Background: Preterm birth (PB) is associated with significant morbidities in surviving infants. Accurate prediction of PB is essential for effective prevention and management. Continuous monitoring of cervical parameters has shown utility in several studies. Objectives: This study aimed to investigate the role of the anterior uterocervical angle (UCA) in predicting the incidence of PB. Methods: A prospective, descriptive-analytic study was conducted with 165 pregnant women referred to the prenatal care clinic at Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, in 2021 - 2022. Participants were selected through convenience sampling. Cervical parameters, including UCA, length, and width, were measured via vaginal ultrasound during each trimester. All women were followed until delivery to determine PB incidence. Data were analyzed using descriptive and analytical statistical tests, including the chi-square or Fisher’s exact test and the independent samples t-test or Mann-Whitney U test. Results: Among the participants, 12 (7.3%) experienced preterm delivery. Cervical length was significantly shorter in women with PB during the second trimester (32.58 ± 4.77 mm vs. 34.68 ± 3.80 mm, P = 0.042) and third trimester (30.00 ± 4.74 mm vs. 32.77 ± 3.88 mm, P = 0.022). The mean UCA in women with preterm delivery was higher than in those with term delivery during both the second (90.58 ± 17.21° vs. 88.66 ± 16.76°) and third (100.25 ± 14.56° vs. 98.89 ± 17.78°) trimesters (P > 0.05). A UCA greater than 105° in the second trimester had a sensitivity of 16.7% and specificity of 81.5% for predicting PB. In the third trimester, a UCA greater than 105° showed a sensitivity of 58.3% and specificity of 60.7% for predicting PB. Conclusions: This study emphasizes the importance of regular cervical parameter measurements throughout pregnancy. A UCA greater than 105° in the third trimester appears to be a potential predictor of PB.
Background: Fetal cardiac monitoring indications during labor and near delivery in high- and low-risk pregnancies and their effects on neonatal outcomes have been investigated in previous studies; however, the data of nonreassuring cardiotocography (CTG) near delivery on neonates are insufficient. Objectives: This study aimed to compare fetal distress with nonreassuring CTG in high- and low-risk pregnancies to see if high-risk pregnancies need different or more care or not. Methods: This retrospective cohort study was conducted on pregnant women candidates for vaginal delivery in an academic hospital within 2017 - 2020. The participants were divided according to maternal and fetal risk factors into two groups of low-risk and high-risk pregnancies (including preeclampsia/eclampsia, diabetes, placenta abruption, and intrauterine growth restriction). Three obstetricians, blinded to the participants and neonatal outcomes, reviewed the CTG tracing near delivery individually. The features of nonreassuring CTG 30 minutes before delivery, including variable deceleration, late deceleration, slow return to base, tachycardia, and shoulder and overshoot patterns, were detected in the traces. Then, the neonatal outcomes, including umbilical artery pH at birth, Apgar scores at the 1st and 5th minutes, and admission to the neonatal intensive care unit (NICU), were compared between the groups. Results: A total of 622 participants, including 322 high-risk and 300 low-risk pregnancies, with nonreassuring CTG, were recruited into the study. The adverse neonatal outcomes, such as NICU admission, low Apgar scores in the 1st and the 5th minutes, and pH < 7.1, were significantly different between high-risk and low-risk pregnancies with variable deceleration, tachycardia, and overshoot patterns. High- and low-risk pregnancies with late deceleration had only significantly different Apgar scores in the 5th minute. In the slow return to base features, the Apgar scores in the 1st and 5th minutes and NICU admission were significantly different in high- and low-risk groups. Additionally, NICU admission and low Apgar score in the 1st minute were higher in high-risk women in shoulder patterns. Conclusions: Nonreassuring CTG near delivery might be accompanied by more fetal distress in high-risk pregnancies. Therefore, the nonreassuring features of CTG in high-risk pregnancies should be considered more important and might need prompt and timely action to decrease the adverse outcomes.
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