Prediction Of Preterm Delivery Research Articles

OC07.05: PAN‐COVID study: factors associated with preterm delivery in women with SARS‐CoV‐2 infection in pregnancy

Preterm delivery is more common in women with SARS-CoV-2 infection. We sought to determine which factors in a woman's history or symptoms were associated with either spontaneous or iatrogenic delivery prior to 37 weeks. Variables included demographics, symptomatology, pregnancy information and co-morbidities. Backward stepwise logistic regression in Stata 16.0 was used for modelling. Of 1606 women whose details were registered with the UK and international PAN-COVID study from January 1st to July 25th 2020, 1147 had complete records for the defined set of predictors for preterm delivery. Details of the prediction model is detailed in table 1. For a one-unit increase in the risk factor, the odds of preterm delivery increase or decrease by a factor equivalent to the value of the odds ratio (OR). Confidence intervals for co-morbidities were wide due to small number of women with these conditions. For ethnicity, the odds of preterm delivery decrease by a factor of 0.54 for European/North American compared to non-European/North American women. These data, for the first time, provide granular detail in relation to the likelihood of preterm delivery in SARS-CoV-2 infection This may help in risk assessing pregnant women for public health interventions. In terms of symptoms, anosmia and myalgia are associated with a decrease in the odds of preterm delivery. All co-morbidities are associated with an increase in the odds of preterm delivery, this risk being notably high for women with pre-existing diabetes.

VP46.16: Second trimester cervical length and maternal characteristics in predicting preterm delivery among singleton pregnancies in a Filipino population

This study aimed to identify second trimester cervical length measurements and maternal characteristics associated with preterm delivery among singleton pregnant Filipino women, to generate a model for the prediction of preterm delivery, and to determine its accuracy. This is a retrospective cohort study of Filipino pregnant patients with singleton pregnancies who underwent cervical length evaluation between 16–27 6/7 weeks AOG by transvaginal ultrasound at The Medical City Women's Healthcare Center and delivered in the same institution between 2015 to 2019. Maternal characteristics and CL measurements were obtained from medical records. Univariate analysis using chi-square test for the predictors was initially done. A receiver operating characteristic curve was obtained to determine the area under the curve and the cut-off values of the variables under investigation with the highest sensitivity and specificity. A p value of < 0.05 was considered statistically significant. A risk scoring index was developed for preterm birth using the beta coefficients/odds ratios of the significant clinical predictor variables derived from the logistic regression model. Age > 34 years (OR 1.82, 95% CI 1.04-3.20), prior spontaneous delivery < 37 weeks (OR 2.90, 95% CI 1.07-7.92), and short CL (OR 5.6, 95% CI 2.52-12.57) were associated with preterm delivery, with specificity of 83.5%, sensitivity 50%, NPV 95.7%, PPV 18.5%, and AUC = 0.571. Combined screening using cervical length, age, and prior spontaneous delivery shows a modest increase in sensitivity to 52.6%, and negative predictive value to 97.4%. Although the specificity was only 82.73% and the positive predictive value remained low at 12.3%, the combined model yielded an AUC = 0.677 compared to AUC = 0.571 when cervical length was used alone. Second trimester cervical length combined with age and prior spontaneous preterm delivery has the potential to predict preterm delivery in the current pregnancy.

Recurrent preterm birth risk assessment for two delivery subtypes: A multivariable analysis.

