Deepa Lakshmi, M (2012) Prediction of Preterm Labour by Estimating the Cervical Length at Mid Gestation by Transvaginal Sonography in Twin Pregnancies. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Preterm birth is a major public health problem in terms of perinatal mortality, long term morbidity and health economics. It is the leading cause of perinatal morbidity in India. It is responsible for more than half of all neonatal deaths. The economic burden of prematurity relates not only to initial neonatal intensive care but also to the longer term, increased use of medical, social and specialist educational services, as well as the lost economic productivity. Despite advancing knowledge of the risk factors and mechanism associated with preterm labour and delivery, the preterm birth rate has risen. This increase has been explained in part by a rise in the number of preterm delivery of multiple pregnancies that occurred as a result of assisted reproductive technologies. Overall, twin pregnancies comprise 15% of all preterm births accounting for a disproportionate share of preterm births. Therefore, there is an urgent need to develop cost-effective tests for the prediction of preterm birth in twin pregnancies. The ability to identify women at high risk for spontaneous preterm birth could allow for patients to undergo targeted interventions such as transfer to a tertiary care centre, antenatal corticosteroid administration and tocolysis, which might improve perinatal outcomes among twins. Previous reviews have suggested that transvaginal sonographic assessment of cervical length is an effective tool for predicting preterm birth, particularly in asymptomatic women or those at a higher risk of spontaneous preterm birth. Preterm birth is defined as the onset of labour in patients before 37 weeks in pregnancy beyond 20 weeks of gestation. Preterm birth is associated with 80% of perinatal morbidity and 70% mortality, for infants born without congenital anomalies. About 66% of preterm birth occurs due to preterm labour and 10% results from preterm prelabour rupture of membranes. The remaining 24% are due to medical or obstetric complications. The incidence of preterm labour in twin gestation is 54.9%. AIM OF THE STUDY: The aim of our study is to evaluate the co-relation of the cervical length measured by transvaginal sonography at 20-24 weeks of gestation in twin pregnancies and to follow them up until delivery to assess role of cervical length as a predictor of preterm labour. MATERIALS AND METHODS: It is an observational prospective study conducted in Institute of Social Obstetrics and Government Kasturba Gandhi Hospital, Madras Medical College, Chennai from October 2010 to September 2011. • This systematic review was conducted following a prospective protocol to determine the correlation between cervical lengths estimated at 20-24 weeks along with period of gestation at delivery in twin pregnancies over a period of 1 year. • This study group included 115 women who attended our hospital. Inclusion Criteria: Primigravida with twin pregnancy, Multigravida with twin pregnancy, Low risk patients, Good dates, Booked in our hospital, Under regular antenatal follow up in our hospital, To deliver in our hospital, Consent taken for their participation. Exclusion Criteria: Maternal factors, Singleton pregnancies, Pregnancy induced hypertension, Gestational diabetes mellitus, Ante partum hemorrhage, Other maternal illness, Patient in other therapeutic trials, Fetal factors, Fetal congenital anomalies, Intrauterine death. CONCLUSION: This prospective study was conducted from September 2010 to October 2011 in Institute of Social Obstetrics and Government Kasturba Gandhi Hospital for Women and Children. Madras Medical College, that included all women who were both primigravida and multigravida belonging to low risk group, among 115 twin pregnancies 3 defaulted the study, 10 were excluded, hence the study included total number of 102 patients. Our study concluded that: • Patients with advancing maternal age had a more predilection towards preterm labour. • Patients who were working did not go in for preterm labour. • The pre-pregnancy weight was not useful in predicting the preterm labour. • Patients whose height was _155 cm’s had a predilection towards preterm labour. • Patients with higher body mass index had more predilections to preterm labour. But patients with lower body mass index did not have any such preponderance. • Patients with primigravida twin pregnancies had a lower risk of preterm labour when compared to multigravida twin pregnancies. • Patients who had previous pregnancy loss were more prone for preterm labour. The magnitude increases as the number of pregnancy loss increases. • Patients who had previous dilatation and curettage were at high risk of preterm labour. • Patients who had low hemoglobin went in for preterm labour. • Patients who had features of urinary tract infection did not go in for preterm labour. • Neonates belonging to the preterm had low birth weight along with increased morbidity. •Finally our study concluded that measuring transvaginal sonographic cervical length at 20 to 24 weeks in twin pregnancies is a valuable predictor of preterm labour when the cut-off of cervical length is more than 30mm. Moreover, it is a simple costeffective, reproducible, and non-invasive method.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | prediction of preterm labour by Estimating the cervical length at mid Gestation by transvaginal sonography in twin pregnancies |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 09:50 |
| Last Modified: | 10 Dec 2017 03:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4070 |
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