Role of transvaginal sonography in the objective diagnosis of incompetent cervix

The syndrome of cervical incompetence is characterized by spontaneous painless passive dilatation of cervix followed by expulsion of an immature foetus. The subject has been subjected to increasing controversy in recent years. The wide variations in the incidence of cervical incompetence arise because there are no standard criteria for the diagnosis of cervical incompetence. The certain way of diagnosing a case of cervical incompetence is by history and vaginal examination. The introduction of transvaginal ultrasonographical examination into the obstetrics diagnosis has created further possibilities in recognition of isthmico – cervical insufficiency. The present study was conducted for a period of 18 months with gestational age between 14 to 26weeks and was aimed to evaluate the efficacy of transvaginal sonography and to know the incidence of cervical incompetence in this area. 50 pregnant women at high risk of pre-term delivery were taken in to the study. 36 out of 50 cases (72%) met the criteria and they were managed surgically and had a cervix length < 2.5 cm. 14 (28%) cases had cervix length. > 2.5 cm at the initial transvaginal sonographic evaluation. 40 out of 50 (80%) delivered at around term. Though the diagnosis of cervical incompetence is based primarily on past obstetric, gynaec history and clinical findings, but transvaginal sonographic surveillance of the cervix helps us to use the cervical cerclage more selectively i.e., when the cervix length i.e, < 2.5 cm, internal os open or close with funneling of cervical canal.