Advanced

Three - dimensional ultrasound studies of the cervix in pregnancy

Rovas, Linas LU (2005)
Abstract (Swedish)
Popular Abstract in Swedish

Tre-dimensionell ultraljudsundersökning av livmodertappen (cervix)



Syftet med avhandlingen var att utvärdera förändringar i livmodertappen (cervix) med tre-dimensionellt ultraljud och utreda om tre-dimensionellt power Doppler ultraljud kan förutsäga tiden till spontan eller inducerad förlossning hos överburna, gravida kvinnor.



Avhandlingen baseras på fem studier: reproducibilitet av cervixmätningar (studie I), referensvärde för normala mätningar på cervix med tre-dimensionellt ultraljud under graviditet (studierna II och III) samt förmåga att förutsäga tiden till spontan eller inducerad förlossning hos överburna, gravida kvinnor med tre-dimensionellt power... (More)
Popular Abstract in Swedish

Tre-dimensionell ultraljudsundersökning av livmodertappen (cervix)



Syftet med avhandlingen var att utvärdera förändringar i livmodertappen (cervix) med tre-dimensionellt ultraljud och utreda om tre-dimensionellt power Doppler ultraljud kan förutsäga tiden till spontan eller inducerad förlossning hos överburna, gravida kvinnor.



Avhandlingen baseras på fem studier: reproducibilitet av cervixmätningar (studie I), referensvärde för normala mätningar på cervix med tre-dimensionellt ultraljud under graviditet (studierna II och III) samt förmåga att förutsäga tiden till spontan eller inducerad förlossning hos överburna, gravida kvinnor med tre-dimensionellt power Doppler ultraljud (studierna IV och V). Vi undersökte 969 kvinnor mellan graviditetsveckor 17 och 42 med två- och tre-dimensionellt ultraljud.



Referensvärden var etablerade för cervix längd, anterior-posterior (AP) diameter och bredd, cervix volym och cervix öppning av inre modermunnen (funneling): längd, anterior-posterior (AP) diameter och bredd, VI (vaskularisationsindex), FI (flödesindex), VFI (vaskularisations-flödesindex), som mätades med tre-dimensionellt power Doppler ultraljud under perioden mellan 17 och 41 graviditetsveckor. Överensstämmelsen var perfekt bland två- och tre-dimensionella ultraljudsresultat. Cervix förkortades från 33:e graviditetsveckan. Cervix diameter och bredd ökade från graviditetsvecka 31. Cervix funneling och öppning av cervixkanalen upptäcktes oftast senare i graviditetsutvecklingen. Olika referensvärden för cervixlängden måste användas för förstföderskor och omföderskor från 33: e graviditetsveckan. Cervix volym och blodflödesindex är konstant mellan vecka 17 och 40 i graviditeten, men cervix volym är mindre vecka 41 än under 17-40: e graviditetsveckorna. Omföderskor har större cervix än förstföderskor and deras cervix är mer vaskulariserad under perioden mellan 17 och 30 graviditetsveckor. Våra referensvärden ligger som bas till studier av patologiska tillstånd i cervix under graviditeten.



Univariat regressionsanalys visade att Bishop score, cervix längd och paritet är relaterade till tiden för spontanangrepp av värkarbete och tid för förlossningen. VI är relaterat till tid för spontant värkarbete. Multivariat logistisk regressionsanalys visade, att Bishop score och blodflödesindex inte passade någon modell till att förutsäga angrepp av värkarbete utan endast cervix längd, bredd och paritet passade. Cervix längd, VI och VFI kan självständigt förutsäga förlossning som skedde efter 48 timmar. Cervix längd och Bishop score kan båda självständigt förutsäga tiden för förlossning som skedde efter 60 timmar. Ytinnehållet under ROC-kurvorna visade inte någon signifikant skillnad mellan diagnostiska tester. VI-indexförändringar tyder på att vaskularisering ändras i livmodertappen före förlossningen under cervixmognaden.



