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Digital examination and transvaginal scan - competing or complementary for predicting preterm birth?
Eva Reiter1, Kurt Aagaard Nielsen, Jens Fedder
1Scientific Unit, Horsens Hospital, Denmark. reiter@ruc.dk
Acta Obstetricia Et Gynecologica Scandinavica
|December 16, 2011
Summary
Transvaginal cervical scans and digital exams have conflicting roles in predicting preterm birth. Current evidence is insufficient for routine screening in asymptomatic women, and outcomes for symptomatic women are not significantly improved.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Imaging
Background:
- Transvaginal ultrasonographic cervix scans are increasingly used for preterm birth diagnosis, partially replacing digital examination.
- Conflicting data exist regarding the predictive accuracy of both methods for preterm birth.
Purpose of the Study:
- To review the predictive value of digital cervical examination and transvaginal ultrasonography.
- To assess their utility in low-risk asymptomatic and symptomatic women prior to treatment.
Main Methods:
- Comprehensive literature search of major databases (PubMed, Web of Science, Cochrane) from 1994 to 2010.
- Inclusion of randomized controlled trials, cohort studies, outcome research, and clinical decision rule studies.
Main Results:
- Nomenclature and methods for digital cervical assessment lack standardization.
- Insufficient evidence supports routine screening for cervical ripening in asymptomatic, low-risk women.
- Transvaginal scans did not significantly improve outcomes in symptomatic women but may reduce hospitalization; they can reduce false positives when used with the Bishop Score.
Conclusions:
- Standardization of cervical assessment methods is required.
- Evidence for transvaginal scanning improving outcomes in symptomatic women remains insufficient.
- Digital examination and transvaginal scanning should be considered complementary diagnostic tools.
