Can transvaginal cervical length and cervical strain elastography predict mid-trimester medical induction to abortion intervals?

Abstract

Objective

Mid-trimester pregnancy terminations are becoming an increasingly common practice in obstetrics. Accurate prediction of delay from induction to abortion may help in planning the optimal time for the medical induction process and optimising the use of healthcare services. Therefore, we aimed to assess whether the transvaginal cervical length and cervical elastography can predict the time interval from medical induction to abortion in cases of medically indicated mid-trimester pregnancy termination.

Materials and methods

We performed a prospective observational pilot study between January 2022 and October 2022 in patients who have undergone medically indicated mid-trimester pregnancy termination with a non-dilated cervix for foetal morphological, chromosomal abnormalities or preterm premature rupture of membranes. Cervical length (CL) and cervical strain ratio (CSR) were measured by transvaginal sonography. The predictive value of CL and CSR on the induction to abortion interval was calculated after medical induction with misoprostol.

Results

Fifty-three eligible pregnant women were evaluated. The mean gestational age at abortion was 17.61 ± 2.81 weeks. The mean time interval from induction to abortion was 31.72 ± 16.57 h. In multivariate linear regression analysis, CL and the history of previous vaginal delivery were the significant independent predictors of the induction to abortion interval (all p < 0.01), with no additional significant contribution from CSR.

Conclusion

Transvaginal CSR is unlikely to be useful in the prediction of induction to abortion interval in the mid-trimester medically indicated termination of pregnancy.

SHORT CONDENSATION

• Transvaginal cervical length is the significant independent predictor of the induction to abortion interval in the mid-trimester medically indicated termination of pregnancy with no additional significant contribution from cervical strain ratio.

摘要

目的：妊娠中期终止妊娠在产科越来越普遍。准确预测从引产到流产的延迟可能有助于规划医疗诱导过程的最佳时间, 并优化医疗服务的使用。因此, 我们我们的目的是评估经阴道宫颈长度和宫颈弹性成像是否可以预测药物引产至流产的时间间隔。

材料和方法：我们在2022年1月至2022年10月期间对因胎儿形态、染色体异常或早产胎膜早破而接受过中期妊娠终止且宫颈未扩张的患者进行了一项前瞻性观察性研究。经阴道超声测量宫颈长度（CL）和宫颈应变率（CSR）。计算米索前列醇药物诱导后CL和CSR对引产至流产间隔时间的预测值。

结果：对53例符合条件的孕妇进行了评估。流产时平均孕周为17.61±2.81周。平均引产至流产间隔时间为(31.72±16.57)h, 经多元线性回归分析, CL和有无阴道分娩史是影响引产至流产间隔时间的显著独立因素(P均<0.01), CSR无显著影响。

结论：经阴道CSR不太可能用于药物终止妊娠中期引产间隔的预测。

简短总结：经阴道宫颈长度是妊娠中期引产至流产间隔时间的显著独立预测因素, 而宫颈应变率比值没有额外的显著贡献。

Keywords:

• Cervical length
• strain elastography
• pregnancy termination
• abortion interval

Ethical approval

The study complies with the Declaration of Helsinki, and the study protocol was approved by the University’s Research Ethics Committee (Reference:2022-KAE-0025). Written informed consent was obtained from all participants.

Author contributions

All authors read and approved the final manuscript.

Secil Karaca Kurtulmus: Data collection and manuscript writing.

Mustafa Sengul: Conceived and designed the analysis.

Ibrahim Omeroglu: Data analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).