PREDICTIVE ACCURACY OF CERVICAL LENGTH IN MID TRIMESTER ON TRANSABDOMINAL ULTRASOUND FOR CESAREAN SECTION
Keywords:Predictive accuracy, cervical length, mid trimester, transabdominal ultrasound, cesarean section
The Cesarean section (CS) delivery is a most frequent surgical technique worldwide. The CS increasing rate and its related problems have drawn an attention towards CS related morbidity. As recommended by WHO, C-section could be carried out only when required medically. In mid-pregnancy cervical extended length predicts the probability of CS early in the pregnancy. The objective of the study is to find the predictive accuracy of cervical length (CL) on transabdominal ultrasound for cesarean section in mid trimester taking mode of delivery as gold standard. It was a cross sectional study in which 362 females were enrolled. Females were undergoing transabdominal ultrasonography for assessment of cervical length. A 2x2 contingency table was generated to calculate sensitivity, specificity, positive predictive valve (PPV), negative predictive value (NPV) and diagnostic accuracy of transabdominal ultrasound taking actual mode of delivery as gold standard. The mean age of the females was 27.92 + 5.75 years while mean parity and mean CL were 2.22 + 1.30 and 35.83 + 7.96 mm, respectively. Among 30 females who had cervical length <25 mm, 24 had CS and 6 had spontaneous vaginal delivery (SVD). Among 332 females who had cervical length >25 mm, 96 had CS and 236 had SVD. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of transabdominal ultrasound for cesarean section were 20.0%, 97.5%, 80.0%, 71.1% and 71.8%, respectively. Study concluded that cesarean section takes place among pregnant females when cervical length is ≤25mm on transabdominal ultrasound during mid trimester.
Anjum, N., Memon, Z., Sheikh, S., and Naz, U. (2020). Relationship between cervical dilatation at which women present in labor and subsequent rate of caesarian section. Journal of Ayub Medical College Abbottabad 32, 58-63.
Caughey, A. B., Cahill, A. G., Guise, J.-M., Rouse, D. J., Obstetricians, A. C. o., and Gynecologists (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology 210, 179-193.
Ehtisham, S., and Hashmi, H. A. (2014). Determinants of caesarean section in a tertiary hospital. Parity 2, 3.65.
El Mekkawi, S., Hanafi, S., Khalaf-Allah, A., Abdelazim, I. A., and Mohammed, E. (2019). Comparison of transvaginal cervical length and modified Bishop’s score as predictors for labor induction in nulliparous women. Asian Pacific Journal of Reproduction 8, 34.
Gameraddin, M. (2018). Ultrasound evaluation of cervical length in the second trimester of pregnancy: The impact of cesarean section and ethnicity. Journal of Current Research in Scientific Medicine 4, 17.
Gameraddin, M. B., and Bashab, N. K. (2018). Characterisation of Benign Ovarian Lesions among Sudanese Women Undergoing Pelvic Ultrasound Scans: The Impact of Parity and Age. Journal of Clinical & Diagnostic Research 12.
Hatfield, A. S., Sanchez-Ramos, L., and Kaunitz, A. M. (2007). Sonographic cervical assessment to predict the success of labor induction: a systematic review with metaanalysis. American journal of obstetrics and gynecology 197, 186-192.
Hernandez-Andrade, E., Romero, R., Ahn, H., Hussein, Y., Yeo, L., Korzeniewski, S. J., Chaiworapongsa, T., and Hassan, S. S. (2012). Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. The Journal of Maternal-Fetal & Neonatal Medicine 25, 1682-1689.
Kagan, K., and Sonek, J. (2015). How to measure cervical length. Ultrasound in Obstetrics & Gynecology 45, 358-362.
Kalu, C. A., Umeora, O., Egwuatu, E., and Okwor, A. (2012). Predicting mode of delivery using mid‑pregnancy ultrasonographic measurement of cervical length. Nigerian journal of clinical practice 15, 338-343.
Naji, O., Abdallah, Y., Bij De Vaate, A., Smith, A., Pexsters, A., Stalder, C., McIndoe, A., Ghaem‐Maghami, S., Lees, C., and Brölmann, H. (2012). Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound in obstetrics & gynecology 39, 252-259.
Nambiar, J. M., Pai, M. V., Reddy, A., and Kumar, P. (2017). Can transabdominal scan predict a short cervix by transvaginal scan? Obstetrics and gynecology international 2017.
Nylund, K., Maconi, G., Hollerweger, A., Ripolles, T., Pallotta, N., Higginson, A., Serra, C., Dietrich, C., Sporea, I., and Saftoiu, A. (2017). EFSUMB recommendations and guidelines for gastrointestinal ultrasound.
Peng, C.-R., Chen, C.-P., Wang, K.-G., Wang, L.-K., Chen, C.-Y., and Chen, Y.-Y. (2015). The reliability of transabdominal cervical length measurement in a low-risk obstetric population: Comparison with transvaginal measurement. Taiwanese Journal of Obstetrics and Gynecology 54, 167-171.
Pomorski, M., Fuchs, T., Rosner-Tenerowicz, A., and Zimmer, M. (2016). Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus. European Journal of Obstetrics & Gynecology and Reproductive Biology 205, 141-145.
Rane, S., Guirgis, R., Higgins, B., and Nicolaides, K. (2003). Pre‐induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of the need for Cesarean section. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 22, 45-48.
Romero, R., Nicolaides, K., Conde‐Agudelo, A., O'brien, J., Cetingoz, E., Da Fonseca, E., Creasy, G., and Hassan, S. (2016). Vaginal progesterone decreases preterm birth≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta‐analysis including data from the OPPTIMUM study. Ultrasound in Obstetrics & Gynecology 48, 308-317.
Saul, L. L., Kurtzman, J. T., Hagemann, C., Ghamsary, M., and Wing, D. A. (2008). Is transabdominal sonography of the cervix after voiding a reliable method of cervical length assessment? Journal of Ultrasound in Medicine 27, 1305-1311.
Stark, M., Odent, M., Tinelli, A., Malvasi, A., and Jauniaux, E. (2017). Cesarean Section: The Evidence-Based Technique, Complications, and Risks. In "Management and Therapy of Late Pregnancy Complications", pp. 209-231. Springer.
Thangaraj, J. S., Habeebullah, S., Samal, S. K., and Amal, S. S. (2018). Mid-pregnancy ultrasonographic cervical length measurement (A predictor of mode and timing of delivery): an observational study. Journal of family & reproductive health 12, 23.
Valentin, L. (2013). Prediction of scar integrity and vaginal birth after caesarean delivery. Best practice & research Clinical obstetrics & gynaecology 27, 285-295.
Verma, V., Vishwakarma, R. K., Nath, D. C., Khan, H. T., Prakash, R., and Abid, O. (2020). Prevalence and determinants of caesarean section in South and South-East Asian women. Plos one 15, e0229906.
Westerway, S. C., Pedersen, L. H., and Hyett, J. (2015). Cervical length measurement: comparison of transabdominal and transvaginal approach. Australasian Journal of Ultrasound in Medicine 18, 19-26.
Yeniel, A., and Petri, E. (2014). Pregnancy, childbirth, and sexual function: perceptions and facts. International urogynecology journal 25, 5-14.
How to Cite
Copyright (c) 2020 A Khalid, MN Anjum, U Daraaz, K Hussain, MA Omer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.