Evaluation of transvaginal ultrasonography, power Doppler indices, electromyography and serum protein 53 level in prediction for preterm labour

Abstract

Objective: The objective of this study is to evaluate the role of cervical length measurement by transvaginal ultrasonography, power Doppler of the uteroplacental circulation, electromyography and serum protein 53 level (p53) in prediction for preterm labour (PTL). Study Design : A prospective observational study. Patients and Methods: The study was conducted at the outpatient clinic of El-Minia University Hospital, Egypt during the period from January 2012 to December 2014. The study included a total of 100 pregnant women at high risk for preterm labor. All included cases were subjected to transvaginal cervical sonography, power Doppler velocimetry and uterine electromyography measurements (EMG), also, serum protein 53 level was determined. Results: The included subjects were classified into two groups according to gestational age at labor: Group (I): patients delivered before < 35 weeks (n=42) and group (II): patients delivered ≥ 35 weeks (n=58). Group (I) had significantly lower cervical length compared to group II (2.86 ± 0.81vs. 3.23 ± 0.67 cm) (P=0.013). There was a significant difference between groups as regards EMG (P = 0.006). No statistically differences were found between groups as regards Doppler indices (both resistance and pulsatility index). Group (I) had significantly higher maternal serum concentration of P53 compared to group II (473.8 ± 146.5 vs. 404.6 ± 164.7 pg/ml), (P≤ 0.01). Serum P 53 level had the higher sensitivity for prediction of PTL (78.6%), however, power Doppler indices had the lowest sensitivity (RI = 23.8% and PI =19.1%), cervical length had sensitivity of 33.3% however, EMG positive parameters had sensitivity of 40.5 % and specificity of 100.0%. Conclusion: From the studied tools for prediction of preterm delivery, different results were obtained, but serum P53 level was the most sensitive and the best option for prediction of preterm delivery, while, power Doppler indices are the least sensitive. However, EMG positive parameters are the most specific for prediction of PTL.

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“…According to Ibrahim et al 16 , cervical length assessment by transvaginal ultrasonography in the prediction of preterm birth in patients with threatened preterm labour was highly promising, with sensitivity, specificity, PPV, NPV, and accuracy of 93. Moreover, for prediction of preterm delivery, Abdel-Ghany 17 showed that cervical length <2.5 cm had a sensitivity, specificity, PPV and NPV of 33.3%, 68.2%, 63.2%, and 64.1%, respectively.…”

“…The prediction ability showed high statistically significant value (p <0.001). Abdel-Ghany 17 reported that pulsatility index of the uterine artery (≥ 1.04) had a sensitivity, specificity, PPV and NPV of 19.1%, 84.5%, 47.1% and 59%, respectively to predict preterm delivery.…”