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incompetencia cervical diagnostico ecografico

 

 





Descripcion:
La incompetencia cervical ha motivado creciente controversia. Un feroz debate puso en teja de juicio la real existencia de la entidad. Tambien hay controversia respecto de si el cerclaje profilactico debe ser indicado siempre, o solamente cuando por ecografia transvaginal se obtiene una medicion cervical que indica cuello corto. Nosotros postulamos que la incompetencia cervical es una variable continua y no categorica: es decir, hay varios grados de competencia cervical. El acortamiento del cuello en la ultima parte del segundo trimestre y en el inicio del tercero parece ser un parametro util para la prediccion de un parto pretermino. En un estudio previo efectuado sobre 80 mujeres, hemos observado que la colocacion de un cerclaje producia aumento estadisticamente significativo de la longitud cervical durante el posoperatorio. Mientras que el grado de alargamiento observado inmediatamente despues de la colocacion del cerclaje no fue predictivo de un parto a termino, el progresivo acortamiento del cuello luego del cerclaje si fue predictivo de parto pretermino. Hasta que se lleven a cabo adecuados estudios aleatorizados, sugerimos la realizacion de ecografias transvaginales seriadas para medir la longitud cervical en las mujeres con factores de riesgo para incompetencia cervical y parto pretermino temprano. El cerclaje deberia efectuarseles a aquellas mujeres que realmente se encuentren en riesgo de parto pretermino y cuya longitud cervical se halle acortada (por ejemplo, largo menor que 15- 25 mm).

Cervical incompetence has been the source of increasing controversy. Debate has raged over whether the entity actually exists. Controversy also exists concerning whether prophylactic cerclage is ever indicated or whether cerclage are only indicated when a short cervical measurement is obtained on transvaginal ultrasonography. We posit that cervical incompetence is not a categoric but rather a continuous variable, meaning that there are various degrees in the competency of the cervix. A short cervical length measurement in the late second or early third trimester seems to be useful in the prediction of preterm birth. In a prior study of 80 women we noted that placement of a cerclage resulted in a statistically significant increase in cervical length postoperatively. While the degree of lengthening immediately after the cerclage placement was not predictive of term delivery, a progressive shortening of the cervix after the cerclage was predictive of preterm birth. Until adequate randomized trials are conducted we suggest that serial transvaginal ultrasonographic measurements of cervical length be performed in women with risk factors for cervical incompetence and early preterm delivery. Those women truly at high risk of preterm delivery in whom a short cervical length (i.e.,

Odibo AO, Ural SH, Macones GA. Editorial, the prospects for multiple-marker screening for preterm delivery: does transvaginal ultrasound of the cervix have a central role? Ultrasound Obstet Gynecol 2002; 19:429-35.

Guzman ER, Houlihan C, Vintzileos A, Ivan J, Benito C, Kappy K. The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage. Am J Obstet Gynecol 1996;175:471-6.

Dijkstra K, Janssen HCJP, Kuczynski E, Lockwood CJ. Cervical length in uncomplicated pregnancy. A study of sociodemographic predictors of cervical changes across gestation. Am J Obstet Gynecol 1999;180:639-44.

Rust OA, Altlas RO, Kelly JJ, Benham BN, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second- trimester preterm dilatation of the internal os. Am J Obstet Gynecol 2000; 183:830-5.

Althuisius SM, Dekker GA, Geijn van HP, Bekedam DJ, Hummel P. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Study design and preliminary results. Am J Obstet Gynecol 2000; 183:823-9.

Althuisius SM, Dekker GA, Hummel P, Bekedam DJ, Geijn van HP. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol 2001; 185:1106-11.

Althuisius S, Dekker G, Hummel P, Bekedam D, Kuik D, van Geijn H. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): effect of therapeutic cerclage with bed rest versus bed rest only on cervical length. Ultrasound Obstet Gynecol 2002; 20(2):163-7.

Guzman ER, Mellon C. Vintzileos AM, Ananth CV, Walters C, Gipson K. Longitudinal assessment of endocervical canal length between 15 and 24 weeks' gestation in women at risk for pregnancy loss or preterm birth. Obstet Gynecol 1998; 92:31-7.

Groom KM, Shennan AH, Bennet PR. Ultrasound-indicated cervical cerclage: Outcome depends on preoperative cervical length and presence of visible membranes at time of cerclage. Am J Obstet Gynecol 2002; 187:445-9.

Iams JD, Johnson FF, Sonek J, Sachs L, Gebauer C, Samuels P. Cervical incompetence as a continuum: A study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol 1995;172:1097-106.

Guzman ER, Walters C, Ananth CV, O'Reilly-Green C, Benito CW, Palermo A, Vintzileos AM. A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations. Ultrasound Obstet Gynecol 2001; 18:204-10.

Esta expresamente prohibida la redistribucion y la redifusion de todo o parte de los contenidos de la Sociedad Iberoamericana de Informacion Cientifica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.





 

 

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