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## Complete Summary

#### GUIDELINE TITLE

Premature cervical dilatation.

#### BIBLIOGRAPHIC SOURCE(S)

Fleischer AC, Andreotti RF, Bohm-Velez M, Fishman EK, Horrow MM, Hrocak
H, Thurmond A, Zelop C, Expert Panel on Women\'s Imaging. Premature
cervical dilation. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2005. 7 p. \[27 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Laing F, Mendelson E,
Bohm-Velez M, Bree RL, Finberg H, Fishman EK, Hricak H, Sartoris D,
Thurmond A, Goldstein S. Premature cervical dilatation. American College
of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun
1;215(Suppl):939-45.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Premature cervical dilatation (cervical incompetence)

#### GUIDELINE CATEGORY

Diagnosis\
Prevention

#### CLINICAL SPECIALTY

Obstetrics and Gynecology\
Radiology

#### INTENDED USERS

Health Plans\
Hospitals\
Managed Care Organizations\
Physicians\
Utilization Management

#### GUIDELINE OBJECTIVE(S)

To evaluate the appropriateness of initial radiologic examinations for
premature cervical dilatation (cervical incompetence)

#### TARGET POPULATION

Patients with premature cervical dilatation (cervical incompetence)

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Transabdominal scan (bladder full or bladder empty)

2.  Translabial/transvaginal sonography

3.  Multiple looks versus single look at cervix during ultrasound (US)
    exam

4.  Reporting of cervical length in mm or cm

5.  Reporting of endocervical diameter in mm (if dilated)

6.  Sonographic cervical stress test

#### MAJOR OUTCOMES CONSIDERED

Utility of radiologic examinations in diagnosis of preterm cervical
dilation

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The guideline developer performed literature searches of peer-reviewed
medical journals, and the major applicable articles were identified and
collected.

#### NUMBER OF SOURCE DOCUMENTS

The total number of source documents identified as the result of the
literature search is not known.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Not Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not stated

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

One or two topic leaders within a panel assume the responsibility of
developing an evidence table for each clinical condition, based on
analysis of the current literature. These tables serve as a basis for
developing a narrative specific to each clinical condition.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Delphi)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Since data available from existing scientific studies are usually
insufficient for meta-analysis, broad-based consensus techniques are
needed for reaching agreement in the formulation of the appropriateness
criteria. The American College of Radiology (ACR) Appropriateness
Criteria panels use a modified Delphi technique to arrive at consensus.
Serial surveys are conducted by distributing questionnaires to
consolidate expert opinions within each panel. These questionnaires are
distributed to the participants along with the evidence table and
narrative as developed by the topic leader(s). Questionnaires are
completed by the participants in their own professional setting without
influence of the other members. Voting is conducted using a scoring
system from 1 to 9, indicating the least to the most appropriate imaging
examination or therapeutic procedure. The survey results are collected,
tabulated in anonymous fashion, and redistributed after each round. A
maximum of three rounds is conducted and opinions are unified to the
highest degree possible. Eighty (80) percent agreement is considered a
consensus. This modified Delphi technique enables individual, unbiased
expression, is economical, easy to understand, and relatively simple to
conduct.

If consensus cannot be reached by this Delphi technique, the panel is
convened and group consensus techniques are utilized. The strengths and
weaknesses of each test or procedure are discussed and consensus reached
whenever possible. If \"No consensus\" appears in the rating column,
reasons for this decision are added to the comment sections.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Criteria developed by the Expert Panels are reviewed by the American
College of Radiology (ACR) Committee on Appropriateness Criteria.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**ACR Appropriateness Criteria®**

**Clinical Condition: Premature Cervical Dilatation**

**Variant 1: Patient not at risk for preterm delivery: 18 weeks
gestation: by transabdominal scan cervix \< 2.5 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Report specific      9                    
  cervical length in                       
  mm or cm                                 

  Transabdominal       8                    
  followed by                              
  translabial or                           
  transvaginal                             

  Multiple looks at    8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated)                                 

