الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Preterm birth affects approximately 12.5% of all deliveries whereas 50% of Preterm birth generally occurs following threatened preterm labor. It’s characterized by regular uterine contractions accompanied by cervical effacement or dilation or both before 37 weeks of gestation
In this account, various predictive methodologies are being developed to distinguish who is truly at risk for preterm birth. Although positive fetal fibronectin and placental alpha microglobulin-1 testing in cervicovaginal fluid, or ruptured membranes, vaginal bleeding, and cervical dilation are highly predictive, there is no precise test for identifying women who will end up with preterm birth.
Lower uterine segment thickness and cervical length measured by transvaginal ultrasound examination best identify the risk for preterm birth. Repeated serial measurement of these parameters could increase their accuracy in the prediction of preterm birth in women who are at high risk.
In this study, we aimed to the assessment of cervical length and thickness of cesarean section scar as predictors for preterm labor in patients with previous cesarean section. from February 2021 to August 2022; a total of 260 women were recruited. In all women cervical length and thickness of cesarean section scar was assessed at 18 0/7 – 25 6/7 weeks and then re-assessed v at 28 0/7 _ 32 6/7 weeks.
Out of those women; 120 (46.2%) women had no history of cesarean section and the other 53.8% women had a history of cesarean section. It was found that women with previous cesarean section had significantly lower thickness of lower uterine segment (5.59 ± 0.80 vs. 5.25 ± 0.77 (mm); p= 0.001) during the second visit.
As regard fetal and maternal outcomes, we found that women with caesarean section had a significantly lower birth weights and a significantly higher frequency of cesarean section and preterm birth. But both groups had insignificant difference as regard neonatal mortality and admission to neonatal intensive care unit.
In the current study, a total of 213 singletons had follow-up at delivery. Out of this group; 41 (19.2%) women had preterm birth and 172 (80.8%) women had full-term labor. Women with preterm birth had a significantly thinner lower uterine segments (4.95 ± 0.85 vs. 5.46 ± 0.76 (mm); p< 0.001) and lower cervical length (2.84 ± 0.49 vs. 3.23 ± 0.53; p< 0.001).
Based on this study predictors for preterm birth were cervical length at recruitment (odd’s ratio=0.422) and history of cesarean section (odd’s ratio =2.328). At the cutoff point< 5 mm; LUS had 75.59% overall accuracy in the prediction of PTB while at the cutoff point < 3.01 cm; CL had 76.53% overall accuracy in the prediction of PTB.
Based on this study; we concluded that in asymptomatic women with a singleton pregnancy, measurement of cervical length and lower uterine segment thickness can be useful to identify a group of women who are at risk for preterm birth. These women could potentially undergo increased monitoring and interventions to improve perinatal outcomes.
It’s recommended to perform;
- Such studies of a large number of women in multiple centers.
- Perform serial measurements of cervical length and lower uterine segment thickness to obtain the best cutoff point to early predict the preterm birth
- Conduct such measurements in cases with twin gestations