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Normative Values of Mid Trimester Cervical Consistency Index in Women Delivering at Term

  • Original Article
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Journal of Fetal Medicine

Abstract

Aims and Objective

Cervical Consistency Index (CCI) is a new technique to measure the consistency of Cervix (softening) and is expected to show changes before cervical shortening. The aim of this study was 1. To find out the normative values of mid-trimester Cervical Consistency Index in women delivering at term. 2. To compare the discriminative ability of cervical consistency index with cervical length for prediction of spontaneous preterm birth.

Method

A total of 144 antenatal patients undergoing mid-trimester anomaly scan were subjected to transvaginal cervical length measurement as per Fetal Medicine Foundation criteria. Cervical consistency index was measured as defined by Para et al. The anterior–posterior diameter of cervix was measured before compression (AP) and after compression (AP') in the same sitting. Cervical consistency index (CCI) was calculated by the formula:

$${\text{CCI }} = {\text{AP}}^{\prime } /{\text{AP}} \times {1}00.$$

The result of CCI was not used in the clinical management of the patient. Women who delivered at 37 weeks and beyond were included to form the normative data. An attempt was made to study the ability of mid-trimester cervical consistency index to predict spontaneous preterm birth as compared to cervical length (CL).

Results

Range of CCI in our study was 41–100% and that of CL was 2–4 cm.Based on values of CCI and CL an ROC curve was made, AUC measured for CCI was 0.923 and for CL was 0.849. The cut off determined for CCI was 64.5%, above which all women delivered at  ≥ 37 weeks. Only Two women who delivered preterm (< 37) weeks had a CCI of less than 64.5% (64 and 47%), but cervical length was greater than 2.5 cms in both of them. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and accuracy of CCI for predicting term delivery at a cutoff of 64.5% in our study was 83.8%, 100%, 100%, 8% and 93.8% respectively, whereas the corresponding figures for predicting preterm delivery were 100%, 83.8%, 8%, 100% and 93.8%. Discriminative ability of CCI in comparison to CL could not be determined because only two women delivered preterm in our study.

Conclusion

This was a pilot study to form the normative values of CCI for women delivering at term. At a cutoff value of 64.5% or more all women delivered at term. Two women who delivered preterm had a CCI of less than 64.5%. Further large studies are required before CCI can be incorporated as a routine to assess the antenatal cervix.

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References

  1. Word RA, Li XH, Hnat M, Carrick K. Dynamics of cervical remodelling during pregnancy and parturition: mechanisms and current concepts. Semin Reprod Med. 2007;25:069–79.

    Article  CAS  Google Scholar 

  2. Timmons B, Akins M, Mahendroo M. Cervical remodelling during pregnancy and parturition. Trends Endocrinol Metab. 2010;21:353–61.

    Article  CAS  Google Scholar 

  3. Feltovich H, Hall TJ, Berghella V. Beyond cervical length: emerging technologies for assessing the pregnant cervix. Am J Obstet Gynecol. 2012;207:345–54.

    Article  Google Scholar 

  4. Berghella V, Roman A, Daskalakis C, Ness A, Baxter JK. Gestational age at cervical length measurement and incidence of preterm birth. Obstet Gynecol. 2007;110:311–7.

    Article  Google Scholar 

  5. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. N Eng J Med. 1996;334:567–73.

    Article  CAS  Google Scholar 

  6. Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol. 1998;12:312–7.

    Article  CAS  Google Scholar 

  7. March of Dimes. The Partnership for Maternal, Newborn and Child Health, Save the Children, World Health Organisation. Born Too Soon: The Global Action Report on Preterm Birth, Howson CP, Kinney MV, Lawn JE (eds). World Health Organisation: Geneva, Switzerland, 2012.

  8. Wulff CB, Rode L, Rosthøj S, Hoseth E, Petersen OB, Tabor A. Trans-vaginal sonographic cervical length in first and second trimesters in a low-risk population: a prospective study. Ultrasound Obstet Gynecol. 2018;51:604–13.

    Article  CAS  Google Scholar 

  9. Van Os MA, Kleinrouweler CE, Schuit E, van der Ven AJ, Pajkrt E, de Groot CJ, et al. Influence of cut-off value on prevalence of short cervical length. Ultrasound Obstet Gynecol. 2017;49:330–6.

    Article  Google Scholar 

  10. Parra-Saavedra M, Gomez L, Barrero A, Parra G, Vergara F, Navarro E. Prediction of preterm birth using the cervical consistency index. Ultrasound Obstet Gynecol. 2011;38:44–51.

    Article  CAS  Google Scholar 

  11. Baños N, Murillo-Bravo C, Julià C, Migliorelli F, Perez-Moreno A, Ríos J, et al. Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low-risk population. Ultrasound Obstet Gynecol. 2018;51:629–36.

    Article  Google Scholar 

  12. Baños N, Julià C, Lorente N, Ferrero S, Cobo T, Gratacos E, et al. Mid-trimester cervical consistency index and cervical length to predict spontaneous preterm birth in a high-risk population. AJP Rep. 2018;8:e43–50.

    Article  Google Scholar 

  13. Cervical assessment. Available from: https://fetalmedi-cine.org/fmf-certification/certificates-of-competence/cervical-assessment-1. Last accessed on December 01, 2018

  14. Parra-Saavedra MA, Libardo AG. Cervical consistency index: a new concept in uterine cervix evaluation. DSJUOG. 2011;25:411–5.

    Article  Google Scholar 

  15. Pooransari P, Salehi F, Afrakhteh M, Mirzamoradi M, Gargari SS, Samani OG. Cervical consistency index is a valid predictor of preterm birth in low-risk pregnant women. Univers Med. 2018;37(2):150–8.

    Article  Google Scholar 

  16. Maul H, Olson G, Fittkow CT, Saade GR, Garfield RE. Cervical light-induced fluorescence in humans decreases throughout gestation and before delivery: preliminary observations. Am J Obstet Gynecol. 2003;188:537–41.

    Article  Google Scholar 

  17. Akins ML, Luby-Phelps K, Mahendroo M. Second harmonic generation imaging as a potential tool for staging pregnancy and predicting preterm birth. J Biomed Optics. 2010;15:026020.

    Article  Google Scholar 

  18. ReuschLM, Anderson J, Carlson LC, Simmons HA, Retake C, Eliceiri K, et al. Detecting cervical microstructure via ultrasound and optical microscopy. In: Institute of electrical and electronics engineers: procedings of ultrasonics symposium (IUS), San Diego, CA, USA. IEEE. 2010 pp. 724–727

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Acknowledgements

We acknowledge and thank the department of diagnostic imaging and ultrasound and all the women participating, for their support and co-operation throughout the study

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India

    Virani Harshad Kumar Shamjibhai, Sakshi Nayar, Sunita Kumar, Chandra Mansukhani & Kanwal Gujral

  2. Department of Fetal Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Nidhish Sharma & Nandita Dimri Gupta

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  1. Virani Harshad Kumar Shamjibhai
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  2. Sakshi Nayar
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  5. Sunita Kumar
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Correspondence to Kanwal Gujral.

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Shamjibhai, V.H.K., Nayar, S., Sharma, N. et al. Normative Values of Mid Trimester Cervical Consistency Index in Women Delivering at Term. J. Fetal Med. 8, 113–119 (2021). https://doi.org/10.1007/s40556-021-00294-7

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  • DOI: https://doi.org/10.1007/s40556-021-00294-7

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