  Transabdominal scan  2                    
  only - bladder full                      

  Transabdominal scan  2                    
  only - bladder empty                     

  Single look at       2                    
  cervix during US                         
  exam                                     

  Sonographic cervical No Consensus        May identify patients requiring
  stress test                              treatment for preterm cervical
                                           dilation. See the summary below.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 2: Patient at risk for preterm delivery (history of 3 prior
mid-trimester spontaneous losses): 18 weeks gestation: by transabdominal
scan cervix \< 3.8 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Report specific      9                    
  cervical length in                       
  mm or cm                                 

  Multiple looks at    8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated)                                 

  Transabdominal scan  6                    
  only - bladder empty                     

  Transabdominal       6                    
  followed by                              
  translabial or                           
  transvaginal                             

  Transabdominal scan  2                    
  only - bladder full                      

  Single look at       2                    
  cervix during US                         
  exam                                     

  Sonographic cervical No Consensus        May identify patients requiring
  stress test                              treatment for preterm cervical
                                           dilation. See the summary below.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 3: Patient at no risk for preterm delivery: 18 weeks
gestation: by transabdominal scan cervix \<3.8 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Transabdominal scan  8                    
  only                                     

  Single look at       8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated)                                 

  Transabdominal       2                    
  followed by                              
  translabial or                           
  transvaginal                             

  Sonographic cervical 2                    
  stress test                              

  Multiple looks at    2                    
  cervix during US                         
  exam                                     

  Report specific      2                    
  cervical length in                       
  mm or cm                                 

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 4: Patient not at risk for preterm delivery: 28 weeks
gestation: by transabdominal scan cervix \< 2.5 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Report specific      9                    
  cervical length in                       
  mm or cm                                 

  Transabdominal       8                    
  followed by                              
  translabial or                           
  transvaginal                             

  Multiple looks at    8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated)                                 

  Transabdominal scan  2                    
  only - bladder full                      

  Transabdominal scan  2                    
  only - bladder empty                     

  Single look at       2                    
  cervix during US                         
  exam                                     

  Sonographic cervical No Consensus        May identify patients requiring
  stress test                              treatment for preterm cervical
                                           dilation. See the summary below.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 5: Patient at risk for preterm delivery (history of 3 prior
mid-trimester spontaneous loses): 28 weeks gestation: by transabdominal
scan cervix \<3.8 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Report specific      9                    
  cervical length in                       
  mm or cm                                 

  Multiple looks at    8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated).                                

  Transabdominal scan  6                    
  only - bladder empty                     

  Transabdominal       6                    
  followed by                              
  translabial or                           
  transvaginal                             

  Transabdominal scan  2                    
  only - bladder full                      

  Single look at       2                    
  cervix during US                         
  exam                                     

  Sonographic cervical No Consensus        May identify patients requiring
  stress test                              treatment for preterm cervical
                                           dilation. See the summary below.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 6: Patient at no risk for preterm delivery: 28 weeks
gestation: by transabdominal scan cervix \<3.8 cm long.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  **Ultrasound**                           

  Transabdominal scan  8                    
  only                                     

  Single look at       8                    
  cervix during US                         
  exam                                     

  Report endocervical  8                    
  diameter in mm (if                       
  dilated)                                 

  Transabdominal       2                    
  followed by                              
  translabial or                           
  transvaginal                             

  Sonographic cervical 2                    
  stress test                              

  Multiple looks at    2                    
  cervix during US                         
  exam                                     

  Report specific      2                    
  cervical length in                       
  mm or cm                                 

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

The term *cervical incompetence* was first introduced in 1948. This
condition, which is characterized by painless midtrimester cervical
dilatation, has a reported incidence of 1% and may be responsible for as
many as 20% of second trimester miscarriages.

As a result of recent investigations that recognize features shared by
women with cervical incompetence and those with premature labor, the
concept of cervical incompetence as an \"all or none\" phenomenon has
been challenged. Cervical incompetence is believed to represent a
continuum that relates to cervical length and pregnancy history.

