Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth (original) (raw)
2011, Journal of Maternal-Fetal and Neonatal Medicine
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Guidelines for managing spontaneous preterm labor emphasize the identification of at-risk patients and the effective diagnosis and management of preterm premature rupture of membranes (PPROM). Key recommendations include the use of transvaginal cervical sonography to assess cervical length as a predictive marker for preterm delivery, and various noninvasive tests for diagnosing membrane rupture. The guidelines also address preventive measures and care strategies to optimize outcomes for infants born prematurely.
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Ultrasound in Obstetrics & Gynecology, 2002
AimThe aim of this study is to evaluate whether cervical length and morphology assessed by transvaginal ultrasound in women admitted in threatened labour, can predict preterm delivery prior to 34 weeks gestation.MethodOver a six‐month period, 25 women presenting with threatened preterm labour were prospectively recruited into the study. Women with ruptured membranes, chorioamnionitis or heavy vaginal bleeding requiring delivery were excluded. Transvaginal sonography for cervical length and morphology was performed shortly after admission. Demographic data, medical observations and interventions were recorded. Pregnancy outcomes were collected after delivery.ResultsThe mean gestation at recruitment was 27+4 weeks (range 21+°−32+6 weeks). 16% (4/25) of patients delivered before 34 weeks gestation. In the latter cases, the cervical lengths were all ≤ 25 mm and the interval between presentation and delivery was < 2 weeks. All pregnancies with a cervical length > 25 mm delivered af...
Journal of Maternal-fetal & Neonatal Medicine, 2019
Objective: To investigate whether sonographic cervical markers can identify women in true preterm labor and predict delivery within 7 d and before 34 or 37 gestational weeks. Methods: This was a prospective observational study of women with singleton pregnancies and intact membranes given a diagnosis of preterm labor between 25 and 34 weeks and 6 d of gestation and who underwent transvaginal evaluation of the following characteristics: cervical length (CL), CL zeta score, absence of endocervical glandular echo, presence of cervical funneling, and presence of amniotic fluid sludge. The outcomes of interest were spontaneous delivery within 7 d of preterm labor and spontaneous delivery before 34 or 37 gestational weeks. Results: The inclusion criteria were met by 126 women, 31 (25%) of whom were excluded and 95 were analyzed. The median gestational age at admission was 31.9 weeks. The median CL at preterm labor was 22.3 mm (range: 0-42.8 mm). The delivery occurred within 7 d of presentation in 13 (13.7%) cases. Delivery before 34 weeks occurred in 16 (16.8%) cases and before 37 weeks in 40 (42.1%) cases. Logistic regression analysis showed CL in millimeters was an independent predictor of delivery within 7 d (OR 0.918, 95% CI 0.862-0.978, p ¼ .008). For birth before 34 weeks, the predictor was gestational age at admission (OR 0.683, 95% CI 0.539-0.866, p ¼ .002) and before 37 weeks, the presence of cervical funneling (OR 3.778, 95% CI 1.460-9.773, p ¼ .006). The CL 15 mm had sensitivity and specificity values of 77 and 77%, respectively, and good accuracy (88%) for prediction of delivery within 7 d. Conclusion: The evaluation of the cervix by transvaginal ultrasound in women in preterm labor predicted delivery within 7 d and helped distinguish between true and false labor. The analysis of CL zeta score was not an independent factor to predict delivery in 7 d.
Preterm labor is the major cause of preterm birth that affects 12–18% of all births in India. Cervical shortening or effacement is one of the first steps in the parturition process. In the present study the mean cervical length at 11-14weeks for the term delivered group is 4.04+-0.35cms and the mean cervical length for the preterm delivered group 3.85±0.33 cms. The cervical length at 18-22 weeks was significantly shorter in the group that had preterm deliveries (2.77 cms) than in those who had term deliveries (3.74 cms) (P < 0.001). The cervical length at 18-22 weeks in the group that delivered preterm was significantly shorter than in those who had delivered at term. The mean cervical length showed a gradual decrease from the first to the second scan and an increased risk for preterm delivery was seen in those cases which demonstrated a rapid shortening in cervical length. Introduction Preterm birth, defined as birth at less than 37 weeks of gestation, is the most important single determinant of adverse infant outcome in terms of both survival and quality of life. Preterm deliveries present a problem, because of the several neonatal complications and the long term sequelae which includes cerebral palsy, developmental delay, chronic lung diseases, visual loss and hearing loss. Preterm labour is the major cause of preterm birth that affects 12 –18% of all births in India 1,2. Cervical length is considered as one of the key predictors of preterm delivery 3. Cervical length assessment by ultrasound is now routinely used during obstetric scan. Transvaginal scan (TVS) of the cervix is now considered as an important screening tool for preterm delivery. When cervical length (CL) on TVS is less than 15 mm, 40‐47% of these women will deliver within 7 days, irrespective of any interventions or use of tocolysis 4. In contrast, a CL ≥15mm is reassuring since less than 1‐2% will deliver within 7 days. In asymptomatic women, TVS of the cervix is most beneficial for the identification of women at low risk for preterm delivery 5. However, a short cervix detected by ultrasound around mid trimester increases the risk of preterm delivery in this group. Transvaginal cervical length
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