الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Preterm birth is a major global public health concern. It is one of the greatest causes of perinatal mortality and also leads to long-term morbidity and increased healthcare costs. However, little is known about the pathophysiology of spontaneous idiopathic PTL, which is responsible for the majority of preterm births. The patient`s obstetric history may provide clues as to whether she is at increased risk of premature delivery. A previous history of preterm labor is the strongest risk marker.
As obstetricians have been faced by the management dilemmas associated with previous PTL, they made many attempts to develop methods that may help to predict the onset of PTL so that measures could be taken to prevent its occurrence. Cervical changes evaluated by TVUS have been the subject of numerous publications in the last decades.
Transvaginal ultrasound cervical measurement is a safe and effective technique to predict increased risk of preterm delivery. Ultrasound evaluation of cervical length is the most useful marker in the prediction of preterm delivery in asymptomatic patients. The risk of delivery is inversely correlated with the length of the cervical canal. However, the cut-off points to be used for PTL remain controversial, especially in populations at high risk.
There have been other TVUS morphological markers used in the prediction of prematurity risk such as funneling and cervical gland area. The non-detection of the CGA could correspond to the beginning of the uterine cervix maturation process. The absence of CGA can be an important ultrasound marker for PTL.
The goal of the present study was to explore the performance of the CGA as a pre-dictor for PTL when compared to the CL. To achieve this goal we conducted a prospective study at El-Shatby Maternity University Hospital. 150 pregnant women attending the outpatient clinic were recruited for the study. Cases with multiple gestations, premature rupture of membranes, Mullerian malformations, fetal congenital anomaly, fetal distress and established PTL were excluded from the study.
These cases were subjected to history taking, obstetric abdominal ultrasound scan and a vaginal sonogram to evaluate the closed cervical length and cervical gland area (ab-sent or present). This scan was repeated at least 2 weeks later. Gestational age at delivery was recorded.
Data collected from these cases were organized and analyzed to identify the relation between different variables considered in this study.
The study revealed that a significant proportion of preterm labor occurs at a cutoff point of CL < 20 mm , with P value was (0.0001). Our results confirmed that women with a preterm delivery were more likely to have an absent CGA (P < 0.05), compared with women who delivered at full term. An absent CGA has been found to correlate significantly with a short CL (<20 mm).
A greater mechanistic understanding of preterm labor, coupled with better tools for prediction, would undoubtedly contribute to the appropriate stratification of women into risk groups and facilitate the development of targeted therapeutic agents and timing of clinical intervention. Future research efforts need to focus on improving our ability to predict and diagnose preterm labor by increasing our understanding of the pathophysiological mechanisms involved.