Transvaginal Cervical Length To Predict Delivery Latency in Preterm Premature Rupture of Membrans

Abstract

Abstract Purpose: To investigate the association between transvaginal cervical length (TVCL) and delivery latency in pregnancies with preterm premature rupture of membranes (PPROM). Methods: A prospective study was conducted with a total of 72 pregnancies diagnosed with PPROM between 24 and 34 weeks' gestation. Maternal characteristics, TVCL, time between diagnosis of PPROM and delivery, obstetric outcomes were documented. Multiple logistic regression was used to evaluate the independent prediction of significant parameters for delivery within 7 days. Patients were divided into two groups with a cutoff of 25 mm TVCL. The two groups were compared for maternal characteristics and neonatal outcome. Sensitivity, specificity, and predictive values were calculated for the combination of TVCL, presence of a cervical funneling and maternal BMI to show the predictive effect of the risk of delivery within 7 days Results: Overall, 44% of the 72 PPROM cases delivered within the first 7 days after PPROM. The median gestational age at diagnosis of PPROM and median body mass index (BMI) were significantly higher in the group who delivered within 7 days after PPROM (p= 0.021, p=0.002, respectively). Presence of cervical funneling and short TVCL were associated with shorter latency (p= 0.001 and p=0.000). In logistic regression analysis, gestational week of PPROM and TVCL were found to be the parameters affecting the risk of delivery with a latency of ≤7 days. (OR =1.402, p=0.039; OR=0.46, p=0.045 respectively). The combination of < 25 mm TVCL and presence of cervical funneling had a sensitivity of 38% and a specificity of 97.5% in predicting latency ≤7 days with an accuracy of %71. The PPV was 92% and the NPV was 66%. When BMI was added to the combination, the PPV reached 100% in predicting latency ≤7 days with 18% sensitivity and 100% specificity. Conclusion: Higher gestational age at diagnosis of PPROM and a short TVCL might help predict delivery within 7 days in pregnancies with PPROM. The combination of the presence of a cervical funneling, TVCL < 25 mm, and maternal obesity clearly demonstrated the potential for delivery within 7 days of PPROM. These findings may be useful for counseling and optimizing maternal and neonatal care in women with PPROM.