The study sought to develop and apply a framework that uses a clinical phenotyping tool to assess risk for recurrent preterm birth. We extended an existing clinical phenotyping tool and applied a 4-step framework for our retrospective cohort study. The study was based on data collected in the Genomic and Proteomic Network for Preterm Birth Research Longitudinal Cohort Study (GPN-PBR LS). A total of 52 sociodemographic, clinical and obstetric history-related risk factors were selected for the analysis. Spontaneous and indicated delivery subtypes were analyzed both individually and in combination. Chi-square analysis and Kaplan-Meier estimate were used for univariate analysis. A Cox proportional hazards model was used for multivariable analysis. : A total of 428 women with a history of spontaneous preterm birth qualified for our analysis. The predictors of preterm delivery used in multivariable model were maternal age, maternal race, household income, marital status, previous caesarean section, number of previous deliveries, number of previous abortions, previous birth weight, cervical insufficiency, decidual hemorrhage, and placental dysfunction. The models stratified by delivery subtype performed better than the naïve model (concordance 0.76 for the spontaneous model, 0.87 for the indicated model, and 0.72 for the naïve model). The proposed 4-step framework is effective to analyze risk factors for recurrent preterm birth in a retrospective cohort and possesses practical features for future analyses with other data sources (eg, electronic health record data). We developed an analytical framework that utilizes a clinical phenotyping tool and performed a survival analysis to analyze risk for recurrent preterm birth.

Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

BACKGROUNDA twin pregnancy can carry greater risks than singleton pregnancies. About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk, which is associated with several complications in the premature babies. Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner, in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIMTo explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1 (IGFBP-1) hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODSA total of 254 pregnant women with twin pregnancies, who were admitted to Hainan General Hospital and underwent maternity examination, were selected as the study subjects from January 2015 to December 2018. All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1 (phIGFBP-1) test between 24 and 34 wk gestation. The pregnancy outcomes were analyzed.RESULTSOf the women with a positive phIGFBP-1 test result, preterm birth rate was higher in those with a cervical length ≤ 25 mm than those with a cervical length > 25 mm (all P < 0.05). Similarly, in women with a negative phIGFBP-1 test result, preterm birth rate was higher in those with a cervical length ≤ 25 mm than those with a cervical length > 25 mm (all P < 0.05). The sensitivity, specificity, and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%, 91.21%, 95.12% and 92.22%, respectively, for the prediction of preterm birth.CONCLUSIONCervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.

Protocolo para captura de señales electromiográficas producidas por músculo uterino en gestantes para predicción de parto pretérmino

Objetivo: diseñar protocolo de proceso de captura de señales electrohisterográficas, para predicción de parto pretérmino. Materiales y métodos: estudio exploratorio – descriptivo, propositivo. Para el diseño se realizó revisión documental de artículos científicos investigativos de corte cualitativo y cuantitativo, en inglés y español, consultados en fuentes de información biomédica especializados como el MEsH y DeCS y en bases de datos como: PubMed, Scielo, IEEE, entre otros. Las expresiones de búsqueda fueron: electromiografía, músculo uterino y protocolo. No se encontraron protocolos específicos para electrohisterografía, por la cual se tomaron publicaciones referentes a protocolos de electromiografía en general, encontrándose un total de 193 publicaciones, de los cuales se seleccionaron 23, publicados entre 2012 y 2020. Para el análisis se utilizó el método de investigación denominado revisión integradora. Resultados: el protocolo plantea criterios que deben tenerse en cuenta antes y durante el procedimiento, equipos y materiales requeridos y contraindicaciones, para la captura de registro de señales electrohisterográficas. Conclusión: los protocolos de atención en salud son fundamentales, ya que por medio de ellos se estandarizan los procesos que se deben seguir en la captura de señales, minimizando las posibles complicaciones durante y después del procedimiento, en beneficio del binomio madre-hijo.

