cavity caused by intracavity fluid. In the presence of uterine fibroids distorting the uterine cavity, transvaginal scanning was better than transabdominal scanning for visualizing the endometrium. The transabdominal full-bladder technique can be of value in detecting asymptomatic bladder pathology.     

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.