The Major Cause Of Pre-Term Labor

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BACKGROUND :

Pre term labour is the major cause of preterm birth that affects 12 – 18 % of all births in India. Cervical shortening (effacement) is one of the first steps in the parturition process, preceding labor by several weeks. As cervical length decreases in the second trimester, the risk of spontaneous preterm birth increases , especially when effacement occurs early in the second trimester . Because effacement begins at the internal cervical os and progresses caudally , it is often detected on ultrasound examination before it can be appreciated on physical examination.Large randomized controlled trials have demonstrated that universal maternal cervical length screening and treatment in women with short cervical length reduces the
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In contrast,

a CL ≥15mm is reassuring since less than 1‐2% will deliver within 7 days1 .In asymptomatic women, TVS of the cervix is most beneficial for the identification of women at low risk for preterm delivery. However, a short cervix at mid‐gestation ultrasound does increase the risk of preterm delivery in this group. Several studies have reported that transvaginal cervical length assessment may be a useful tool for prediction of preterm delivery. Many studies have found that cervical length at 20‐24 weeks is a reliable predictor of preterm delivery .Our study is aimed at comparing the predictive value of transvaginal cervical length at 11‐14 weeks and at 18‐22 weeks in preterm labour. In asymptomatic women, TVS of the cervix is most beneficial for the identification of women who is otherwise considered low risk for preterm delivery. However, a short cervix at mid‐gestation ultrasound does increase the risk of preterm delivery in this group. Although cut‐off points vary between different studies, a CL smaller than 25mm is the most commonly used threshold to detect women at risk for
preterm
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The primary goal of delaying the delivery is to improve chances for the baby to survive once delivered. Because of its devastating consequences, PTB has been the focus of a dedicated effort to identify causes and outline effective strategies for prevention and treatment of those who are affected. So transvaginal sonography can be used to measure maternal cervical length during pregnancy to predict the risk of preterm delivery. The cervical length at 11-14 weeks was not significantly different between those who delivered at preterm and term but the cervical length at 18-22 weeks was significantly shorter in the group that had preterm deliveries than in those who had term deliveries .
In pregnant women in whom the mean cervical length tapered gradually from the first to the second scan, and in whom there is more rapid cervical shortening there was increased risk for preterm delivery .
This findings confirm with those of previous studies that have found an inverse relation between the length of the cervix and the frequency of SPTB . This data suggests that the duration of pregnancy is directly correlated to the length of the cervix; the shorter the cervix, the greater the likelihood of preterm delivery.
Indeed, surveillance of cervical length has been used to identify those women who are experiencing activation of the cervix in preparation for SPTB

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