Of all forms of ectopic gestation, the possibility of fertility catastrophe is highest with a cervical pregnancy. Though rare, it is a potentially life-threatening condition. In the past it was diagnosed late, after there was profuse hemorrhage from the cervix and it usually required hysterectomy. With ultrasound, diagnosis can be made earlier and conservative management attempted in order to preserve the reproductive potential. Methotrexate has been used both systemically and intra-amniotically to treat cervical ectopic gestation conservatively.
Cervix Uteri ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Hysterectomy ; Methotrexate ; Pregnancy* ; Ultrasonography

OBJECTIVES: To determine the change in cervical length after cerclage and whether a transvaginal ultrasonographic measurement about change in cervical lengthening after cerclage is predictive of term delivery METHODS: Twenty-nine single pregnant women were suspected as cervical incompetence by using a serial transvaginal ultrasonography. When a shortening of the cervix was substantial before 25 weeks' gestation, a therapeuric McDonald cerclage was applied. The 29 pregnant women had a transvaginal ultrasonographic measurement of the cervix within 48-72 hours before and after cerclage. At each examination, the first measurement was discarded, and the mean of the subsequent three measurements was calculated. Statistical analysis was performed by use of SAS with the significance set at the 5% level. RESULTS: In the 29 single pregnancies examined, the mean cervical length (distance between internal os and external os) before cerclage was 30.0+/-4.5 mm. A cerclage was applied at the mean gestational age of 16.76+/-3.02 weeks. After the cerclage the mean cervical length increased significantly (r=0.895, p=0.0001) to 34.1+/-4.5 mm. There was a significant relation between the gestational age at delivery and the length of postoperative upper cervix (endocervical canal length above suture) (r=0.378, p=0.043). But there was no significant relation between the gestational age at delivery and the following measurements; preoperative cervical length (r=0.348, p=0.064), postoperative cervical length (r=0.279, p=0.143), cervical lengthening (postoperative cervical length - preoperative cervical length) (r=-0.156, p=0.420), length of postoperative lower cervix (endocervical canal length below suture) (r=-0.003, p=0.999). CONCLUSION: Therapeutic McDonald cerclage results in a longer cervical length as measured by transvaginal ultrasonography. The increase in cervical length after cerclage is not a predictive term delivery. But the Length in upper cervix after cerclage correlated with gestational weeks at delivery.
Cervix Uteri ; Female ; Gestational Age ; Humans ; Pregnancy ; Pregnant Women ; Ultrasonography*

OBJECTIVES: Estimation of the anterior lower uterine segment (LUS) thickness difference who underwent prior cesarean delivery measured with transvaginal sonography at or after 36 gestational weeks (sonographic thickness) and a ruler during elective cesarean section (operation thickness) Methods: One hundred sixty women who underwent prior cesarean delivery had the thickness of their LUS measured with transvaginal sonography at or after 36 gestational weeks. The LUS thickness was measured with a ruler during elective cesarean section. We compared group I whose LUS was fairly well visualized 4 cm or more from the uterine cervix to group II which had less than 4 cm. RESULTS: The mean sonographic thickness of LUS was 1.7 0.8 mm and that of operation thickness was 1.9 0.5 mm. The mean difference of the two (thickness difference) was 0.5 0.5 mm. In 31.3% the sonographic thickness was same as the operation thickness and in 70.7% of the total with 0.5 mm or less difference, the sonographic thickness could be regarded as accurate. The thickness difference with the sonographic thickness with 2 mm or more was smaller than those with 1 mm or less (0.4 0.5; 0.6 0.6) and that of group I was smaller than that of group II (0.4 0.4; 0.9 0.6) (p< .05). CONCLUSION: The thickness difference was 0.5 0.5 mm and it was smaller when the LUS thickness is 2 mm or over, clearly visible 4 cm or over from the cervix.
Cervix Uteri ; Cesarean Section ; Cicatrix* ; Female ; Humans ; Pregnancy ; Ultrasonography*

