INVESTIGATION OFTHE ROLE OF MID PREGNANCY CERVICAL STATUS IN ADVERSE PREGNANCY OUTCOME IN ILORIN, NIGERIA

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INVESTIGATION OFTHE ROLE OF MID PREGNANCY CERVICAL STATUS IN ADVERSE PREGNANCY OUTCOME IN ILORIN, NIGERIA

Abstract

The cervix is one of the organs responsible for the sustainability of pregnancy and its eventual outcome. Sonographic evaluation of the cervix may help in assessing its variation in pregnancy. Most of the evaluation of the cervix was done in late pregnancy thus; there is limited knowledge on its assessment before the age of viability and possible pregnancy outcome(This outcome includes late miscarriages and early preterm delivery). It is therefore important to assess the cervical status before the age of viability.

Aim

To determine the mid- pregnancy cervical parameters and their relationship with pregnancy outcome among women receiving antenatal care at the University of Ilorin Teaching Hospital, Ilorin.
Methodology

Setting

The study was carried out in the department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital.
Study Population
They were pregnant women that received antenatal care and delivered at UITH Ilorin.

Study Design

It was a prospective study. Pregnant women who consented at the gestational age of 20 – 24 weeks and met the criteria for the study were recruited until the sample size was completed. A transvaginal ultrasound was done to assess the cervical length and internal Os diameter after the

initial abdominal ultrasound to exclude low lying placenta, multiple gestations and to satisfy the inclusion criteria. The pregnancy outcome was assessed by determining the gestational age at delivery, spontaneous onset of labour, induced labour, duration of labour and mode of delivery.

Data Analysis

The data were analyzed with Statistical Package for Social Science (SPSS) software package version
Results
The mean cervical length was 39.72±6.81mm and the range of 25.00-65.00mm.The mean internal Os diameter was 3.06±0.74mm with a range of 2.00-5.00mm.There was a direct relationship between the cervical length and the gestational age at delivery. It followed a linear pattern. The Pearson correlation coefficient r=0.245,p=0.002 which was statistically significant. The cut-off cervical length in determining a term delivery was >35.00mm.The relationship between cervical length and duration of labour also followed a linear pattern. The Pearson correlation coefficient was r=0.458, p<0.001 which was statistically significant. The cut-off of cervical length for determining the duration of labour of ≤12 hours was ≤39.00mm. The cervical length cut-off point for determining vaginal delivery was ≤44.00mm.The difference between those with cervical length of >44.00mm and those with cervical length of ≤44.00mm for caesarean delivery was statisticallysignificant p=0.026. The relationship between internal Os diameter and the pregnancy outcomes in terms of gestational age at delivery, duration of labour and modes of delivery were not statistically significant. Internal Os diameter is probably a poor predictor of pregnancy outcome

CONCLUSION

Cervical length measurement by trans vaginal ultrasound scan play a vital role in antenatal cervical surveillance and in predicting the pregnancy outcome. The mean cervical length was 39.72±6.8mm and the mean internal Os diameter was 3.06±0.74mm.It is clearly shown in this study that the longer the cervix the higher the gestational age at delivery. The cut-off of cervical length for delivery at term was >35.00mm.Also the longer the cervix, the longer the duration of labour. The cut-off of cervical length for duration of labour of ≤12 hours was ≤39.00mm.Furthermore, the longer the cervix beyond a cut -off of>44mm, the higher the chance of caesarean delivery.

INVESTIGATION OFTHE ROLE OF MID PREGNANCY CERVICAL STATUS IN ADVERSE PREGNANCY OUTCOME IN ILORIN, NIGERIA

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