The natural history of a positive response to transfundal pressure in women at risk for cervical incompetence

• Published in: American journal of obstetrics and gynecology Vol. 176; no. 3; pp. 634 - 638
• Main Authors: Guzman, Edwin R., Vintzileos, Anthony M., McLean, David A., Martins, Maria E., Benito, Carlos W., Hanley, Maryellen L.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.03.1997; Elsevier
• Subjects: Biological and medical sciences; cervical incompetence; Cervix Uteri - anatomy & histology; Cervix Uteri - diagnostic imaging; Cervix Uteri - surgery; Diseases of mother, fetus and pregnancy; Female; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Pregnancy; pregnancy loss; Pregnancy Trimester, Second; Pregnancy. Fetus. Placenta; Pressure; transvaginal ultrasonography; Ultrasonography, Prenatal; Uterine Cervical Incompetence - diagnosis; Uterine Cervical Incompetence - diagnostic imaging; Uterine Cervical Incompetence - surgery; Pregnancy; cervical incompetence; pregnancy loss; transvaginal ultrasonography; Sonography; Second trimester; Human; Pregnancy disorders; Incompetent cervix; Abortion; Pressure; Prenatal; Length; Echography; Endocervix; Female; Diagnosis
• DOI: 10.1016/S0002-9378(97)70560-X
• ISSN: 0002-9378

OBJECTIVE: Our purpose was to observe the evolution of the endocervical canal length in women at risk for cervical incompetence after a positive response to transfundal pressure. STUDY DESIGN: Ten women at risk for cervical incompetence had a midtrimester cervical evaluation with transvaginal ultrasonography and transfundal pressure. With a transvaginal probe, the endocervical canal length was first measured. Transfundal pressure was then applied and the endocervical canal length was remeasured. All patients had a positive response to transfundal pressure as defined by a decrease in endocervical canal length after application of transfundal pressure. At the initial evaluation the digital examination of the cervix had revealed a closed and long cervix in all 10 cases. In 9 of the 10 patients repeat examinations were performed until the endocervical canal length progressively shortened to <10 mm or the digital examination revealed a dilated cervix. The endocervical canal lengths after application of transfundal pressure from the first and last examination were compared. One patient was lost to follow-up, but the obstetric outcome was available. RESULTS: The median time interval between the first and final examination was 7 (2 to 20) days in 9 of the patients. The median (range) gestational age at the first and final examination was 19.0 (15 to 22) weeks ( n = 10) and 20.5 (18 to 24) weeks ( n = 9), respectively. There was significant shortening of the endocervical canal length from the first to the last examination; 12.2 (4 to 20) mm ( n = 10) versus 0.0 (0 to 9.5) mm ( n = 9), p = 0.008. Six patients had membranes at the external cervical os before application of transfundal pressure at the last examination. The one patient lost to ultrasonographic follow-up had a pregnancy loss at 23 weeks of gestation, 6 weeks after a positive response to transfundal pressure. CONCLUSION: In patients at risk for cervical incompetence, shortening of the endocervical canal length in response to transfundal pressure requires treatment with a cervical cerclage because it is associated with progressive cervical changes over 1 to 3 weeks. (Am J Obstet Gynecol 1997;176:634-8.)