THE SIGNIFICANCE OF TRANSVAGINAL ULTRASONOGRAPHIC EVALUATION OF THE CERVIX IN WOMEN TREATED WITH EMERGENCY CERCLAGE

OBJECTIVE: Our purpose was to determine whether perioperative transvag inal ultrasonographic evaluation of the incompetent cervix treated wit h emergency cerclage is predictive of pregnancy outcome. STUDY DESIGN: Twenty-nine women who underwent emergency cerclage at 16 to 26 weeks of gestation had transvaginal ultrasonographic evaluation of the cervi x within 48 hours before and after surgery and at least three times th ereafter until 28 weeks of gestation. The following measurements were obtained: (1) funnel width, (2) funnel length, (3) endocervical canal length, (4) the distance between the internal and external os, (5) upp er cervix (length of closed endocervical canal above the cervical cerc lage), (6) lower cervix (endocervical canal length below suture), and (7) cervical index (1 + Funnel length/Endocervical canal length). Valu es are reported as the median in millimeters, and statistical analysis was performed by use of the Mann-Whitney U test, Wilcoxon signed-lank test, Spearman rank correlation, 2 x 2 contingency tables, and multip le regression analysis with significance set at p < 0.05. RESULTS: Cer clage procedures resulted in significant improvement in postoperative median measurements of funnel width (15 vs 4.0 mm, p < 0.0001), funnel length (29 vs 3 mm, p < 0.0001), and endocervical canal length (2 vs 27 mm, p < 0.0001). There was a significant relationship between gesta tional age at delivery and the following measurements: preoperative fu nnel width (r = -0.51, p = 0.007), postoperative endocervical canal le ngth (r = 0.39, p = 0.04), length of the lower cervix (r = 0.39, p = 0 .038), and the cervical index (r = -0.39, p = 0.038). An upper cervica l length <10 mm was a good predictor of delivery before 36 weeks of ge station, sensitivity 85.7% (12/14), specificity 66.7% (10/15), positiv e predictive value 70.6% (12/17), negative predictive value 83% (10/12 ), and Fisher's exact p = 0.008. Postoperatively all patients had uppe r cervical lengths <10 mm by 28 weeks of gestation. Preoperative digit al assessments of cervical dilatation before surgery did not correlate with gestational age at birth (r = -0.031, p = 0.36). CONCLUSIONS: In cases of cervical incompetence treated with emergency cerclage, perio perative transvaginal ultrasonographic assessment of the cervix reveal s that the procedure results in improved ultrasonographic status of th e cervix and that the ultrasonographic cervical findings before and af ter surgery correlate with pregnancy outcome.