Role of ultrasound in screening patients at risk for preterm delivery

Nora M. Doyle, Manju Monga

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations

Abstract

The ultrasound assessment of the cervix has contributed to the understanding of the pathways to preterm birth [3]. Transvaginal ultrasound measurement of the cervix provides an objective and noninvasive tool for the evaluation of cervical status. Despite widespread use of this procedure, standardization of measurement indications, technique, and interval between examinations has not been achieved. The American College of Radiology has recently recommended that the cervix and lower uterine segment be imaged as part of every obstetric ultrasound examination in the second trimester. These guidelines specifically suggest a search for a short cervix (less than 30 mm) or funneling [8]. The expert panel on women's imaging further recommended evaluating the cervix sonographically on both the initial examination and all follow-up examinations for twin gestations [51]. The American Institute of Ultrasound in Medicine guidelines indicate that evaluation of the uterus, including cervix, should be performed, but does not indicate specifically that the cervix should be measured [52]. In contrast, the American College of Obstetricians and Gynecologists, although recognizing that cervical length assessment may be helpful in predicting the risk of preterm delivery (particularly from a negative predictive value), does not recommend routine use of cervical length measurement because of the lack of proved treatment or intervention methods [53]. A review of the literature suggests that at the time of this writing the role of routine screening of low-risk women with cervical length assessment by ultrasound is not supported. In contrast, in women at risk for preterm delivery (eg, women with a prior history of preterm birth or women with multiple gestations) cervical length assessment may be useful for its negative predictive value. At present, however, there is no therapeutic intervention that has been proved to decrease the risk of preterm delivery in women with a documented cervix on ultrasound.

Original languageEnglish (US)
Pages (from-to)125-139
Number of pages15
JournalObstetrics and Gynecology Clinics of North America
Volume31
Issue number1
DOIs
StatePublished - Mar 2004
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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