Abstract
Objective: Preterm labor is one of the most significant obstetric problems associated with high rate of actual and long-term perinatal complications. Despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers, the prediction and prevention of preterm labor is still a matter of concern. The aim of this study was to examine cervical findings for the prediction and the comparative use of Arabin pessary or cerclage for the prevention of preterm birth in asymptomatic women with high risk factors for preterm labor. Material and methods: The study group was composed of singleton pregnancies (spontaneously conceived) with high risk factors for preterm labor. Cervical length, dilatation of the internal cervical os and funneling, were estimated with transvaginal ultrasound during the first and the second trimesters of pregnancy. Results: Cervical funneling, during the second trimester of pregnancy, was the most significant factor for the prediction of preterm labor. The use of Arabin cervical pessary was found to be more effective than cerclage in the prolongation of pregnancy. Conclusion: In women at risk for preterm labor, the detection of cervical funneling in the second trimester of pregnancy may help to predict preterm labor and to apply the appropriate treatment for its prevention. Although the use of cervical pessary was found to be more effective than cerclage, more studies are needed to classify the effectiveness of different methods for such prevention.
Highlights
Premature birth is defined as birth between 23 weeks + 5 days and 37 weeks of gestation, occurs in 10–12% of deliveries and is the leading cause of perinatal morbidity and mortality [1,2,3]
This study evaluates the possible role of cervical length, dilatation of the internal cervical os, funneling and the use of cerclage or pessary in avoiding this problem
166 women were examined sonographically and we found that 95 (57.2%) had cervical length less than 2.7 cm
Summary
In the interval between 2007 and 2012 in a retrospective cohort research study, we studied the cervical length and the dilatation of the internal os of pregnant women in the 1st trimester (10–14 weeks of gestation) and in the 2nd trimester (14–28 weeks of gestation). Ninety-five percent of all women were followed in Teaching Hospital Aschaffenburg of Germany and the rest in the Democritus University, Department of Obstetrics and Gynecology. The study was approved by the scientific committee as a clinical audit in the two departments. All studied pregnancies were singleton asymptomatic pregnancies with high risk factors in the past such as recurrent miscarriage, previous preterm birth, recurrent vaginal bleeding, cervical surgical procedures, and infections. Exclusion criteria included: stillbirths, fetal congenital anomalies, uterine anomalies, preeclampsia and metabolic diseases.
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