Ultrasound surveillance of the cervix in twin gestations: management of cervical incompetency

Article Abstract:

The cervix is located at the base of the uterus and it forms the opening from the uterus into the vagina. During pregnancy, the cervix must maintain its proper shape, and not dilate too early, to ensure a normal delivery. Cervical incompetency occurs when the muscle in the cervix does not maintain its proper shape, which can cause premature birth. This condition can be treated by cervical cerclage, in which a ring is placed around the outside of the cervix to help the cervix maintain in its shape. Most physicians do not recommend this procedure for twin pregnancies, and cerclage can cause premature rupture of the membranes, infection, and irritation of the uterus. Premature birth is the leading cause of death in twins, so a study was performed to determine whether ultrasound for diagnosing cervical incompetence and performing cervical cerclage could reduce the incidence of premature birth during twin pregnancies. Fifty-one twin pregnancies were monitored using ultrasound (the study group) and 153 were not monitored (the control group). Between weeks 18 and 28 of gestation, cervical incompetence was diagnosed and cerclage was performed in seven (14 percent) of the 51 pregnancies in the study group. Fourteen (9 percent) of the 153 pregnancies in the control group gave birth to their babies before week 30 of gestation. All of the twins in the study group survived, while 17 of those in the control group died. Based on these findings, it is concluded that ultrasound is useful for diagnosing cervical incompetence and that cerclage can help prevent premature birth and reduce mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Complications and side effects, Premature birth, Twins, Multiple birth, Prenatal ultrasonography, Ultrasonics in obstetrics

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Imaging the fetal brain in the second and third trimesters using transvaginal sonography

Article Abstract:

The structure of the brain of a fetus can be assessed while it is still in the uterus by means of ultrasonography. This noninvasive diagnostic technique involves the use of sound waves to provide images of internal structures. A form of ultrasonography, called transvaginal sonography, involves the insertion of a specialized transducer, a device that sends and receives the sound wave signal, into the vagina to gain better access to the fetal brain. Transvaginal sonography has been used during the last three to six months of pregnancy to diagnose placenta previa, the abnormal implantation of the placenta in the uterus; and to measure the fetal head deep within the pelvis. However, the diagnostic use of transvaginal sonography to evaluate the fetal head in the second half of pregnancy has not been assessed. The use of transvaginal sonography to examine 83 fetuses with normal and abnormal brain development is described. The fetuses were examined between 20 to 40 weeks' gestation. The diagnosis was changed after transvaginal sonographic examination in 13 cases involving central nervous system or other abnormalities. It is recommended that examination of the fetal brain by transvaginal sonography be included in a complete examination of the fetal nervous system, particularly in cases where a fetal defect is suspected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Ultrasound imaging, Fetal brain, Diagnosis, Ultrasonic, Diagnostic ultrasonography

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