Cervix längd, Bishop score och paritet var relaterade till framgång av förlossningsinduktion hos överburna gravida kvinnor, vilka genomgick förlossningsinduktion med prostaglandin vagitorier. Bloflödes-index framtagna med power Doppler ultraljud var inte relaterade till framgång av induktion. VI - och VFI-index var ändå något större hos kvinnor som hade värkarbete inom 12 timmar efter prostaglandin vagitorium.



Vår studie, att fastställa reproducibilitet av cervix-undersökning med tre-dimensionellt ultraljud, visade bra Inter-CC och Intra-CC värden för cervix volym och blodflödes-index, men ganska breda gränser av överenskommelse. Detta tyder sannolikt på att det är omöjligt att upptäcka små förändringar i cervix volym och blodflödesindex när man använder dagens tre-dimensionella power Doppler ultraljud. (Less)
Abstract
The aim of this thesis was to evaluate cervical physiological changes by three-dimensional (3D) ultrasound during pregnancy and to investigate the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.



The thesis is based on five studies: reproducibility of cervical measurements by 3D power Doppler ultrasound (study I), reference data representative normal findings of the cervix assessed by 3D ultrasound during pregnancy (studies II, III) and the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.



(Study IV and V). 935 women from 17 to 42 gestational weeks (gws) were examined by 2D and 3D... (More)
The aim of this thesis was to evaluate cervical physiological changes by three-dimensional (3D) ultrasound during pregnancy and to investigate the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.



The thesis is based on five studies: reproducibility of cervical measurements by 3D power Doppler ultrasound (study I), reference data representative normal findings of the cervix assessed by 3D ultrasound during pregnancy (studies II, III) and the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.



(Study IV and V). 935 women from 17 to 42 gestational weeks (gws) were examined by 2D and 3D ultrasound.



Reference values for cervical length, anterior-posterior (AP) diameter and width, cervical volume and cervical funneling length, AP diameter and width, and for cervical blood flow indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) as assessed by 3D ultrasound at 17 to 41 gws were established. There was excellent agreement between 2D and 3D ultrasound results. The cervix shortens from 33 gws. Cervical diameter and width increases from 31 gws. Cervical funneling and an opening of the cervical canal become more common with advancing gestation. Separate values for cervical length for nullipara and multipara should be used from 33 gws. Cervical volume and blood flow indices do not change from 17 to 40 gws but cervical volume is smaller at 41 gws than at 17 to 40 gws. Multipara have larger cervix than nullipara and their cervix is more vascularized at 17 to 30 gws. Our reference data lay the basis for studies of pathological conditions in the cervix during pregnancy.



Univariate regression analyses showed that Bishop score, cervical length and parity are related with time to spontaneous onset of labor and time to delivery. VI is related to time to spontaneous delivery. Multivariate logistic regression showed that Bishop score and vascular indices did not enter any model to predict onset of labor, only cervical length, width and parity did. Model including cervical length, VI and VFI predict delivery > 48h. Cervical length and Bishop score were both independent predictors of delivery > 60h. The areas under the ROC curves did not differ significantly between the diagnostic tests. Changes in VI give some credibility to assumption that vascular changes in the cervix occur when it ripens.



In women with prolonged pregnancy undergoing labor induction with prostaglandin suppositories ultrasonographic cervical length, Bishop score and parity were related to the success of labor induction, but 3D power Doppler indices were not. Nonetheless, VI and VFI were slightly higher in women who were in labor <12h after start of induction.



