SONOGRAPHIC EVALUATION OF THE UTERINE CERVIX
1998; Elsevier BV; Volume: 25; Issue: 3 Linguagem: Inglês
10.1016/s0889-8545(05)70031-0
ISSN1558-0474
Autores Tópico(s)Ectopic Pregnancy Diagnosis and Management
ResumoPreviously, the uterine cervix was one of the least studied organs in obstetrics; however, because of the capability and increased utilization of both transvaginal and transabdominal ultrasound, examination of the cervix has now assumed an important role. Certain findings can allow clinicians to detect and possibly alter outcomes associated with preterm labor and cervical incompetence. As the ability to detect patients destined to deliver preterm becomes more reliable, the distinction among precipitating events becomes less clear. For example, the patient who presents at 26 weeks' gestation with infrequent or absent uterine activity and a shortened cervix with significant funneling would be considered by some to have late-onset cervical incompetence and possibly would benefit from management intervention (e.g., cerclage, bed rest, steroids). Before the advent of cervical ultrasound, preterm premature rupture of the membranes might have developed in this patient at 27 or 28 weeks without a thought given to assessing the cervix. Although this clinical scenario is common, the evidence regarding the optimal management of such cases is far from established. The goals of this article are to answer the following questions: How does one measure cervical length during pregnancy, and is one method superior to another? What is considered a normal cervical length in pregnancy, and does it vary with gestational age, previous history, or other risk factors for premature delivery (i.e., multiple gestation)? How does one apply cervical length measurement to patient management? Finally, what adjuncts to cervical length measurement can the practicing obstetrician use to enhance the reliability of management decisions, and can these improve patient care or reduce health care costs?
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