World  Health Organization defines Preterm Delivery as birth before completion of 37 weeks of gestation.This is the leading cause of perinatal mortality and long term morbidity.In developing countries it ranges from 5% to 18% and in developed countries it ranges from 5% to 10%(1,2,3,4). It is one of the important reason for neurological handicap and neonatal death (5).The early signs of the preterm labour was cervical shortening which will be detected several weeks before the onset of active labour

we are measuring the mid trimester Cervical length will be assessed through transvaginal ultrasound which will be used as a tool for the prediction of preterm labour. Whereas the women with short cervix and previous history of preterm labour has the highest risk for preterm labour.

Three methods for sonographic cervical assessment: Transvaginal route, transabdominal and transperineal.Several methods like uterine monitoring at home,cervical examination,fetal fibronectin in the cervico-vaginal secretions et was also used to identify the risk of preterm delivery women.But they are found to be associated with low sensitivity and specificity and are not cost effective.

High vaginal swab is also taken to rule out the infections.In pregnant women an increase in Lactobacillus found to be associated with Term birth whereas increase in Gardanella vaginalis,Ureoplasma species,Prevotella species,Atopobium vaginae ,Peptoniphilus species ,Staphylococcus and Streptococcus species found to be associated with Preterm birth.Thus it not only leads to preterm labour but also can cause neonatal sepsis. Many studies have been done for predicting preterm labour by assessing cervical length only .Only few studies have been done using high vaginal swab.So our study has been done by comparing all the two methods and effectiveness in predicting the preterm labour.

Aim and objectives:

To determine the cervical length by transvaginal sonography and access the high vaginal swab at second trimester in association with preterm labour.

PLACE OF STUDY                           : Government Coimbatore Medical College and hospital

DURATION OF STUDY                      : One year

PERIOD OF STUDY                          :2023 to 1^ST December 2024

TYPE OF STUDY                              : Prospective observational study

STUDY POPULATION: All the primigravida in their second trimester attending the OPD in Government Coimbatore Medical College

SAMPLE SIZE                                : Based on the inclusion and the exclusion criteria the final sample size obtained was 200.

INCLUSION CRITERIA:

• Low risk
• Primigravida women
• Pregnant women with correct dates

EXCLUSION CRITERIA

• Anemia
• Gestational Diabetes Mellitus
• Pregnancy induced hypertension
• Foetal anomalies
• Unknown LMP

DATA COLLECTION:

After obtaining the permission from the Institutional Ethical Committee the study was done in the Department of obstetrics and Gynaecology , Coimbatore Medical College and Hospital,Coimbatore by recruiting antenatal mothers who filled the inclusion and exclusion criteria were included in the study. All the study participants were evaluated through a semi-structured questionnaire which includes demographic details and clinical examination ,abdomen examination and laboratory test was performed.Study participants details like the pregnant women age, parity, gestational age at the time of delivery, comorbidities were obtained. Standard techniques were used for the measurement of the anthropometric parameters.

Transvaginal Ultrasound examination:

The cervical length is measured using the transvaginal sonography.The patients with <25 mm is considered to have short cervical length .

High vaginal swabs:

By sterile speculum examination the visualizing the amniotic fluid in the posterior fornix of the vagina and the fluid flowing out of the cervical os with Valsalva maneuver. with the help of the sterile swab sticks taking all the necessary precautions the high vaginal swab will be taken. Then the specimens were gram stained and cultured in both aerobic and anaerobic methods for the identification of the pathogens.

STATISTICAL ANALYSIS:

After collecting the data it was entered in MS Excel Windows 10.Statistical analysis was done in SPSS 23.Continuous data were expressed in terms of Mean± Standard deviation and Categorical variables were expressed in terms of numbers (percentages).Chi square test was used for Test of Association for Categorical variables. Anova test or Student t test was used for Test of Association for Continuous variables. Sensitivity ,specificity, positive predictive value and the negative predictive value are used to compare the three methods. P value of <0.005 is considered to be statistically significant

The most common age group in our study is 21-25 years of age 53% followed by 26- 30 years of age 24%.Similarly in Wadhawan UT et al (53)study the common age group was found to be 21-25 years (53%).In Ameena Beevi et al(57) study less than 22 years was the most common group 31(29.5%) followed by 21-25 years of age 27(25.7%) .Class III was predominant in our study participants 117(78%) followed by Class II 24(16%).In contrast to our results in Verma et al(61) study the Upper middle class were found to be more.44(43.5%)

Majority of the study participants had ideal body weight 45%.Similar results was also seen in Verma et al(61) study where 88.1% where in ideal body weight . 78(52%) of the study participants delivered term babies in our study.Similarly Waldhawan UT el(53)al study 88% of the study participants delivered full term which is contrast to our results .65(43%) of the study participants are admitted in NICU in our study.

