Cervical incompetence: preliminary evaluation with MR imaging

Article Abstract:

Cervical incompetence is an abnormality of the cervix uteri, the neck of the uterus. The defect is in the muscular ring that controls the size of the opening of the cervix. The condition can lead to spontaneous abortion during pregnancy. The defect can be treated with cervical cerclage, which involves placing a suture or seam around the cervix, but the defect is difficult to diagnose. Various diagnostic imaging techniques have been used to detect this abnormality, but none has proven adequate. This study examined using magnetic resonance (MR) imaging to detect cervical incompetence in nonpregnant women. MR imaging uses magnetic properties of tissues to produce anatomical images. Imaging was performed on 20 women with normal cervices and 21 with diagnosed incompetent cervices. Of the 21 women with incompetent cervices, 11 were either born with the defect or else the defect was caused by trauma. In the other 10, it was caused by exposure to the drug diethylstilbestrol (DES). Cervical length averaged 33.0 mm in the normal group and 32.5 mm in the cervical incompetent group in which DES was not the cause, an insignificant difference. In the DES subjects, the average length was 22.9, a significant difference from the other two groups. Cervical width averaged 3.3 mm for the normal group and 4.5 for the non-DES group, a significant difference. MR signal intensities from the cervical stroma (connective tissue) were abnormal in many of the cervical incompetent patients. These results indicate that MR imaging can be very effective in detecting cervical incompetence. MR findings of an abnormally wide cervical width, and abnormally short cervical length, or abnormal signal intensities from the cervical stroma are indicative of cervical incompetence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Magnetic resonance imaging, Cervix uteri, Miscarriage

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Endovaginal sonography in very early pregnancy: new observations

Article Abstract:

An article by Levi et al. in the July 1990 issue of Radiology examines the use of endosonography (imaging of internal tissues by means of high-frequency sound waves) in studying small embryos. Prior to the advent of endovaginal sonography, the ability to evaluate the development of these small embryos was limited. A number of important issues are raised by new findings. The presence or absence of cardiac pulsations in embryos is an important determinant of a successful pregnancy. The combination of a highly developed embryo as seen by traditional sonography and the lack of cardiac activity has been considered almost 100 percent accurate in predicting a poor outcome of the pregnancy. The ability of endovaginal sonography to image embryos at a much smaller and earlier stage brings into question how detection of cardiac activity in these embryos will relate to outcome. The research of Levi suggests that embryos that will have a favorable prognosis can now be imaged before cardiac activity can be detected. This and other research indicate that in embryos with a crown-to-rump length of less than 4 mm, lack of cardiac activity is normal. The importance of this finding is that being able to visualize an embryo and not detecting cardiac activity is not necessarily indicative of a poor outcome. Another consideration is that since most pregnancies that spontaneously abort do so before traditional sonography could image the embryos, this new technique, which can image embryos much earlier, will reveal more frequent losses of these embryos, even when cardiac activity can be detected. The ability to image embryos at an earlier stage of development will significantly improve early evaluation of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Innovations, Fetus, Fetal heart rate monitoring, Electronic fetal monitoring, editorial

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Ectopic pregnancy: features at transvaginal sonography

Article Abstract:

An ectopic pregnancy occurs when the embryo does not implant in the uterus. Frequently, the embryo implants and grows in one of the fallopian tubes. If the ectopic pregnancy is not discovered early and treated, the tube may rupture. Sonography is a diagnostic imaging technique that uses high frequency sound waves to produce images of soft tissues in the body, and has been used to examine women suspected of having an ectopic pregnancy. Transvaginal sonography is performed by using a sonographic probe, which is placed in the vagina. This study reports on the findings of transvaginal sonography, which were indicative of ectopic pregnancy in 50 cases. The ectopic pregnancies were subsequently confirmed by surgery. The fallopian tubes were involved in 47 of the 50 cases, and 13 tubes had ruptured. A tubal ring was seen on sonograms from 23 of the 34 tubal pregnancies in which a rupture did not occur. Embryos could be seen in 16 of the 47 tubal pregnancies. The endometrium, the tissue that lines the uterus, appeared thickened in 20 of the 50 cases. Peritoneal fluid accumulation was seen in 35 cases. For all patients, at least one sonographic abnormality was found. These results indicate that transvaginal sonography is valuable in evaluating suspected ectopic pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Pregnancy, Ectopic, Ectopic pregnancy

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