Can stress predict delivery date?: Role of chronic and acute stress to the threatened preterm labor as predictors of delivery date

IntroductionThreatened preterm labor (TPL) is a traumatic event during pregnancy that involves a threat to the physical integrity of the upcoming baby. Despite biomarkers would be the strongest delivery date predictors, an assessment of chronic and acute stress response to TPL diagnosis may improve this prediction.ObjectivesThe objective is to predict delivery date in women with TPL based on their response to this diagnosis and chronic stressors, along with relevant obstetric variables.MethodsA prospective cohort study was conducted with a sample was formed by 157 pregnant women with TPL diagnosis between 24 and 31 weeks. Determination of salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured to estimate stress response to TPL. Cumulative life stressors as traumas, social and familiar functioning were also registered. To examine the effect of the possible predictor variables of delivery date, linear regression models were used.ResultsA correlation was found between the variables of response to chronic stress and between the variables of psychological response to stress. The main predictors of preterm delivery were low family adaptation, higher BMI, higher cortisol levels, and the week of diagnosis of TPL (&lt;29 weeks of gestation).ConclusionsThe best predictor of delivery date was the combination of the stress response to the diagnosis of TPL measured by cortisol in saliva, cumulative life stressors (mainly family adaptation) and obstetric factors (week TPL and BMI). Through psychosocial therapeutic intervention programs, it is possible to influence this modifiable predictive factors of preterm birth in symptomatic women.

Cervical expression of elafin and secretory leukocyte peptidase inhibitor does not predict preterm delivery in twin pregnancy – results from a pilot study

Background. Elafin and secretory leukocyte peptidase inhibitor may serve as the predictors of cervical shortening and preterm delivery in twin gestation. Material and Methods. A prospective observational study was conducted between September 2016 and March 2017. Cervicovaginal swabs collected from 40 women with twin gestation were analysed and the mRNA expression of elafin and secretory leukocyte peptidase inhibitor (SLPI) correlated with preterm delivery. Results. The mean gestational age at delivery was 35.6 ± 5.8 weeks, with 23 women delivering before 37 weeks (57.5%), 7 before 34 weeks (17.5%) and 3 before 32 weeks of gestation (7.5%). The mRNA expression of elafin and SLPI was not dependent on chorionicity and did not correlate with gestational age at delivery. Conclusions. Elafin and SLPI are not appropriate predictors of preterm delivery in twins.

710 Mid-gestation cervicovaginal cytokines correlate with gestational age at delivery in women with prior preterm birth

Our objective was to identify if the baseline cervico-vaginal cytokine profile differed in women with a history of preterm birth in comparison to women with only term births and to determine if there are cytokine predictors for preterm delivery. This was a sub-analysis of a multicenter prospective observational trial comparing the pregnancy outcomes in women without and with a history of preterm birth. Women with a cervical length <25mm were excluded from the study. Cervicovaginal fluid was collected from the posterior fornix for baseline assessment prior to any treatments. Maternal and pregnancy characteristics were collected. We performed unbiased multiplex luminex profiling on 37 cytokines and compared women with a history of preterm birth to controls as well as pregnancy characteristics. Pregnancy characteristics including age, BMI, race did not differ between groups. Women with a prior preterm birth delivered at an earlier gestational age than controls (39.4 w compared to 37.6 w) p=0.0012. We found that several cervicovaginal fluid cytokines were different in women with a prior preterm birth than controls. IL-26 (p=0.04), IL-6R-beta (p=0.03), MMP-2 (p=0.02) were elevated in women with a prior preterm birth (Figure 1). We found no correlations in baseline cervicovaginal cytokine levels and gestational age at delivery in the combined cohort. In women with prior preterm birth, both IL-26 and IL-27 correlated with gestational age at delivery (Figure 2) We found that several cervicovaginal fluid cytokines were elevated in the second trimester in women with a prior preterm birth, suggesting aberrations in inflammatory pathways are important in the pathogenesis of recurrent preterm birth. Additionally, our data suggest that the cervicovaginal immune profile may predict risk of preterm birth in high risk women and suggests that further investigation into the immune modulation of cervicovaginal fluid is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Association of Inflammatory Biomarker of Neutrophil-to-Lymphocyte Ratio with Spontaneous Preterm Delivery: A Systematic Review and Meta-analysis.

