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Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

The Upper and Lower Uterine Segment Thickness Ratio: A Simple Sonographic Tool to Triage for Preterm Delivery among Women with Threatened Preterm Labor

Author(s): Anapthi Anil, Sujatha Bagepalli Srinivas*, Shripad Hebbar and Muralidhar Vaman Pai

Volume 16, Issue 3, 2020

Page: [236 - 243] Pages: 8

DOI: 10.2174/1573404816666200309153236

Price: $65

Abstract

Background: Preterm delivery is a predominant cause of neonatal morbidity and mortality. Below 20% of women with threatened preterm labor, progress to active labor and delivery. Identification of such women will help to improve neonatal outcome by an early intervention such as administration of steroids and in utero transfer to the hospitals with better neonatal care.

Objective: To evaluate the importance of ultrasonographic measurement of the upper and lower uterine segments thickness ratio to distinguish between true and false labor in women with threatened preterm.

Methods: A prospective cohort study was carried out at a tertiary care hospital in Southern India from June 2017 to July 2018 on 151 singleton pregnant women at 24-36 weeks of gestation with regular or painful uterine contractions. Transabdominal ultrasound was performed to measure upper and lower uterine segments wall thickness and then the thickness ratio was calculated. Delivery within 7 days was the primary outcome of study.

Results: Out of 151 patients, 32 (21.2%) delivered within 7 days of presentation and the rest (78.8%) delivered after 7 days and had a significant difference in the ratio of upper/lower uterine segments thickness (p<0.001). The ROC curve showed a sensitivity of 81.3% and specificity of 84.2% when the cut-off value of the thickness ratio was ≥1.61.

Conclusion: The sonographic assessment of upper and lower uterine segment thickness ratio may be helpful to differentiate true labor from false labor among women with threatened preterm labor.

Keywords: Threatened preterm, upper uterine segment thickness, lower uterine segment thickness, true labor, false labor, transabdominal ultrasound, preterm delivery.

Graphical Abstract
[1]
Kumari A, Saini V, Jain PK, Gupta M. Prediction of delivery in women with threatening preterm labour using phosphorylated insulin-like growth factor binding protein-1 and cervical length using transvaginal ultrasound. J Clin Diagn Res 2017; 11(9): QC01-4.
[http://dx.doi.org/10.7860/JCDR/2017/28794.10585] [PMID: 29207782]
[2]
Tsoi E, Akmal S, Rane S, Otigbah C, Nicolaides KH. Ultrasound assessment of cervical length in threatened preterm labor. Ultrasound Obstet Gynecol 2003; 21(6): 552-5.
[http://dx.doi.org/10.1002/uog.131] [PMID: 12808671]
[3]
Pachtman SL, Ghorayeb SR, Blitz MJ, et al. Ultrasonic assessment of cervical heterogeneity for prediction of spontaneous preterm birth: a feasibility study. Am J Perinatol 2018; 35(3): 292-7.
[http://dx.doi.org/10.1055/s-0037-1607286] [PMID: 29017183]
[4]
Georgiou HM, Di Quinzio MKW, Permezel M, Brennecke SP. Predicting preterm labour: Current status and future prospects. Dis Markers 2015; 2015 435014
[http://dx.doi.org/10.1155/2015/435014] [PMID: 26160993]
[5]
Chawanpaiboon S, Pimol K, Sirisomboon R. Comparison of success rate of nifedipine, progesterone, and bed rest for inhibiting uterine contraction in threatened preterm labor. J Obstet Gynaecol Res 2011; 37(7): 787-91.
[http://dx.doi.org/10.1111/j.1447-0756.2010.01434.x] [PMID: 21395905]
[6]
Chao TT, Bloom SL, Mitchell JS, McIntire DD, Leveno KJ. The diagnosis and natural history of false preterm labor. Obstet Gynecol 2011; 118(6): 1301-8.
[http://dx.doi.org/10.1097/AOG.0b013e318236e7db] [PMID: 22105259]
[7]
Rundell K, Panchal B. Preterm Labor: Prevention and Management. Am Fam Physician 2017; 95(6): 366-72.
[PMID: 28318214]
[8]
Gyetvai K, Hannah ME, Hodnett ED, Ohlsson A. Tocolytics for preterm labor: a systematic review. Obstet Gynecol 1999; 94(5 Pt 2): 869-77.
[http://dx.doi.org/10.1097/00006250-199911001-00043] [PMID: 10546776]
[9]
Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2013; 8(8) CD006764
[http://dx.doi.org/10.1002/14651858.CD006764.pub3] [PMID: 23990333]
[10]
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3 CD004454
[http://dx.doi.org/10.1002/14651858.CD004454.pub3] [PMID: 28321847]
[11]
Sayed Ahmed WA, Madny EH, Habash YH, Ibrahim ZM, Morsy AGK, Said ME. Ultrasonographic wall thickness measurement of the upper and lower uterine segments in the prediction of the progress of preterm labour. Clin Exp Obstet Gynecol 2015; 42(3): 331-5.
[PMID: 26152004]
[12]
Oi R, Miyasaka N, Yamashita T, Adachi T. Associations of temporal changes in cervical length and lower uterine segment length with spontaneous preterm delivery risk: a prospective study of 727 Japanese women. J Med Ultrason (2001) 2019;; 46( 2): : 201-7.
[http://dx.doi.org//10.1007/s10396-018-0919-5 ] [PMID: 30506488]
[13]
Darwish HS, Zaytoun HA, Kamel HA, Habsah YH. Sonographic assessment of first stage of labor progress (ULTRASONIC PARTOGRAM). Egypt J Radiol Nucl Med 2013; 44: 673-80.
[http://dx.doi.org/10.1016/j.ejrnm.2013.04.009]
[14]
Son M, Miller ES. Predicting preterm birth: Cervical length and fetal fibronectin. Semin Perinatol 2017; 41(8): 445-51.
[http://dx.doi.org/10.1053/j.semperi.2017.08.002] [PMID: 28935263]
[15]
Buhimschi CS, Buhimschi IA, Norwitz ER, et al. Sonographic myometrial thickness predicts the latency interval of women with preterm premature rupture of the membranes and oligohydramnios. Am J Obstet Gynecol 2005; 193(3 Pt 1): 762-70.
[http://dx.doi.org/10.1016/j.ajog.2005.01.053] [PMID: 16150272]
[16]
Woraboot W, Wanitpongpan P, Phaophan A. Correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women J Chin Med Assoc 2018; S1726-4901(18): 30228-4
[17]
Peaceman AM, Andrews WW, Thorp JM, et al. Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol 1997; 177(1): 13-8.
[http://dx.doi.org/10.1016/S0002-9378(97)70431-9] [PMID: 9240576]
[18]
Durnwald CP, Mercer BM. Myometrial thickness according to uterine site, gestational age and prior cesarean delivery. J Matern Fetal Neonatal Med 2008; 21(4): 247-50.
[http://dx.doi.org/10.1080/14767050801926709] [PMID: 18330820]

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