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Wednesday, November 22, 2023

Prematurity

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Preterm birth is considered to be any spontaneous or induced birth before 37 weeks of gestation.

Premature birth has collateral effects on neonatal mortality, infant morbidity in the short and long term and for public health the costs are astronomical, considering preterm birth as the main problem in current obstetrics despite numerous research studies and technological advances.

In developed countries, 75% of perinatal mortality occurs in preterm infants, but more attention is now being paid to early preterm births (<32 weeks’ gestation), as they account for 1-2% of all births and of this corresponds to 60% of all neonatal mortality and almost 50% of all long-term neurological morbidity. Morbidities include respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, neurotizing enterocolitis, sepsis, and retinopathy of prematurity.

Long-term complications include cognitive disorders, social and behavioral problems, and cerebral palsy.

Is there a way to identify preterm labor?

Preterm labor can be identified through vaginal examination that provides information when an open cervix is ​​already found and the other way is through the measurement of cervical length by transvaginal ultrasound that identifies shortening of the cervix, this being part of the terminal pathway. common in a substantial number of cases of spontaneous preterm birth in both single and multiple gestations, regardless of whether or not they had a history of preterm birth.

When should I have the cervical length done?

International guidelines indicate that a cervical length of 25 mm at 18-24 weeks of gestation identifies around 50% of spontaneous preterm births before 32 weeks. In the Maternal Fetal Unit UR- Managua develops a model to predict premature delivery based on international protocols when performing cervical length in:

1. First trimester (12 weeks of pregnancy) to patients at high risk of preterm birth established by previous history of preterm birth and age.

2. In the second trimester (18-24 weeks of pregnancy) to ALL pregnant women classified as low risk.

Any cervical length less than 25 mm is considered high risk of preterm birth, before which a series of preventive measures are initiated, such as progesterone administration, cerclage and pessary placement.

Is it safe to perform the Transvaginal Cervical Length while pregnant?

A simple ultrasound measurement of the cervix is ​​not only safe but effective and does not cause discomfort or side effects.

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