Regardless of the precise definition for this condition, there is no
debate that preterm birth (\<37 weeks of gestation) continues as the
leading cause of perinatal morbidity and mortality. Consequently, it
remains a major obstetrical challenge. Various methods for diagnosing
preterm cervical dilatation have been proposed.

**Digital Examination**

Initial assessment is usually clinical and is based on digital palpation
of the cervix. This examination can detect changes in cervical texture
such as softening (which occurs as a precursor to delivery), and it can
appreciate distensibility of the external os. These findings occur
relatively late in the process of cervical dilatation, however, and in
some cases are found too late to be reversed. Further, some physicians
question the accuracy of digital measurements, which consistently
underestimate measurements made by translabial or transvaginal
ultrasound. Most likely, this inaccuracy is due to the anatomic
configuration of the cervix because the portion of cervix that lies
above the anterior fornix or above the bladder base is hidden from the
examiner\'s fingers. The digital examination has other limitations: 1)
it is a subjective assessment; 2) the internal cervical os, which
reflects initial changes associated with premature cervical dilatation,
is beyond the examiner\'s reach; and 3) there are potential side effects
that include risk of infection and ruptured membranes.

Nonetheless, if a patient is clinically at risk for preterm delivery, or
if the ultrasound examination detects a short cervical length, some
obstetrician-gynecologists may perform a digital cervical examination.
If she is near term (\>37 weeks), however, this examination can be
omitted, unless clinically indicated for other reasons. To optimize the
results and patient management, it is important to correlate the
findings of the ultrasound examination with the digital examination.

**Sonographic Examination**

Unlike digital examination, sonographic measurement of cervical length
generates an image that may be reviewed and standardized, thus
overcoming subjectivity.

*Normal appearing cervix*: During pregnancy, the length of the cervix
does not elongate appreciably. Most authorities consider 3.0 cm in
length as the lower limit of normal. In one large prospective,
multicenter study, 4.0 cm was reported as the 75th percentile, 3.5 cm as
the 50th percentile, 3.0 cm as the 25th percentile, and 2.6 as the 10th
percentile.

*Transabdominal evaluation*: Because most obstetrical sonographic
examinations are done transabdominally, this method remains the most
common, even though it is the least reliable imaging method for
evaluating the cervix. Using this approach, bladder overdistension can
compress the walls of the lower uterine segment and cervix, creating a
deceivingly normal appearance in women with cervical effacement,
shortening, or frank dilatation. Furthermore, an underdistended bladder
may preclude adequate cervical visualization for any one of a variety of
reasons: acoustic shadowing from the pubic symphysis, refractive
shadowing from the bladder-uterine interface, and loss of the acoustic
window provided by the urinary bladder and/or amniotic fluid, or an
inability to elevate the fetal head or other presenting part. Even when
visible on a transabdominal scan, the cervical image is usually
suboptimal. Because the external os is often not clearly identified, a
technically correct cervical length measurement may not be possible.
Aside from women near term (\>37 weeks), if a patient has a clinical
history or sonographic findings suspicious for cervical pathology,
consideration should be given to additional scanning using either a
transperineal or transvaginal approach. Rarely, in an at-risk patient,
the entire cervix is clearly visible on a technically adequate
transabdominal examination, in which case the translabial/transvaginal
scan may be omitted. If a patient is not at risk, and has a
normal-appearing cervix on transabdominal scans (with an empty or
minimally filled bladder), it is not necessary to proceed to
translabial/transvaginal imaging.

*Translabial/transvaginal evaluation*: These approaches are the most
accurate for assessing the cervix. Cervical length is determined as the
distance between the internal and external os. The internal os is
normally at the level where the cervical canal meets the amniotic sac.
The external os is often more difficult to precisely define because of
acoustic shadowing from rectal gas. This problem can be minimized by
either scanning the patient in a lateral decubitus position or elevating
the hips and buttocks on a thick pad or pillow.