BACKGROUND: To examine the ultrasonographic and magnetic resonance (MRI) imaging findings of a cervical mass type cervical pregnancy. MATERIALS AND METHODS: The ultrasonographic and MRI findings of 5 patients pathologically confirmed as having a cervical pregnancy were analyzed retrospectively. On ultrasonography, the size and echo pattern of the uterine cervix, the shape and echo pattern of the lesion, the degree and the pattern of blood flow on the color Doppler study and the spectral Doppler pattern were analyzed. The shape, signal intensity, and degree and pattern of enhancement of the lesion were evaluated on MRI. RESULTS: The uterine cervix was enlarged and the size of the lesion was 6.1 to 7.1 (average, 6.5) cm. The endocervical canal was irregularly dilated and showed heterogeneous echogenicity in all 5 cases. Four of the 5 lesions were heterogeneously hyper- or mixed echoic and remaining one was relatively homogeneous echogenic. Doppler ultrasonography revealed an increased vascularity of the peritrophoblastic flow pattern. In all 4 cases where MRI performed, the lesion was irregular in shape and the margin was not sharply demarcated. The T2-weighed image showed that the lesions were mixed signal intensity. Three of the 4 lesions contained high signal intensity nodular portions and a low signal intensity rim was observed along the margin of the nodular portions. The T1-weighted image revealed multiple signal voids along the periphery of the lesions and high signal intensity portions as a result of hemorrhage were noted. The dynamic enhanced study showed that the high signal intensity portions on the T2-weighted image were strongly enhanced similar to the vessels on the early phase and the contrast enhancement gradually decreased with time. CONCLUSION: A cervical mass type cervical pregnancy can be correctly diagnosed using the patient's clinical symptom, the elevation in the serum beta-HCG level, and characteristic ultrasonographic and MRI findings.
Cervix Uteri ; Female ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Pregnancy* ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler

The cervical pregnancy is a rare condition representing less than 1% of ectopic gestations. But, it is potentially life-threatening condition because of profuse hemorrhage and requires hysterectomy in some cases. With ultrasound, diagnosis can be made earlier and conservative management is attempted in order to preserve the reproductive potential. Most cervical pregnancies are implanted within the cervical canal below the internal os of the cervix. However, we experienced one case of a unique viable cervical pregnancy in anterior lip of the cervix and treated successfully by local injection of potassium chloride into gestational sac and systemic methotrexate treatment.
Cervix Uteri* ; Diagnosis ; Female ; Gestational Sac ; Hemorrhage ; Hysterectomy ; Lip* ; Methotrexate* ; Potassium Chloride* ; Potassium* ; Pregnancy* ; Ultrasonography

OBJECTIVE: The Bishop score and length of the uterine cervix are good predictors of successful labor induction. However, little is known about the association between the funneling of the uterine cervix and successful labor induction. The study aimed to evaluate cervical funneling as a predictor of successful labor induction. METHODS: This study was designed as a prospective observational study. Subjects who delivered a baby by labor induction were enrolled in the study from July 2011 to August 2013. Cervical funneling and length were examined with transvaginal ultrasonography. The Bishop score was rated by digital pelvic examination. RESULTS: A total of 163 primigravida women were recruited for the study. Of these, 137 participants (84.0%) delivered vaginally by labor induction. Cervical funneling was observed in 93 women (57.1%). Successful labor induction was significantly higher in patients with cervical funneling than those without it (91.4% vs. 74.3%, P<0.01), and was significantly associated with cervical funneling, as well as the Bishop score and cervical length. In a multivariate analysis, cervical funneling was an independent predictor for successful vaginal delivery by labor induction ( odd ratio, 2.70; 95% confidence interval, 1.02 to 7.10; P=0.04). However, the Bishop score and cervical length had no association with successful vaginal delivery. CONCLUSION: This study showed that cervical funneling could be a predictive marker for vaginal delivery during labor induction.
Cervix Uteri* ; Cesarean Section ; Female ; Gynecological Examination ; Humans ; Multivariate Analysis ; Observational Study ; Pregnancy ; Prospective Studies ; Ultrasonography