Background Neutrophil-to-lymphocyte ratio (NLR), as an inflammatory biomarker, has been investigated in several studies for early prediction of preterm delivery. However, their findings seem to be controversial. Thus, this systematic review and meta-analysis was conducted to evaluate the role of NLR in predicting preterm delivery as compared to term controls. Methods PubMed, Web of Science, Embase, Scopus, and Google Scholar were systematically searched from inception up to December 2020. Interstudy heterogeneity was assessed using Cochrane's Q test and the I2 statistic. The random-effects model was employed to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Results Out of a total of 4369 recodes, fifteen articles including 3327 participants were enrolled. The meta-analysis finding using the random-effects model produced a pooled estimate suggesting a significantly higher NLR (WMD = 1.23, 95% CI: 0.40–2.07) in women with preterm delivery (P = 0.01). We found significant heterogeneity across the included studies (P < 0.001, I2 = 92.33%). However, interstudy heterogeneity exists mainly due to differences in the definition of preterm delivery (I2 = 0.0%). In the metaregression analysis, there was no significant effect of publication year (B = −0.288, P = 0.088), total sample size (B = −0.002, P = 0.276), and the mean age of cases (B = −0.06, P = 0.692) on the association between NLR and preterm delivery. Conclusion The results of this meta-analysis revealed that the NLR value is higher in patients with preterm delivery. The NLR could be a useful biomarker for predicting preterm delivery; however, further prospective case-control studies are required to produce stronger evidence.

Absence of Antenatal Care and Antiretroviral Therapy Associated with Preterm Delivery in Women with HIV: An 11-Year Retrospective Cohort in South Carolina.

Our primary aim was to determine if combined antiretroviral therapy (cART) increased the risk of poor infant outcomes among women with HIV. Maternal antiretroviral regimens were classified as mono-(mARV), dual (dARV), cART, and no ARV. Differences in dichotomous outcomes were compared using χ2 tests and continuous outcomes were compared using Kruskal-Wallis tests. Predictors of preterm delivery (PTD), low birth weight, and perinatal HIV infection were determined using logistic regression. During the 11-year study period, 643 mother-baby pairs with HIV exposure were eligible for analysis. Non-Hispanic, Black women were more likely to report mARV or no ARV use (p=.03). Women not taking ARVs were more likely to have PTD (p=.01). Prenatal care was associated with a reduction in PTD [aOR 0.12 (95% CI 0.03-0.5)] and perinatal HIV infection [aOR 0.1 (95% CI 0.01-0.7)]. Maternal cART and race were not associated with PTD. Rather, absence of prenatal care and lack of ARV use during pregnancy increased the risk of PTD and perinatal HIV infection.

Simple ultrasound evaluation of fetal adrenal glands as a marker of imminent preterm birth: a preliminary report.

We present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker. This was a prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area). In biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %. A simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).

Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gestation and Prediction of Preterm Delivery

Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gestation and Prediction of Preterm Delivery

Effect of Dipping Pattern of Gestational Hypertension on Maternal Symptoms and Physical Findings, Birth Weight and Preterm Delivery

SUMMARYThe study aimed to determine if the non-dipping pattern of blood pressure (BP) influences preterm delivery in gestational hypertension (GH), but also maternal clinical findings and birth weight. Sixty women with GH, i.e. 30 women with a dipping BP profile (control group) and 30 non-dippers (study group), were included in the study. Echocardiography was performed in all subjects, as well as ambulatory blood pressure monitoring (ABPM) during third trimester. ABPM was repeated 6-8 weeks after delivery. Thirteen women with preterm delivery were classified as non-dippers and only four as dippers (p=0.01). The average and peak systolic and diastolic night-time BP had negative linear correlation with birth weight (p<0.0005). Total vascular resistance (p<0.0005) and mass index (p=0.014) were significantly higher as compared with women with term delivery, while ejection fraction (EF) (p=0.007) and circumferential systolic velocity (p=0.042) were significantly reduced in the preterm delivery group. Multivariate binary logistic regression identified the average night-time systolic BP, left ventricular mass index and EF as independent predictors of preterm delivery. Study results suggested a relationship of the non-dipping BP pattern in GH with preterm delivery, birth weight, and maternal clinical findings.

