Cervical sonography in pregnant women with a prior cone biopsy or loop electrosurgical excision procedure.
OBJECTIVE
To determine if pregnant women with a prior cone biopsy or loop electrosurgical excision procedure (LEEP) have a shorter midtrimester cervical length than do matched controls without a history of cervical surgery.


METHODS
Eighty-five pregnant women with a singleton gestation and previous cone biopsy or LEEP and 85 controls matched by age (± 5 years), race, gestational age (± 2 weeks), and number of prior vaginal deliveries underwent a single transvaginal cervical sonographic scan at 15-22 weeks' gestation. No patient had a cerclage in either group.


RESULTS
Mean cervical length was significantly shorter in the cone biopsy/LEEP group (3.3 vs. 3.9 cm, P < 0.001), with no significant difference in the proportion of cervical lengths less than 2.5 cm (5.9 vs. 2.4%). Gestational age at delivery was slightly but significantly lower in the cone biopsy/LEEP group (38.1 vs. 39.1 weeks, P = 0.005) than in the control group, with a higher proportion of women delivering late preterm and very preterm in the cone biopsy/LEEP group. However, no woman with a prior cone biopsy/LEEP experienced a midtrimester loss suggestive of cervical insufficiency, and no patient with a cervical length less than 2.5 cm delivered before 34 weeks' gestation.


CONCLUSIONS
Midtrimester cervical length in women with a previous cone biopsy or LEEP is significantly shorter than in those without prior cervical surgery. Based on the low frequency of a short cervix or midtrimester loss in women with prior excisional surgery, the routine use of midtrimester cervical sonography in such women is not supported.
Fischer
R L
RL
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper University Hospital, Camden, NJ 08103-1489, USA. fischer-richard@cooperhealth.edu
Sveinbjornsson
G
G
Hansen
C
C
D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019092:Conization / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*