OBJECTIVE: The Bishop score and length of the uterine cervix are good predictors of successful labor induction. However, little is known about the association between the funneling of the uterine cervix and successful labor induction. The study aimed to evaluate cervical funneling as a predictor of successful labor induction. METHODS: This study was designed as a prospective observational study. Subjects who delivered a baby by labor induction were enrolled in the study from July 2011 to August 2013. Cervical funneling and length were examined with transvaginal ultrasonography. The Bishop score was rated by digital pelvic examination. RESULTS: A total of 163 primigravida women were recruited for the study. Of these, 137 participants (84.0%) delivered vaginally by labor induction. Cervical funneling was observed in 93 women (57.1%). Successful labor induction was significantly higher in patients with cervical funneling than those without it (91.4% vs. 74.3%, P<0.01), and was significantly associated with cervical funneling, as well as the Bishop score and cervical length. In a multivariate analysis, cervical funneling was an independent predictor for successful vaginal delivery by labor induction ( odd ratio, 2.70; 95% confidence interval, 1.02 to 7.10; P=0.04). However, the Bishop score and cervical length had no association with successful vaginal delivery. CONCLUSION: This study showed that cervical funneling could be a predictive marker for vaginal delivery during labor induction.
Cervix Uteri* ; Cesarean Section ; Female ; Gynecological Examination ; Humans ; Multivariate Analysis ; Observational Study ; Pregnancy ; Prospective Studies ; Ultrasonography

Adenoma Malignum (Minimal Deviation Adenocarcinoma) is a rare type well-differenciated adenocarcinoma of uterine cervix. Despite benign histologic appearance, this tumor have usually clinical malignancy. It is quite difficult to diagnosis, and the prognosis is poor. We report of this case with a brief review of literature that Adenoma Malignum was diagnosed early on transvaginal Doppler ultrasonography and MR Imaging and performed hysterectomy.
Adenocarcinoma ; Adenoma* ; Cervix Uteri* ; Diagnosis ; Female ; Hysterectomy ; Magnetic Resonance Imaging ; Prognosis ; Ultrasonography, Doppler

Adenoma Malignum (Minimal Deviation Adenocarcinoma) is a rare type well-differenciated adenocarcinoma of uterine cervix. Despite benign histologic appearance, this tumor have usually clinical malignancy. It is quite difficult to diagnosis, and the prognosis is poor. We report of this case with a brief review of literature that Adenoma Malignum was diagnosed early on transvaginal Doppler ultrasonography and MR Imaging and performed hysterectomy.
Adenocarcinoma ; Adenoma* ; Cervix Uteri* ; Diagnosis ; Female ; Hysterectomy ; Magnetic Resonance Imaging ; Prognosis ; Ultrasonography, Doppler

The objective of this study was to construct multi-element ultrasound applicators for the treatment of gynecologic cancer with high dose rate brachytherapy. For the treatment of uterus, piezo-ceramic crystal transducer (PZT-5A) with outer diameter of 4 mm, wall thickness of 1.3 mm, and length of 24.5 mm was selected. For the treatment of cervix or vagina, it should be possible to insert the applicator into the vagina. Thus, a cylindrical PZT-8 material with outer diameter of 24.5 mm, wall thickness of 1.3 mm, and length of 15.2 mm was selected. The operating frequencies determined by vector impedance measurement were 3.2 MHz for the PZT 5A cylinder (OD=4 mm) and 1.7 MHz for the PZT-8 cylinder (OD: 24.5 mm). The ratios of generated acoustic output power to applied electric power were 33% and 61% for the tandem type crystal and the cylinder type crystal, respectively. The radiated acoustic pressure fields from both transducers were calculated using a Matlab code and measured in water using hydrophone. There was good agreement between measured and calculated acoustic pressure field distribution. For a tandem type transducer, the calculated acoustic pressure field decreased from 0.023 MPa at 10 mm to 0.010 Mpa at 30 mm, the reduction of 57%. For the cylinder type transducer which will be used for the treatment of vagina showed 78% reduction at 15 mm and 66% at 25 mm as compared to values at 5 mm from the surface. Based on the characteristics of the transducers, this study demonstrated the possibility of using the crystals as a heating source. Finally, a 3-element and 4-element prototype applicators were constructed. The 3-element applicator is 75 mm long and 4 mm thick and will be used for the treatment of uterus. The 4-element applicator is 61 mm long and 24.5 mm thick and will be used for the treatment of vagina. Using these applicators, it is possible to generate enough power to increase temperature to therapeutic level.
Acoustics ; Brachytherapy ; Cervix Uteri* ; Electric Impedance ; Female ; Heating ; Hot Temperature ; Transducers ; Ultrasonography* ; Uterus* ; Vagina ; Water