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Article
Comparism Between Transvaginal Cervical Length Measurement and Digital Examination in Prediction of Imminent preterm Delivery

Authors: Maha M. AL-Bayati --- Asmaa Mohammed Abid --- Shaima Kadhim Jasim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 195-201
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Preterm labour is a major cause of perinatal morbidity and mortality, so it is important to predict preterm delivery using the clinical examination of the cervix and uterine contraction frequency. New markers for the prediction of preterm birth have been developed such as transvaginal ultrasound measurement of cervical length as this method is widely available.OBJECTIVE: To determine, whether transvaginal cervical length measurement predicts imminent preterm delivery better than digital cervical length measurement in women presented with preterm labour and intact membranes. PATIENTS AND METHODS: Two hundred women presented with preterm labour between 24 and 36+6 weeks of gestation were included in this study. All women subjected for digital and transvaginal ultrasound cervical length measurement and the outcome measures were occurrence of preterm delivery within 48 hours and within 7 days. RESULTS: Assessment of cervical length measurement using transvaginal ultrasound for the 200 women presented with preterm labour with intact membrane revealed that 8 (4%) delivered within 48 hours and 16 (8%) delivered within 7 days. According to the Bishop score, the test was positive if the Bishop score was ≥8, or 4-7 with cervical length ≤30 mm. The cut-off value for transvaginal ultrasound cervical length considered as 30 mm in the study group. CONCLUSION: Transvaginal sonographic measurement of cervical length can predict imminent preterm delivery in women presented with preterm uterine contractions and Bishop score between 4 - 7 compared with digital cervical length measurement.


Article
Sociodemographic and Medical Factors of Preterm Delivery According to the Clinical Subtypes of Prematurity

Author: Sijal Fadhil Farhood Al‑Joborae, Farah Wajid Alwan
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 4 Pages: 341-348
Publisher: Babylon University جامعة بابل

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Abstract

Background: Preterm delivery is defined as childbirth occurring at <37 completed weeks. Preterm birth remains one of the most importantproblems in pregnancy, as it is still a major health problem worldwide, which results in 75% of neonatal mortality. Often, the cause of pretermdelivery is unknown; however, several etiological risk factors have been identified. Objective: The objective of this study was to examinesociodemographic and medical risk factors of preterm delivery in relation to clinical subtypes as follows: extremely preterm (<28 weeks), verypreterm (28 up to 32 weeks), and moderate‑to‑late preterm (32 up to 37 weeks). Materials and Methods: It is a descriptive hospital‑basedcross‑sectional study which was carried out on a convenient sample of 200 preterm babies who were cared for in the neonatal care units inBabylon Maternity and Pediatrics Hospital, Hilla General Teaching Hospital whose mothers accepted to participate in this study. This studywas conducted over 5 months from March 1, 2018 to August 1, 2018. Results: Thirty‑nine percent of respondent mothers had a history ofabortion and (18.0%) had a history of recurrent preterm birth. Spontaneous preterm delivery (premature rupture of membrane) was the mode ofdelivery in (53.5%) of mothers and (49.5%) of respondents were multigravida. As high as (43.5%) of respondent mothers had current medicalillnesses, hypertension representing (33.33%) of these illnesses. Forty percent of mothers had irregular ANC and (15.5%) did not have anyantenatal care at all. Conclusion: Several significant risk associations between preterm birth according to clinical subtypes of prematurity andthe following risk factors were identified as follows: maternal age, gravidity, birth order, BMI, educational level, mode of delivery, history ofabortion, contraceptive use before pregnancy, and genetic defects.


Article
Evaluation of serum Predictive Markers for Placental Inflammatory Response in Preterm delivery

Author: Maha Mohammed Al-Bayati*, Azhar Ibrahim Alwan Shaimaa Sabri Athab
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2019 Volume: 18 Issue: 2 Pages: 161-168
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Placental inflammation represents a crucial pathogenic process responsible for preterm labor& neonatal complications for example low birth weight, premature delivery, cerebral palsy ,sepsis , and neonatal death. Being able to predict preterm labor with histological chorioamnionitis is important. However, there may be an urgent requirement for sensitive and noninvasive markers to predict inflammatory response of PlacentaOBJECTIVE: To assess the usefulness of inflammatory markers in maternal serum to predict placental inflammation in patients with threatening premature Labor.PATIENTS AND METHODS: A prospective study conducted in the department of Obstetrics and Gynecology of Al-Yermook Teaching Hospital for a period of one year from 1st of May 2015 to the 30th of April 2016 The study included 74 pregnant women presented with preterm labour or preterm prelabour rupture of membrane. Measurement of differential counts of leukocyte, C-reactive protein in maternal serum and histological examination of placenta post delivery done to identify placental inflammatory status. Comparison of neutrophil to lymphocyte ratio is done in patients with no inflammation of placenta and those with placental inflammatory response RESULTS: The level of neutrophil to lymphocyte ratio in patients with inflammatory response in the mother and/ or the fetus (8.3±5.4), (11.8±9.2) respectively were significantly higher than those with no placental inflammation (5.2±3.1). It showed higher Predictive accuracy; with 77.9% specificity, 71.4% sensitivity 81.5% positive predictive value, and 65.8% negative predictive value for prediction of PIR. Regarding CRP the results show significant relationships among women with no PIR and those with MIR alone or MIR with FIR (P values = 0.011, 0.005, 0.003) respectively. Also revealed that women with inflammatory response in the mother or both mother and fetus who had high levels of neutrophil to lymphocyte ratio had a shorter admission to delivery interval (mean=2.6 days, 3.2±7.5) than those with no placental inflammation (mean=4.1days).CONCLUSION: A placental inflammatory change may be simply and quickly verified at low expense by measuring the NLR .The Maternal blood NLR can be considered a useful, quick, noninvasive prenatal method to predict placental inflammatory response and for diagnosis of HCA in pregnant women presented with preterm labor.KEYWORDS: preterm delivery, serum inflammatory markers, placental inflammatory response