Cevical length assessment:

Cervical length Sensitivity was found to be 75% and Specificity 76.9%.                                  

High vaginal swab culture:

Swab culture result states that among the study participants 30(20%) are positives of high vaginal swab.E.Coli is the predominant organism 6(30%) followed by Klebsiella 5(25%).Similar results was also seen in Ameena Beevi et al where E.coli was found in 8.5% of study participants followed by Klebsiella 5(4.8%).The sensitivity of high vaginal swab was found to be 66.6% and specificity was found to be 56.6%%.The positive predictive value as found to be 27.78% whereas negative predictive value was found to be 87.18%.The diagnostic accuracy of the study participants was found to be 58.67%.Similar results was also seen in Ameena Beevi P et al study where 80% were sterile.

Limitations :

Our sample size is very small and it is the first limitation.The study is done in single centre so generalizability of results cannot be done.

Our study concludes that cervical length screening can be done for all antenatal women to predict the risk of preterm birth.The transvaginal ultrasonography is a simple,non invasive and safe OPD procedure which can be carried at all centres from primary to tertiary .Among all the  preterm predicting test cervical length has a good sensitivity and specificity.The diagnostic accuracy was also found to be good.This is followed by high vaginal swab

Contributions: All authors contributed to this journal

Funding: Nil

Conflict of Interest: Nil

Acknowledgement:

The authors like to thank the Dean and Head of the Department of Obstetrics and Gynaecology for helping and guiding in completing this research.

1. International classification of diseases and related health problems.10th revision.Geneva:World Health Organization;1992
2. Government Statistical services for the department of Health .NHS Maternity Statistics.England .2002-2003
3. Haas DM. Preterm birth.Clinevid (Online).2008
4. Martin JA, Hamilton BE,Sutton PD,Ventura SJ,MEnacker F,Kirmeyer S,Munson ML;Centres for Disease Control and prevention National center for  Health statistics National Vital statistics system.Births:final date for 2005.Natl Vital Stat Rep.2007;56(6):1-103
5. Goldernberg RL, Culhane JF,Iams JD, Romero R:Epidemiology and causes of preterm birth.Lancet 2008;371:75-84
6. Centre for Maternal and Child Enquires (CMACE):Perinatal mortality 2008:United Kingdom.London,CMACE,2010.
7. WAadhan UT ,Shah NP,Patil AN.Prediction of preterm labour by cervical length.Int J Reprod Contracept Obstet Gynecol.2017;6:2978-82
8. Amina Beevi P,Girjia Kumari AG,Sudhamani C.High vaginal swab study in preterm labour and preterm premature rupture of membranes and its relationship with neonatal sepsis.J Evid Based Med Healthc.2018;5(30):2249-2254
9. Verma Indu,Avasthi Kumkum-Berry Vandana.Urogenital infections as risk factor for preterm labor:A hospital based case control study.The  journal of Obstetrics and  Gynecology of  2014;64(4):274-278
10. Meena Priyadharshini V-First trimester cervical length and Preterm birth-IOSR.Journal of Dental and Medical science(IOSR-JDMS)-2018;17(10):31-34
11. Iams JD,Goldenberg RL,Meis PJ,Mercer BM,Moawad A.The length of cervix and the risk of spontaneous premature delivery.National institute of child health and Human Development Maternal Fetal Medicine Unit Network.New England Journal of Medicine.1996;334:567-572
12. Owen J,Yost N,Berghella V,Mac Pherson C,Swain
    M,Dildy GA et al.Maternal and Fetal Medicine units Networks.Can shortened midtrimester cervical length predict very early spontaneous preterm birth?Am J Obstet Gynecol.2004;191(1):298-303
13. Hebbar S,Samjhana K.Role of mid trimester transvaginal cervical ultrasound in prediction of  preterm delivery.Med J Malaysia.2006;61(3):307-11
14. Priyadarshani P,Kaur G.Predicting preterm labour by cervical length measurement.Int J Reprod Cotnracept Obstet Gynecol.2016;5:1809-13