Abstract
Objective:To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor (PTL) predictor.Methods:During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively.Results:Vaginal pH of 5 and above was found in 162/438 women (37%) while cervical length <30mm was found in 38/438 (8.7%). The incidence of PTL < 37 weeks was 87/438 (19.9%) while the incidence of early (PTL <34 weeks) was 51/438 (11.6%). Predictive value of higher vaginal PH was significantly more (31%) than vaginal PH<5 (13%) in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor (OR=3.06). Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth (OR=13.9).Conclusion:Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL (<34 weeks).
Highlights
In spite of advances achieved in perinatal care, prematurity has remained a major public health problem and is a leading cause of death and morbidity and imposes large costs to the health care system.[1,2] Early detection of pregnant women at risk of premature labor (PTL) will help to reduce the occurrence of prematurity- related mortality and morbidity
Women with history of preterm labor, preterm premature rupture of membranes ( PPROM), in utero diethylstilbestrol (DES) exposure, or collagen disorders (e.g., Ehlers-Danlos syndrome), cervical lacerations during labor and delivery and cervical injuries due to gynecologic procedures are at risk of premature labor.[11,12]
Our study showed alkaline vaginal PH and short cervical length (
Summary
In spite of advances achieved in perinatal care, prematurity has remained a major public health problem and is a leading cause of death and morbidity and imposes large costs to the health care system.[1,2] Early detection of pregnant women at risk of premature labor (PTL) will help to reduce the occurrence of prematurity- related mortality and morbidity. Incidence of premature birth is approximately 9.6% of all birth globally.[3] Cervical insufficiency and bacterial vaginosis are two items that recently known play an essential role in preterm delivery They can be diagnosed using safe, simple and reliable methods. Women with history of preterm labor, preterm premature rupture of membranes ( PPROM), in utero diethylstilbestrol (DES) exposure, or collagen disorders (e.g., Ehlers-Danlos syndrome), cervical lacerations during labor and delivery and cervical injuries due to gynecologic procedures are at risk of premature labor.[11,12] Transvaginal ultrasound screening, cervical length measurements and early intervention like cerclage prevent premature birth.[12]
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