Mid-Pregnancy Ultrasonographic Cervical Length Measurement (A Predictor of Mode and Timing of Delivery): An Observational Study
AbstractObjective: Even though cervical length is considered as predictor of timing and mode of delivery, it is not used as a screening tool in low risk asymptomatic population. This study was carried out with the intention to know the timing and mode of delivery in asymptomatic low risk women using second trimester ultrasonographic cervical length measurement and predict the risk of pretermlabor, prolonged pregnancy and need for caesarean section. 1) To determine the association between cervical length at mid-pregnancy and timing of delivery. 2) To determine the usefulness of mid-pregnancy ultrasonographic cervical length measurement in predicting mode of delivery.Materials and methods: Transvaginal sonography was performed to measure the cervical length between 20-24 weeks of gestation. These patients were followed till delivery to assess the gestational age at delivery and mode of delivery.Results: Totally 237 patients were recruited of which 173 satisfied the inclusion criteria. Out of 15 patients with cervical length less than 3cm, 14(93.33%) had preterm delivery. Postdated pregnancy was observed in 45(90%) out of 50 patients with cervical length more than 4cm. In the group with cervical length less than 3cm, 12 (80%) delivered vaginally. Among cervical length more than 4cm group 24 (48%) required cesarean section.Conclusion: Cervical length of less than 3cm measured between 20-24 weeks of gestation is associated with preterm births and favours vaginal birth whereas, cervical length of more than 4cm is associated with postdated pregnancy and increased incidence of cesarean section.
Cunningham FG, Leveno KJ, Bloom SL et al (ed). Williams Obstetrics. 24th Ed. New York: McGraw Hill Education; 2014:831-67.
Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA3rd, et al. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 2001;286:1340–8.
Berghella V, Saccone G. Fetal fibronectin testing for prevention of preterm birth In singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2016; 215:431–8.
Karakash SD, Tschankoshvili N, Weedon J, Schwartz RM, Kirschbaum C, Minkoff H. Hypocortisolism and preterm birth. J Neonatal Perinatal Med 2016; 9:333–9.
Lim H, Powell S, Mcnamara HC, Howie AF, Doust A, Bowman ME, et al. Placental hormone profiles as predictors of preterm birth in twin pregnancy: A Prospective cohort study. PloS One 2017; 12:e0173732.
Lucovnik M, Maner WL, Chambliss LR, Blumrick R,
Balducci J, Novak-AntolicZ, et al. Noninvasive uterine electromyography for prediction of preterm delivery. Am J Obstet Gynecol 2011; 204:228.e1-10.
Al-Bayati MM,Salman SS,Ghanem EJ. Prediction of Prolonged Pregnancy in Nulliparous Women by Transvaginal Ultrasound Measurement of Cervical Length at 37 Weeks of Pregnancy. Iraqi Journal Community Medicine 2013; 19–23.
Tanvir, Ghose S, Samal S, Armugam S, Parida P. Measurement of cervical biometry using Transvaginal ultrasonography in predicting preterm labor. J Nat SciBiol Med 2014; 5:369–72.
Kalu CA, Umeora OU, Egwuatu EV, Okwor A. Predicting mode of delivery using Mid-pregnancyultrasonographic measurement of cervical length. Niger J Clin Pract 2012; 15:338–43.
Boelig RC, Orzechowski KM, Suhag A, Berghella V. Second trimester cervical Length and prolonged pregnancy. J Matern-Fetal Neonatal Med 2016; 29:4088–91.