Mesure de la longueur du canal cervical du col de l’utérus par échographie par voie vaginale Intérêt dans la prévision de l’accouchement prématuré spontané - Cervical length mesurement with transvaginal ultrasonography to predict spontaneous preterm birth - Abstract

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Posted on Sep 13 2010 To assess the accuracy of transvaginal sonographic measurement of cervical length to predict of spontaneous preterm birth. Posted on Sep 13 2010

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haute-autorite-sante-techniques-et-procedures-de-diagnostic

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Imagerie médicale Grossesse

Cervical length measurement with transvaginal ultrasonography to predict spontaneous preterm birth Haute Autorité de Santé (HAS), Saint-Denis La Plaine, France Author : Olivier Allaire, HAS, France Aim To assess the accuracy of transvaginal sonographic measurement of cervical length to predict of spontaneous preterm birth. Conclusions and results Cervical length measurement with transvaginal ultrasonography is predictive of spontaneous preterm delivery regardless of the population investigated. However, it isn’t sensible enough to surely predict spontaneous preterm birth itself alone, but it allows assessing a level of risk to deliver preterm. Thus, the usefulness of transvaginal cervical length measurement depends on risk-benefit ratio of treatment aimed to prevent spontaneous preterm birth. Recommendations (if any) The HAS considers that cervical length measurement with transvaginal ultrasonography can help to select patients who might benefit from specific therapy, especially in the case of : - patients with signs of threatened preterm labour ; Symptomatic - Asymptomatic patients with identified risk factor (uterine malformation, history of spontaneous preterm delivery, late miscarriages, or cervical surgery). Cervical length measurement with transvaginal ultrasound has no benefit in asymptomatic patients without identified risk factor and in case of dichorionic twin pregnancies. Methods Assessment strategy consisted in a literature searc h and analysis of scientific published between 01/1999 and 05/2010. 33 studies were analysed. The results of this analysis were discussed with a multidisciplinary working group consisting of 4 midwives, 2 radiologists, 6 gynaecologists-obstetricians, and 1 neonatologist-paediatrician. Conclusions have been reviewed by the HAS Committee for Assessment of Medical and Surgical Procedure. The HAS Board has approved the final report before publication. Further research/reviews required Specific studies are needed to better define specific cut-off values to gestational age under which the treatment decision is taken. The usefulne ss of transvaginal cervical length measurement depends on risk-benefit ratio of treatment aimed to prevent spontaneous preterm birth. An assessment of these treatment risks and benefits is needed.

2 Avenue du Stade de France 93218 Saint-Denis La Plaine CEDEX, France Tel. : +33(0) 1 55 93 71 97 Fax : 33(0) 1 55 93 70 00 ca.tespaoctnte.fr@has-san-tnasrf.e.www-sah

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