Comparison of Transvaginal Sonographic Cervical Length with Neonatal Outcomes among Pregnant Women Presented with Preterm Premature Rupture of Membrane

Abstract

Background: Preterm premature rupture of membranes (PPROM) is a significant complication in pregnancy, contributing to maternal, fetal, and neonatal morbidity and mortality. Identifying those at increased risk is crucial to address the problem of prematurity. Transvaginal sonography has emerged as an effective tool for assessing cervical length and predicting preterm delivery. The purpose of the present study was to compare the cervical length measured by transvaginal sonography with neonatal outcomes among pregnant women presented with premature rupture of the membrane. Material & Methods: This comparative cross-sectional study was conducted in the Department of Obstetrics and Gynecology at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from October 2017 to April 2018 for six months. A total of 44 Women who were admitted with premature rupture of membranes after completion of 28 weeks of gestation and before 37 weeks of gestational age, irrespective of their parity and were admitted in labor and antenatal ward were selected as the study population. The study population was divided into two groups designated as Group A where the cervical length of the fetus measured by transvaginal sonography was less than 2 cm and Group B where cervical length was more than 2 cm. Each group had 28 patients respectively. The collected data were analyzed using Statistical Package for Social Sciences (SPSS), version-23, 0. Chi-square tests were performed to compare the results, between the groups where p<0.05 considered, the level of significance with 95% CI. The ethical clearance of this study was obtained from the Institutional Review Board (IRB) of Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh. Results: A total number of 44 pregnant women were recruited for this study of which 22 cases were in group A who had the cervical length less than 2 cm and the rest of the 22 cases were in group B who had the cervical length more than 2 cm. The mean age of the patients in Group A is 25.91±3.66 years and in Group B it is 24.32±3.34 years (P >0.05). Mean birth weight was 1.7±0 .37kg in group A and 2.1±0.2kg in group B (p=0.015). In this study, 36.6% baby needed resuscitation in group A whereas only 13.6% needed resuscitation in group B. Regarding neonatal complications in group A, (22.72%) neonates had pneumonia and followed by RDS (36.36%), neonatal sepsis (9.09%), hypoglycemia (9.09%). In group B, 36.36% neonates developed complications which were pneumonia (4.55%), RDS (9.09%), neonatal sepsis (13.63%), hypoglycemia (4.55%) and others (4.55%).Regarding neonatal outcome among the study population, in group A, 1-Min Apgar score <7 was observed in 59.01%) neonates, while in group B, 7(31.81%) was observed(p=0.073). 5- Min Apgar score <7 was observed in 18.18% neonates in group A, while in group B, 4.54% was observed (p=0.158) In group A, (77.27%) neonates needed to be admitted to NICU, while in group B, 36.36% neonates needed to be admitted to NICU(p=0.006). In group A, 77.27% neonates had complications whereas, in group B, only 36.36% neonates had complications (p=0.006). Both in group A and in B, no neonatal death was observed. Conclusion: In conclusion, neonatal complications are significantly associated with the cervical length measured by transvaginal sonography with perinatal outcomes among pregnant women presented with premature rupture of the membrane.