Our study to determine the reproducibility of 3D ultrasound examination of the cervix showed high inter-CC and intra-CC values for cervical volume and blood flow indices, but wide limits of agreement. This means that it is probably not possible to detect anything but large differences or changes in cervical volume and blood flow indices using current 3D ultrasound technique. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Tekay, Aydin, Oulu, Finland
organization
alternative title
Tre-dimensionell ultraljudsundersökning av livmodertappen (cervix)
publishing date
type
Thesis
publication status
published
subject
keywords
andrology, gynaecology, Obstetrics, 'Prostaglandin'., 'Labor induction'., 'Spontaneous delivery'., 'Pregnancy'., 'Cervix uteri'., 'Blood flow indices'., 'Doppler ultrasound'., 'Three-dimensional imaging'., sexuality, reproduction, Obstetrik, sexualitet, reproduktion, gynekologi, andrologi
pages
116 pages
publisher
Medicinsk Informationsteknik, Malmö
defense location
Föreläsningssalen, Avdelningen för obstetrik och gynekologi, tredje våningen, Universitetssjukhuset MAS, Malmö.
defense date
2005-12-15 13:00
ISSN
1652-8220
ISBN
91-85481-17-3
language
English
LU publication?
yes
id
0cd0cecc-eb8d-428c-83fc-7be3bcf3d141 (old id 545582)
date added to LUP
2007-09-25 10:07:58
date last changed
2016-09-19 08:44:54
@phdthesis{0cd0cecc-eb8d-428c-83fc-7be3bcf3d141,
  abstract     = {The aim of this thesis was to evaluate cervical physiological changes by three-dimensional (3D) ultrasound during pregnancy and to investigate the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.<br/><br>
<br/><br>
The thesis is based on five studies: reproducibility of cervical measurements by 3D power Doppler ultrasound (study I), reference data representative normal findings of the cervix assessed by 3D ultrasound during pregnancy (studies II, III) and the ability of 3D power Doppler to predict time to spontaneous and induced delivery in prolonged pregnancy.<br/><br>
<br/><br>
(Study IV and V). 935 women from 17 to 42 gestational weeks (gws) were examined by 2D and 3D ultrasound.<br/><br>
<br/><br>
Reference values for cervical length, anterior-posterior (AP) diameter and width, cervical volume and cervical funneling length, AP diameter and width, and for cervical blood flow indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) as assessed by 3D ultrasound at 17 to 41 gws were established. There was excellent agreement between 2D and 3D ultrasound results. The cervix shortens from 33 gws. Cervical diameter and width increases from 31 gws. Cervical funneling and an opening of the cervical canal become more common with advancing gestation. Separate values for cervical length for nullipara and multipara should be used from 33 gws. Cervical volume and blood flow indices do not change from 17 to 40 gws but cervical volume is smaller at 41 gws than at 17 to 40 gws. Multipara have larger cervix than nullipara and their cervix is more vascularized at 17 to 30 gws. Our reference data lay the basis for studies of pathological conditions in the cervix during pregnancy.<br/><br>
<br/><br>
Univariate regression analyses showed that Bishop score, cervical length and parity are related with time to spontaneous onset of labor and time to delivery. VI is related to time to spontaneous delivery. Multivariate logistic regression showed that Bishop score and vascular indices did not enter any model to predict onset of labor, only cervical length, width and parity did. Model including cervical length, VI and VFI predict delivery &gt; 48h. Cervical length and Bishop score were both independent predictors of delivery &gt; 60h. The areas under the ROC curves did not differ significantly between the diagnostic tests. Changes in VI give some credibility to assumption that vascular changes in the cervix occur when it ripens.<br/><br>
<br/><br>
In women with prolonged pregnancy undergoing labor induction with prostaglandin suppositories ultrasonographic cervical length, Bishop score and parity were related to the success of labor induction, but 3D power Doppler indices were not. Nonetheless, VI and VFI were slightly higher in women who were in labor &lt;12h after start of induction.<br/><br>
<br/><br>
Our study to determine the reproducibility of 3D ultrasound examination of the cervix showed high inter-CC and intra-CC values for cervical volume and blood flow indices, but wide limits of agreement. This means that it is probably not possible to detect anything but large differences or changes in cervical volume and blood flow indices using current 3D ultrasound technique.},
  author       = {Rovas, Linas},
  isbn         = {91-85481-17-3},
  issn         = {1652-8220},
  keyword      = {andrology,gynaecology,Obstetrics,'Prostaglandin'.,'Labor induction'.,'Spontaneous delivery'.,'Pregnancy'.,'Cervix uteri'.,'Blood flow indices'.,'Doppler ultrasound'.,'Three-dimensional imaging'.,sexuality,reproduction,Obstetrik,sexualitet,reproduktion,gynekologi,andrologi},
  language     = {eng},
  pages        = {116},
  publisher    = {Medicinsk Informationsteknik, Malmö},
  school       = {Lund University},
  title        = {Three - dimensional ultrasound studies of the cervix in pregnancy},
  year         = {2005},
}