Impact of Uterocervical Angle on Preterm Birth

Abstract

Introduction: Preterm birth is defined by ACOG as birth between 28 weeks of gestation to 37 weeks of gestation. Preterm birth complications are the leading cause of neonatal death. preterm babies are at increased risk of neuro developmental impairments, respiratory and gastrointestinal complications, sepsis etc. Approximately 40-50% of all preterm births are idiopathic,30% is attributable to PPROM,15-20% are elective due to medical reasons. Prediction of preterm is one of the most difficult and important tasks. Among them uterocervical angle have major impact on preterm birth which is a simpler technique that can be measured by transvaginal ultrasonography.

Aim & Objective: To study the impact of uterocervical angle by transvaginal ultrasonography on preterm birth.

Methodology: This study was conducted in tertiary care hospital over a period of one year among 110 patients. patients will be selected according to the inclusion criteria and they are explained about the nature of study and informed consent was obtained  in their own language A complete history was taken .Transvaginal ultrasonography was done along with their routine antenatal scans in 2nd trimester(anamoly scan),3rd trimester (growth scan) for the measurement of uterocervical angle. Two measurement were obtained in each patient during the course of examination and shortest measurement was used for reporting.  If uterocervical cervical angle was more than 95 degrees at any time of examination, I will treat the patient accordingly. After that all women were followed- both  normal angle  and  abnormal angle patient with intervention throughout the course of gestation and delivered in our hospital. After delivery POG, weight of newborn, sex, APGAR, need for ICU were noted and analysed.

Results: Among 110 patients in 3^rd trimester, 64 patients have angle less than 95, In that 60 patients delivered at term and 4 patients were delivered preterm.46 patients have angle more than 95, In that 33 patients were delivered preterm and 13 patients were delivered term.so we concluded that acute angle delivered at term and wider the angle more prone for preterm delivery even if we intervene if the angle is wider. Mean UCA at second trimester preterm delivered patients was 118֯ for less than 34 weeks,96 for 34-37weeks which was significantly higher as compared to the patients with term delivered group 91֯.Mean UCA value at third trimester of preterm delivered patients was 122֯ for those who delivered less than 34 weeks,100֯ for those who delivered between 34-37 weeks which was significantly higher as compared to term delivered patients which was 94 So it is concluded that patients with greater UCA had significantly higher chances of preterm delivery even after the intervention made if the angle is high and it was also seen in our study UCA value keeps on increasing with gestational age and mean UCA at  every trimester predicts spontaneous preterm birth with equal predictive value and efficacy.

Conclusion: Uterocervical angle have major impact on preterm birth and it was concluded that a wide uterocervical angle ≥95 and ≥105 degrees detected during any trimester was associated with an increased risk for spontaneous preterm birth <37 and<34weeks, respectively. The advantage of uterocervical angle is that its measurement in each trimester has also shown very good results in prediction of preterm labour. It can be measured at the time of routine antenatal ultrasound (ANOMALY SCAN, GROWTH SCAN) thus obviating the need for additional ultrasounds. This can lead to its application for the prediction of spontaneous preterm labour both in low and high risk population. Thus, it helps for early intervention and prevention of complications in preterm birth.