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Abstract
Preterm labour is defined as the onset of labour between 20 and 37 completed weeks of gestation. The incidence of preterm delivery varies between 5% and 11% .30 % of cases are iatrogenic and 30 % are idiopathic, while the remaining bulk are due to infection.
Myometrial quiescence corresponds to phase 0 of parturition, and it is mainly due to progesterone. Phase 1 and 2 of parturition contribute to contractions of labour and they accomplished by ion channels (e.g. potassium and calcium) and agonist receptors (e.g. for oxytocin and prostaglandins). Postpartum involution of the uterus corresponds to phase 3 of parturition.
There are several risk factors for preterm labour, but a previous preterm delivery is the most significant risk factor for subsequent preterm delivery. Other risk factors for example: cervical incompetence and assisted reproduction.
There are several measures for prediction of preterm labour, but the detection of cervicovaginal fetal fibronctin (fFn) and the ultrasonographic measure¬ment of cervical length appear to perform better than risk scoring systems and digital examination of the cervix .
Transvaginal ultrasound assessment of the cervix appears to be superior to the transabdominal and the transperineial routes as a predictor of preterm labour. There is an inverse relationship between cervical length (CL) and the risk of preterm delivery. Transvaginal ultrasound measurement of the cervix has a high negative predictive value if length is greater than three cm after 24 weeks. This information can be used to avoid unnecessary interventions. Repeating ultrasonographic cervical length (CL) measurement after successful tocolysis is almost useless.
Dynamic changes of the cervix occur in 50% of women with preterm labor. There are several types of dynamic cervical assessment; the one that chosen in our study was by fundal pressure. Other types include measurement over 10 minutes and during standing peristalsis or fetal movements. Dynamic cervical assessment increases the predictive ability of the transvaginal ultrasound for preterm labour.
Prophylactic tocolysis should not be given except for women at high risk of preterm labour, or in those who have had one episode of threatened preterm labour in that pregnancy. Cervical cerclage should not be offered except for those with cervical length ≤ 30 mm at the beginning of the second trimester or those with history of habitual abortion.
The only evidenced therapy for those with preterm labour is maternal steroids as they associated with a reduction in neonatal mortality and morbidity. Repeated doses of steroids should be avoided.
There are several types of tocolytic agents but no tocolytic is completely effective and safe. The mostly used one, and the one that used in this study, is nifedipine. Multiple tocolysis better to be avoided.
No evidence supporting a role for routine antibiotic prophylaxis in the management of women presenting with spontaneous preterm labour with intact membranes.
Our study was conducted on seventy five pregnant female patients randomly recruited from the antenatal clinic of El-Shatby Maternity University hospital signed a well informed consent to declare their agreement to be in this study as agreed upon by the ethical committee. They divided into three groups; the first group included twenty five patients and all were subjected to static cervical assessment, the second group included twenty five patients and all were subjected to dynamic cervical assessment and the last group included twenty five patients and all were subjected to interval dynamic cervical assessment. All groups are almost matched in their general characteristics. All groups received tocolysis in the form of nifedipene slow release tablets 20 mg twice daily.
There were inverse relationships between gestational age (GA), fundal level (FL) and mean gestational age (MGA) with the latency period but there were a direct relationship between the parity and the static cervical length in all the studied groups.
There was a statistically significant difference between group A, B and C as regard their means of latency period in those with static cervical length >1.5-2.5 cm (most of cases in all groups). Although there was statistically significant difference between group A, B and C as regard their means of static and dynamic cervical length, there was no statistically significant difference between them as regard the latency period in those with cervical length ≤ 1,5 cm , >1.5-2.5cm and > 2.5cm.In group B, There was no statistically significant difference between both categories of funnel width (<0.7cm and ≥ 0.7cm) as regard their latency period in those with dynamic cervical length ≤ 1.5 cm and >1.5-2.5cm. Also there was no correlation between funnel width and latency period.