A new marker in preterm labor: RDW and MPV

Aim: To evaluate whether serum platelets Mean Platelet Volum (MPV), and Red Cell Distribution width (RDW) are useful as predictors of preterm labour (PL) in patients with preterm labour (PL), and to compare the clinical efficacy of various serum inflammatory markers to predict the risk of preterm delivery (PD). Materials, and methods: The main group consisted of pregnant women who were earlier than the 37th gestational week. The control group has consisted of pregnant bigger than 37th weeks of gestation. The patients with PL who participated in the study group were divided into early preterm labour (EPL), and late preterm labour (LPL) groups. The two groups were investigated in terms of clinical aspects of RDW, and MPV and serum markers studied at admission. ROC curve analysis was used to determine the optimal MPV, RDW cut-off levels predicting PL. Results: Neutrophil (NEU), MPW, RDW, and neutrophil to lymphocyte ratio (NLR) were significantly higher in LPL than in women who gave birth at term (p=0.006, OR=1.411; p&lt;0.001, OR=1.410; 0.002, OR=1.612, p=0.035, OR=1.294). In multivariate regression analysis, MPV positive was the strongest predictor variable. Besides, there was a significant correlation between MPV and RDW elevation, and neonatal intensive care needs (NICU) in women who delivered between 34 weeks, and 37 weeks. Conclusion: High RDW and MPV are independent predictors of preterm delivery in patients with LPL. In our study, we found that the increase of RDW and MPV was higher in women with high PL risk more than in healthy individuals. MPV has the highest area for prediction of preterm birth, and RDW&gt;14,5, and MPV&gt;9,6 have the highest sensitivity and specificity. RDW may be more significant than measuring any of the individual markers in the simultaneous use of preterm delivery. The simultaneous use of RDW and MPV with existing markers to increase our identifying abilities of preterm labour may be stronger than that of any of the individual markers.

Maternal Serum C – Reactive Protein: A Biomarker for Prediction of Preterm Delivery and Neonatal Outcome at Early Pregnancy

Background: Preterm labour defined as less than 37 weeks of gestation is responsible for most of the neonatal morbidity and mortality worldwide. This study was conducted to estimate the relation between C reactive protein (CRP) with preterm labour. Method: This prospective observational cohort study was conducted from February 2018 to January 2019 at Obstetrics and Gynecology department of Srimati Heera Kunwar Ba hospital, Jhalawar Medical College, Jhalawar, Rajasthan with 150 outpatient singleton pregnant women of &lt;20 weeks of gestation enrolled at the prenatal visit. Baseline data and serum CRP values were taken in all participants. Conventional statistical methods were used for analysis. Result: We discovered measurably critical contrasts in the CRP levels estimated in early pregnancy between the women delivering preterm and those delivering at term. The baseline cut off value for maternal CRP was 5.5 mg/l with sensitivity of 100%, and specificity of 95.7%, positive and negative predictive value for serum CRP to predict preterm labour were 95.8 % and 99.2% respectfully. Conclusion: Maternal serum concentration of CRP can be utilized as fitting biomarker for foreseeing preterm delivery.

A novel technique for prediction of preterm birth: fetal nasal flow Doppler.

Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24h (0.98±0.2 vs. 1.25±0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) <1.25 detects 94.6% of patients who will eventually deliver in the first 24h after admission. Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.

