Abstract
Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth.
 Aim and Objectives: To assess fetal adrenal gland volume, fetal zone enlargement and cervical length on ultrasound and compare their efficacy in the prediction of preterm birth. 
 Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume, fetal zone enlargement and cervical length was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters and cervical length was assessed. 
 Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Cervical length was found to be the least important marker for predicting the preterm birth as having the least AUC as 0.209, sensitivity as 36.4 % and specificity as 76.1%.
 Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth and is a better predictor than cervical length.
 Keywords: Preterm, Cervical length, Adrenal biometry.
Highlights
IntroductionPreterm birth is defined as the onset of delivery prior to 37 completed weeks but after the age of viability, which may range from 24 weeks to 28 weeks, based on which those born before 28 weeks are termed as extreme preterm and those above 32 weeks are late preterm
Preterm birth is defined as the onset of delivery prior to 37 completed weeks but after the age of viability, which may range from 24 weeks to 28 weeks, based on which those born before 28 weeks are termed as extreme preterm and those above 32 weeks are late preterm1.Preterm labor remains to be one of the most important challenges of contemporary perinatology and constitutes one of the main reasons of perinatal mortality
The present study demonstrates that preterm delivery is still a challenge in our country
Summary
Preterm birth is defined as the onset of delivery prior to 37 completed weeks but after the age of viability, which may range from 24 weeks to 28 weeks, based on which those born before 28 weeks are termed as extreme preterm and those above 32 weeks are late preterm. Preterm labor remains to be one of the most important challenges of contemporary perinatology and constitutes one of the main reasons of perinatal mortality. Every year an estimated 15 billion babies are born preterm. More than 60 percent of these preterm births occur in Asia and Africa. Preterm birth is the leading cause of death among children less than five years of age, constituting to about one million deaths every year. India contributes the greatest number of preterm births worldwide. Out of 27 million babies born every year in
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