Comparison between trans-vaginal and trans-abdominal ultrasound examination of the cervix in the second trimester of pregnancy: a prospective study

Davide Calandra; Martina Mercaldi; Marika De Vito; Danilo Buca; Marco Liberati; Alessandra Lucidi; Giuseppe Rizzo; Francesco D’Antonio

doi:10.1515/jpm-2023-0103

Article

Comparison between trans-vaginal and trans-abdominal ultrasound examination of the cervix in the second trimester of pregnancy: a prospective study

Davide Calandra , Martina Mercaldi , Marika De Vito , Danilo Buca , Marco Liberati , Alessandra Lucidi , Giuseppe Rizzo and Francesco D’Antonio

Published/Copyright: November 10, 2023

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From the journal Journal of Perinatal Medicine Volume 52 Issue 1

Abstract

Objectives

To compare transvaginal (TV) and trans-abdominal (TA) ultrasound assessment of cervical length (CL) at the time of the second-trimester scan for fetal anomalies.

Methods

This was a prospective study including consecutive pregnant women attending the low-risk ultrasound clinic of two fetal medicine centres in Italy. The inclusion criteria were women between 19 + 0 and 22 + 0 weeks of gestation, attending the prenatal ultrasound clinic for the routine second trimester screening for fetal anomalies. The primary outcome was to compare the CL measurement obtained at TV compared to TA ultrasound; the secondary outcome was to report the inter and intra-observer variability of CL measured with the two different approaches. All women underwent TV and TA assessment of the cervix performed by two experienced certified operators, blinded to each other. Intra-class correlation coefficients (ICC) and Bland–Altman analyses were used to analyse the data.

Results

Two hundred and fifty women were included in the analysis. All women had anteverted uterus. The mean gestational age at ultrasound was 20.7 ± 0.7 weeks; 1.2 % (3/250) scans were performed at 19 weeks, 49.2 % (123/250) at 20 weeks, 44.8 % (112/250) at 21 weeks and 4.8 % (12/250) at 22 weeks of gestations. Identification of the major landmarks of CL at TA ultrasound was achieved in all the included cases. There was good reliability between CL measured at TA (ICC 0.95, 95 % CI 0.93–0.97 for observer 1 and 0.92 %, 95 % CI 0.89–0.94 for observer 2) and TV ultrasound 0.97, 95 % CI 0.96–0.98 for observer 1 and 0.96, 95 % CI 0.95–0.97 for observer 2). There was also good reliability between the two observers for both the TA and TV assessment of the CL. Mean TA CL was 41.4 ± 5.5 for observer 1 and 40.5 ± 4.8 for observer 2 with no significant differences between the two measurements (mean difference 0.92 mm, 95 % CI −9.7 to 11.2). Likewise, there was no difference between the CL measured at TV ultrasound between the two observers (mean difference −0.83 mm, 95 % CI −5.97 to 4.30). Finally, there was no difference in the mean CL measured at TA compared to TV, either considering the overall population of women (mean difference: −0.43, 955 CI −8.65 to 7.79), or when stratifying the analysis according to the parity status and the operator.

Conclusions

Among experienced operators, there was no difference between TV and TA ultrasound assessment of the CL at the time of the routine anomaly scan for fetal anomaly.

Keywords: ultrasound; cervix length; second trimester; pregnancy

Corresponding author: Prof. Francesco D’Antonio, Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy, E-mail: francesco.dantonio@unich.it

Research ethics: The local Institutional Review Board deemed the study exempt from review.
Informed consent: Informed consent was obtained from all individuals included in this study.
Author contributions: Calandra Davide: data collection, write the manuscript. Mercaldi Martina: data collection, write the manuscript. De Vito Marika: data collection. Buca Danilo: designed the experiments, write the manuscript. Liberati Marco: helped to write the manuscript. Lucidi Alessandro: data collection and data analysis. Rizzo Giuseppe: helped to write the manuscript. D’Antonio Francesco: designed the experimentes, data collection and analysis, wrote the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Data available from the authors at reasonable request.

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Received: 2023-03-12

Accepted: 2023-07-10

Published Online: 2023-11-10

Published in Print: 2024-01-29

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0103

Keywords for this article

ultrasound; cervix length; second trimester; pregnancy