Composite Morphometric/Morphographic Ultrasound Parameters of the Second Trimester Cervix for the Prediction of Spontaneous Preterm Labor
Journal Title: UNKNOWN - Year 2018, Vol 2, Issue 1
Abstract
BACKGROUNDThere is need for simple, cheap and highly predctive test for spontaneous preterm labor (SPL). The"zone of endocervical crypts (ZEC)" is a well-defined sonographic landmark corresponding toenfolding of the endocervical mucosa. Early loss of ZEC might be considered as indicative of“premature effacement”. We tested the efficacy of a "composite" parameter of cervical length plusZEC loss for the prediction SPL.MATERIAL/METHODSThe study included singleton pregnant women attending Asyout Clinic for Gynecology andObstetrics between 20 and <24 weeks’ gestation.Transvaginal ultrasonography was used for:a) measuring the cervical length, and, b) detecting the existence/non-existance of ZEC.* Cervical lengthwas measured as the distance between the internal os of the cervix and theexternal os.* The Zone of Endocervical Crypts (ZEC) was defined as the heteroechoic area around thecervical canal (CC). Monoechoic appearance of the cervix was described as loss of the ZEC.The sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculatedfor: 1) cervical shortening 2) ZEC loss, 3) combined 1 & 2, and, 4) funnelingRESULTSTwo thousand and one pregnancies were evaluated for the incidence and sonographic prediction ofSPL (24 - <32 weeks, and 32-36 weeks).The overall SPL rate was 9%.Loss of ZEC, and, the combined ZEC loss with shortened cervix were found to have betterspecificity and better PPV than the cervical shortening alone.ZEC loss had better PPV for early rather than late PL.“Funneling” had poor PPV, but, is still a good “negative”CONCLUSIONThe composite parameter of the “lost ZEC” and short cervix is superior to the cervical length alonefor the early prediction of SPL. Wider scale study is now being run for: a) ensuring thereproducibility of the parameter testing values, and b) to find any correlation between the ZEC lossand other clinical criteria as subtle infection.
Authors and Affiliations
Ahmed TageldinAbdelhafiz, JihanAbdelmoneim Mohamed
Keywords
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- EP ID EP648616
- DOI 10.26415/2572-004X-vol2iss1p193-193
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