In patients at risk for cervical shortening or incompetence, some
investigators suggest performing a cervical \"stress test\" by either
applying transfundal pressure while scanning transvaginally, or by
examining the patient while she is standing. Because some patients will
initially have a completely normal-appearing cervix, these important
maneuvers may identify additional women who may require treatment for
preterm cervical dilatation. If the cervix is already dilated or short,
the cervical stress test may not be necessary because it may compound
the problem by inducing further dilatation and shortening.

*Abnormal-appearing cervix*: Although the clinical presentation varies,
from an imager\'s point of view cervical changes are essentially
identical in patients in term labor, preterm labor, or cervical
incompetence. In each of these clinical situations, cervical dilatation
begins proximally, at the level of the internal os, and progresses
distally. As the internal os dilates, membranes and amniotic fluid
invaginate into the proximal endocervical canal. The most accepted
terminology for these changes is *funneling*, although *wedging* or
*beaking* have also been used. Eventually the entire endocervical canal
becomes filled with fluid, and if the membranes remain intact, they may
be visible bulging into the vagina. Concurrent with dilatation, the
cervix becomes effaced and shortened. Dilatation and effacement
typically progress simultaneously, although, in a given patient, one or
the other event may appear to predominate. In fact, in a series of
patients with short cervices ([\<]{.underline}2.5 cm in length),
funneling correlated with earlier delivery as well as higher neonatal
mortality and morbidity.

Investigators have recommended quantitating these cervical changes using
a variety of measuring techniques, but the simplest and most
reproducible measurement in sensitivity and predictive value appears to
be the residual closed length of the cervix. This calculation, which
takes into account both dilatation and effacement, can be obtained by
measuring from the distal apex of endocervical funneling at the internal
os to the external os. Analysis supports 3.0 cm as the optimal cutoff to
maximize sensitivity and specificity for predicting premature delivery.
One investigation showed that all 24 subjects who delivered prematurely
had a cervical length of less than 3.0 cm, and none of 15 women who had
a cervical length of at least 3.0 cm delivered spontaneously before 36
weeks.

If a woman is clinically at risk for preterm delivery, or if a short
cervix is detected by sonography, the precise length of the cervix
should be measured and reported (this measurement is usually based on
translabial or transvaginal scans). Studies have shown that serial
transvaginal surveillance of cervical length in patients followed by
cervical cerclage when cervical changes are encountered appears to
reduce the cerclage rate without compromising pregnancy outcome. In
addition, in cases with visible dilatation, sonologists should report
the maximal endocervical diameter. The percent of \"effacement\" based
on sonographic images is not reliable, because it is not possible to
determine the location of the internal os once dilatation becomes
apparent.

*Pitfalls*: A false diagnosis of preterm cervical dilatation may be made
on a transabdominal scan in a patient who has a resolving lower uterine
segment contraction, or whose cervix is vertically oriented (typically
with a nondistended maternal bladder), and lacks prominent endocervical
mucus. Under these circumstances, the glandular tissue circumferentially
surrounding the endocervical canal can appear quite sonolucent and mimic
endocervical fluid. These false positive errors can be avoided if a
patient with suspicious findings on transabdominal images is reevaluated
using a translabial or transvaginal approach. A false diagnosis of
preterm cervical shortening may occur on a translabial scan if rectal
gas obscured the external os.

False negative diagnoses can occur during transperineal or transvaginal
scanning if a cervical stress test is omitted. One of the most
challenging groups of patients to evaluate are those in whom the
appearance of the cervix changes during the sonographic examination.
These transient but important observations underscore the need to
observe the appearance of the cervix several times during a single
obstetrical sonographic study, and suggest that a single image of the
cervix may be insufficient for thorough cervical evaluation. This is
particularly the case in women at-risk for preterm delivery, or those in
whom a short cervix is detected by sonography. When a woman has
transitory cervical changes, the minimal length of residual cervix
should be reported and the patient should be considered at risk.
Clinical follow-up of these women reveals that 61% to 74% have preterm
labor or deliver prematurely.

