Comment on the article: "A shortened suppository with dilatation of the inner gate: how to proceed after the diagnosis?"
Abstract
Assessing the condition of the cervix in the prediction of impending preterm birth is without discussion a basic act of the obstetrician during prenatal care. It is not so long since the only method of assessing the condition of the cervix was palpation of the vaginal examination and scoring the condition of the uterine closure apparatus according to Bishop.
Today we have the opportunity to supplement this method with ultrasound transvaginal cervicometry. I intentionally use the term 'supplement', not 'replace', because I believe that vaginal examination provides a relatively wide range of data that cannot be obtained other than by tactile sensation.
It is mainly an assessment of the consistency of the throat, its placement, but also permeability, or an assessment of the relationship of the leading part of the fetus to the pelvic entrance and vaginal arches. On the other hand, it is clear that Bishop's scoring is subject to individual error.
The more investigators there are, the bigger the mistake. Another big disadvantage is the fact that by palpation it is very difficult to objectively evaluate the length of the cervical canal and especially the condition of the inner gate.
Cervicometry, if done correctly, can do it. I emphasize the exact execution of the examination, as described in the article.
Improperly performed examination with a probe inserted too deeply can paradoxically lead to false negative results. The great advantage of the method is the possibility of obtaining photo documentation.
Thus, by combining palpation vaginal examination and transvaginal ultrasound cervicometry, we obtain a relatively complex picture of the anatomical condition of the uterine occlusion apparatus.