Article
Neutrophil to lymphocyte ratio & cervical length for prediction of spontaneous preterm delivery in threatened preterm labour.

Authors: Amal M. Mubark أمل مبارك --- Luma Saad Zeiny, لمى سعد زيني --- Alaa M. Sadiq, علاء صادق
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 19 Pages: 232-241
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies. As inflammation represents a crucial pathogenic process of preterm delivery, the aim of this study is to define the role of serum inflammatory markers in the prediction of spontaneous preterm delivery & to combine these markers with cervical length to increase the diagnostic accuracy.Methods: Eighty pregnant women with threatened preterm labour (group I) were compared with 40 women at term (group II (, subdivided into 2 subgroups (20 of them were not in labour & the other 20 were in labour). Neutrophils to lymphocytes ratio (NLR) & C-reactive protein (CRP) level were measured & compared for all study subjects. For group I, transvaginal cervical length was measured & combined marker (defined as NLR divided by the cervical length) was estimated & they were subdivided into: (group Ia) who delivered before 37 weeks (n=30) & (group Ib) who delivered at term (n=50).Results: The levels of NLR (P<0.001), CRP (P<0.016) in group Ia were significantly different from those in group Ib & they were also significantly higher in group IIa than in group IIb (P<0.001). The cervix length (P< 0.001) & combined marker (P<0.001) in group Ia were significantly different from those of group Ib. It has been shown that the combined marker has higher sensitivity (65%) & specificity (87%) for prediction of preterm delivery, as compared to cervical length or systemic inflammatory markers each alone. Conclusions Combined marker is useful for identifying women at risk of preterm delivery in patients with threatened preterm labour.

خلفية الدراسة و الاهداف : أن القدرة على التنبؤ بالولادة المبكرة هو امر في غاية الاهمية ، لأنها قد تسمح بتحديد النساء المعرضات لخطر الولادة المبكرة و اخضاعهن للدراسات التداخلية في المستقبل، وبما ان الالتهاب يمثل احد أهم اسباب الولادة المبكرة ، فان الهدف من هذه الدراسة هو تحديد دور الواسمات البيولوجية المصلية في التنبؤ بالولادة المبكرة والجمع بين هذه الواسمات مع طول عنق الرحم لاستخدامهما كوصمة مشتركة لزيادة دقة التشخيص.الطريقة: اشتملت هذه الدراسة المرتقبة على 80 امرأة حامل ادخلن المستشفى لكونهن مهددات بالولادة المبكرة(المجموعة الأولى) وتمت مقارنتهن مع40 امرأة في الشهر التاسع من الحمل (المجموعة الثانية) قسمن إلى مجموعتين: عشرون منهن لسن في حالة ولادة و20 أمرأة أخرى كن في حالة ولادة. تم قياس عدد الكريات البيض التبايني ومستوى البروتين المتفاعل في الدم لكل المشتركات في الدراسة وبالنسبة للمجموعة الاولى فقد تم قياس طول عنق الرحم عبر السونار المهبلي واستخراج وصمة مشتركة (نسبة الكريات البيض التبايني مقسومة على طول عنق الرحم). في نهاية الدراسة انقسمت المجموعة الاولى الى مجموعتين حسب وقت الولادة: اللواتي انجبن قبل37 أسبوع (وتشمل 30 امرأة) واللواتي انجبن بعد 37 اسبوع (و تشمل 50 امرأة). النتائج: اثبتت الدراسة ان مستوى كريات الدم البيض التبايني ومستوى البروتين المتفاعل والوصمة المشتركة اعلى بفارق معتد به احصائيا في المجموعة الاولى عند اللواتي انجبن قبل 37 أسبوع بالمقارنة مع اللواتي انجبن بعد 37 أسبوع كما ان ان مستوى كريات الدم البيض التبايني ومستوى البروتين المتفاعل في المجموعة الثانية أعلى بفارق معتد به احصائيا عند النساء اللواتي كن في حالة ولادة بالمقارنة مع االلواتي لم يكن في حالة ولادة. يستنتج من ذلك أنه يمكن استخدام الواسمات البيولوجية المصلية كمعلمة بسيطة وحساسة لتحديد النساء المعرضات لخطر الولادة المبكرة. كما ان استخدام السونار المهبلي معها لاستخدامهما كوصمة مشتركة يزيد من دقة و حساسية كل وصمة على حدة.

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