Effectiveness of cervical length screening by transvaginal sonography and use of progesterone for preventing preterm labour

Authors

  • Snehal S. Dhobale Consultant Reproductive Medicine Origin International Fertility Centre, Thane, Maharashtra, India
  • Meena Satia Department of Obstetrics and Gynaecology, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20162672

Keywords:

Preterm labour, Transvaginal sonography, Cervical length, Progesterone

Abstract

Background: Incidence of preterm labour is about 6-15 % of pregnancies worldwide. It is major public health problem in terms of loss of life, long term disability, and health care cost both in developing and developed countries. The incidence of preterm births in India is estimated to be 11-14 % which means about 3 to 4 million preterm live births annually. Early identification of at risk pregnant women with timely referral will help to decrease the extreme prematurity rate, thereby reducing morbidity, mortality and will have a profound impact on societal and long-term public healthcare costs. So this study where vaginal progesterone was administered in women with short cervix detected by Transvaginal sonography to prevent preterm labour will be helpful in decreasing cases with preterm delivery and hence improve the perinatal outcome.

Methods: It is prospective observational study in which 100 ANC patients who were registered at KEM Hospital a tertiary care centre in Mumbai in India at 16-24 weeks of gestation were studied to determine usefulness of 200 mg vaginal progesterone twice daily till 36 weeks in preventing preterm birth in those having cervical length 25mm or less.

Results: Among 100 participants in this study, 48 (48%) were primigravida and 52 (52%) were multigravida. Out of 48% primigravida in the present study, preterm labour is prevented in 75% of women by the use of vaginal progesterone and out of 52% of multigravida, it is prevented in 71.2% of women.

Conclusions: The study concluded that use of vaginal progesterone 200 mg in women with cervical length 25 mm or less measured by transvaginal sonography (as a good predictor of preterm labour) has useful effect in preventing preterm labour as well as associated neonatal mortality and morbidity. Neonatal survival is critically dependent on maturity of an infant and progressively increases with gestational age. Each day critically impacts on maturity and survival. Thus prevention and/or effective management of preterm labour will improve neonatal outcome and will have a profound impact on societal and long-term public healthcare costs.

References

Slattery MM, Morrison JJ. Preterm delivery. Lancet. 2002;360(9344):1489-97.

ABC of Labour Care, Preterm Labour and Premature Rupture of Membranes, Philip Steer, Caroline Flint; BMJ. 1999:318.

Romero R. The child is the father of the man. Prenat Neonat Med. 1996;1:8-11.

Holcomb WL Jr, Smeltzer JS. Cervical effacement: variation in belief among clinicians. Obstet Gynecol. 1991;78:43-5.

Sonek JD, Iams JD, Blumenfeld M, Johnson F, Landon M, Gabbe S. Measurement of cervical length in pregnancy: comparison between vaginal ultrasonography and digital examination. Obstet Gynecol. 1990;76:172-5.

Andersen HF. Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy. J Clin Ultrasound. 1991;19:77-83.

Iams JD, Goldenberg RL, Meis PJ. The length of cervix and the risk of spontaneous preterm delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334:567-72.

Berghella V, Bega G, Tolosa JE, Berghella M. Ultrasound assessment of the cervix. Clinical Obstetrics and Gynecology. 2003;46:947-62.

Grimes-Dennis J, Berghella V. Cervical length and prediction of preterm birth. Current Opinion in Obstetrics and Gynecology. 2007;19:191-5.

Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA, et al. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA. 2001;286:1340-8.

To MS, Skentou C, Liao AW, Cacho A, Nicolaides KH. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol. 2001;18:200-3.

Fukami T, Ishihara K, Sekiya T, Araki T. Is transvaginal ultrasonography at mid-trimester useful for predicting early spontaneous preterm birth? J Nippon Med Sch. 2003;70:135-40.

Mattison DR, Damus K, Fiore E, Petrini J, Alter C. Preterm delivery: a public health perspective. Paediatric and Perinatal Epidemiology. 2001;15(Suppl. 2):7-16.

Stanley F. Survival and cerebral palsy in low birth weight infants implications for Perinatal care. Paediatr Perinat Epidemiol. 1992;6:298-310.

DeFranco EA, O'Brien JM, Adair CD. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2007;30(5):697-705.

Hassan SS, Romero R, Vidyadhari D. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial Ultrasound Obstet Gynecol. 2011;38:18-31.

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Published

2017-01-11

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Original Research Articles