COMPARISON OF THE PREDICTIVE VALUE OF TRANSVAGINAL CERVICAL LENGTH AT 11-14 WEEKS AND AT 20-22 WEEKS OF GESTATION IN PRETERM LABOUR

Background: Preterm labour is defined as the onset of labour before 37 weeks of gestation, in pregnancy beyond 20 weeks of gestation, and is responsible for nearly 75% of all neonatal mortality and neurological morbidity. Cervical length (CL) is one of the major determinants of preterm delivery. Several studies have been able to conclude that transvaginal CL assessment may be a useful tool for the prediction of preterm delivery. The risk of preterm birth varies inversely with CL measured by ultrasound in low-risk women. Objective: To evaluate and compare the predictive value of transvaginal cervical length between 11-14 weeks and 20- 22 weeks of gestation in preterm labour. Material and Methods: A total of 264 pregnant women who were primigravida, singleton pregnancy, and women at gestational age 11-14 weeks and 20-22 weeks were included in the study. They were subjected for CL measurement at 11-14 and 20-22 weeks of gestation using transvaginal ultrasonography with the standard longitudinal view of the cervix while the patient’s bladder was empty. GEL VOLUSON 730 PRO Trans Vaginal Ultrasound (TVS) probe IC 5-9 H instrument with 5-9 MHz was used to measure CL. Results: The variables analyzed were the mean cervical length at 11-14 weeks and 20-22 weeks, the rate of shortening of cervical length in those who deliver at term and preterm and the cervical length at 11-14 weeks 20-22 weeks was correlated with gestational age at delivery and the predictive value of the same was determined. Cut-off of cervical length at 11-14 and 20-22 weeks of gestation was 3.73 cm and 2.89 and was statistically significant for the prediction of pre-term labour. Reduction in cervical length from 11-14 weeks to 20-22 weeks of gestation of more than 0.7 cm is predictive of preterm labour with statistical significance (p&lt;0.001). Conclusion: Routine mid-pregnancy cervical length assessment in low-risk women can be a cost-effective method of preterm birth reduction but the implementation of such a policy is highly dependent upon local factors. If it is to be undertaken, cervical length assessment should be performed according to a standardized technique.

Role of cervical length assessment at mid-trimester scan for predicting preterm births: An experience from Tertiary Hospital

Background: Ultrasound has revolutionized the pattern of care and management. Mid trimester ultrasound (transabdominal) is a valuable method for pregnant clients to predict preterm births.&#x0D; Objectives: To assess cervical length at 20 to 24 weeks obstetric scan for predicting risk of preterm delivery and to determine the sensitivity and specificity of assessing cervical length as a predictor of preterm delivery.&#x0D; Methodology: This is a prospective study conducted at a Tertiary Hospital. Pregnant clients with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for assessing cervical length as a predictor of preterm delivery.&#x0D; Results: Of 1027 pregnant clients screened, the mean age was 22.92±3.45. Mean gestational age during scan was 21+5 weeks of gestation. About 2.43% of clients were found to have short cervix &lt; 2.5 cm with mean cervical length 3.8 cm. The risk of preterm delivery was almost two fold when cervical length was &lt; 2.5 cm. The sensitivity, specificity, positive predictive value and negative predictive value to predict preterm delivery were 32%, 85.9%, 5.44% and 98.04% respectively.&#x0D; Conclusion: Assessment of the cervical length at mid-trimester can be useful tool for predicting risk of preterm delivery.

Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial Thickness for the Prediction of Preterm Labor in Twins Gestations. Observational Study

Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and recently lower uterine segment myometrial thickness had been used for this purpose. Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies. Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm group and full-term group. Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT ≥4. among patients who delivered at full term, 50 patients (96.2%) had LUS-MT ≥4.26 and 19 patients (43.2%) had LUS-MT <4.26. The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %, specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %. Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to be investigated.

Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial Thickness for the Prediction of Preterm Labor in Twins Gestations. Observational Study

Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and recently lower uterine segment myometrial thickness had been used for this purpose. Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies. Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm group and full-term group. Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT ≥4. among patients who delivered at full term, 50 patients (96.2%) had LUS-MT ≥4.26 and 19 patients (43.2%) had LUS-MT <4.26. The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %, specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %. Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to be investigated.