Premature births remain a major challenge for healthcare systems worldwide. They are a leading cause of illness and death in newborns. Preterm infants, born before 37 weeks, are at higher risk of serious health problems. These include brain bleeding, intestinal complications, breathing difficulties, infections, and long-term developmental delays.
Despite advances in medicine, preterm birth rates have not significantly declined over the past 40 years. The increased use of assisted reproductive technologies (ART) has contributed to this steady trend, especially in industrialized countries.
About two-thirds of preterm births happen spontaneously, often due to early labor or preterm premature rupture of membranes (PPROM). The remaining one-third are medically induced because of complications in the mother or baby. Preterm labour can start at different stages of pregnancy and can be caused by multiple factors.
While normal labor is triggered by natural physiological processes, preterm labour is often triggered by abnormal or pathological factors that activate the same pathways, including uterine contractions, cervical dilation, and membrane activation.
Early identification of women at risk is crucial. Even with improved neonatal care, preventing premature birth remains essential. Researchers are therefore focused on developing sensitive methods to identify high-risk pregnancies and implement preventive strategies.
Measuring cervical length is considered the gold standard for predicting preterm labour. Since the 1980s, transvaginal ultrasonography (TVU) has been used to measure cervical length. This method is non-invasive, simple, and widely available. TVU can be performed alongside routine scans, such as nuchal translucency (NT) and anomaly scans, to improve early detection. In some cases, recognizing a short cervix early allows interventions that can lower the risk of preterm birth.
Studies show that treatments like 17α-hydroxyprogesterone caproate, micronized progesterone, and cervical cerclage can help prevent early labor. Measuring cervical length at the first-trimester NT scan (10–14 weeks) and again during the second-trimester anomaly scan (20–24 weeks) provides valuable information about preterm labour risk. Although early measurements alone do not always distinguish between term and preterm pregnancies, they provide a useful baseline for monitoring changes over time.
A recent prospective cohort study examined 70 asymptomatic pregnant women aged 18–35 with singleton pregnancies. All had cervical lengths above 25 mm and no history of cervical problems. Cervical length was measured at 10–14 weeks and 20–24 weeks, and pregnancy outcomes were recorded. Regression models analyzed the link between cervical changes and preterm labour.
Results showed that 30% of participants experienced preterm labour. The risk was higher among women whose cervical length was under 26 mm during the second measurement. Significant differences in cervical length were noted between pregnancies that ended before and after 37 weeks. The study reported a sensitivity of 76.19% and specificity of 90.91% for predicting preterm labour using cervical length measurements.
Most patients were aged 26–30, an important reproductive period. Parity (whether a woman was a first-time mother or had previous pregnancies) did not significantly affect preterm labour risk. Shorter cervical lengths, especially under 26 mm during the second scan, were strongly linked to preterm delivery. Vaginal delivery was the most common birth method, followed by cesarean sections.
The findings highlight the importance of cervical length measurement as a predictive tool. Regular monitoring could improve early detection and intervention, helping reduce preterm births and improve maternal and neonatal outcomes.
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