**Conclusion**

Translabial and transvaginal sonography can each provide unique
information about the cervix, that otherwise might not be readily
available. These examinations are easy to perform, and in the
appropriate clinical setting, should become an integral part of the
sonographic study.

**Abbreviations**

-   US, ultrasound

#### CLINICAL ALGORITHM(S)

Algorithms were not developed from criteria guidelines.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on analysis of the current literature and
expert panel consensus.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Selection of appropriate radiologic imaging procedures of patients with
premature cervical dilatation (\<37 weeks of gestation)

#### POTENTIAL HARMS

There is potential for a false diagnosis (false positive) on a
transabdominal scan or for a failure to diagnose (false negative)
preterm cervical dilatation during transperineal or transvaginal
scanning. See \"Major Recommendations\" above under \"Pitfalls\" for
details.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

An American College of Radiology (ACR) Committee on Appropriateness
Criteria and its expert panels have developed criteria for determining
appropriate imaging examinations for diagnosis and treatment of
specified medical condition(s). These criteria are intended to guide
radiologists, radiation oncologists, and referring physicians in making
decisions regarding radiologic imaging and treatment. Generally, the
complexity and severity of a patient\'s clinical condition should
dictate the selection of appropriate imaging procedures or treatments.
Only those exams generally used for evaluation of the patient\'s
condition are ranked. Other imaging studies necessary to evaluate other
co-existent diseases or other medical consequences of this condition are
not considered in this document. The availability of equipment or
personnel may influence the selection of appropriate imaging procedures
or treatments. Imaging techniques classified as investigational by the
U.S. Food and Drug Administration (FDA) have not been considered in
developing these criteria; however, study of new equipment and
applications should be encouraged. The ultimate decision regarding the
appropriateness of any specific radiologic examination or treatment must
be made by the referring physician and radiologist in light of all the
circumstances presented in an individual examination.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Fleischer AC, Andreotti RF, Bohm-Velez M, Fishman EK, Horrow MM, Hrocak
H, Thurmond A, Zelop C, Expert Panel on Women\'s Imaging. Premature
cervical dilation. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2005. 7 p. \[27 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 (revised 2005)

#### GUIDELINE DEVELOPER(S)

American College of Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American College of Radiology (ACR) provided the funding and the
resources for these ACR Appropriateness Criteria®.

#### GUIDELINE COMMITTEE

Committee on Appropriateness Criteria, Expert Panel on Women\'s Imaging

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: Arthur C. Fleischer, MD; Rochelle F. Andreotti, MD;
Marcela Böhm-Vélez, MD; Elliot K. Fishman, MD; Mindy M. Horrow, MD;
Hedvig Hricak, MD, PhD; Amy Thurmond, MD; Carolyn Zelop, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Laing F, Mendelson E,
Bohm-Velez M, Bree RL, Finberg H, Fishman EK, Hricak H, Sartoris D,
Thurmond A, Goldstein S. Premature cervical dilatation. American College
of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun
1;215(Suppl):939-45.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American College of Radiology Web
site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonWomensImaging/PrematureCervicalDilatationDoc8.aspx).

ACR Appropriateness Criteria® *Anytime*, *Anywhere*™ (PDA application).
Available from the [ACR Web
site](http://www.acr.org/SecondaryMainMenuCategories/ACRStore/FeaturedCategories/QualityandSafety/ac_pda.aspx).

Print copies: Available from the American College of Radiology, 1891
Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   ACR Appropriateness Criteria®. Background and development. Reston
    (VA): American College of Radiology; 2 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [American
    College of Radiology (ACR) Web
    site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/background_dev.aspx).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on December 28, 2000. The information
was verified by the guideline developer on January 25, 2001. This NGC
summary was completed by ECRI on January 31, 2006.

#### COPYRIGHT STATEMENT

Instructions for downloading, use, and reproduction of the American
College of Radiology (ACR) Appropriateness Criteria® may be found on the
[ACR Web
site.](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/ACRAppropriatenessCriteriaTermsandConditionsDoc1.aspx)

### DISCLAIMER

#### NGC DISCLAIMER

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Date Modified: 11/3/2008