Study of Ultrasonic Assessment of Cervical Length and Amniotic Fluid Index in Predicting Delivery Latency Following Premature Preterm Rupture of Membranes

Abstract

Abstract: Preterm premature rupture of membrane (PPROM) is among the most important causes of perinatal morbidity and mortality. We sought to determine whether cervical length and amniotic fluid index, individually or in combination, can predict the pregnancy outcome in cases of PPROM. Aims and Objectives: To study the role of amniotic fluid index (AFI) and cervical length in the prediction of delivery latency period among women with premature preterm rupture of membranes.
Material and Method: This was a prospective observational study performed during July 2022 to July 2023 in the Department of Obstetrics and Gynecology, NCMCH, Panipat, on 100 singleton pregnant women between 28 weeks and 34 weeks gestation with cephalic presentation and preterm premature rupture of membranes. All the women were subjected to ultrasound to determine AFI and cervical length and were followed up until delivery. Results: Out of 100 women, 86 women who underwent spontaneous labor were included in the study. 41 women delivered within 7 days of the test, and 45 delivered afterwards. Out of 41 women, 29 (67.44%) had amniotic fluid index of ≤5cm and 28 (65.12)% women had cervical length of ≤ 2 cm. The sensitivity, specificity, positive and negative predictive value of AFI alone in predicting delivery within 7 days were 72.14%, 64%, 67.22%, 70.15% respectively.
The sensitivity, specificity, positive and negative predictive value of cervical length alone in predicting delivery within 7 days were 68%, 73%, 76% and 69% respectively. Out of 86 women, 30 had both the characteristics, (amniotic fluid index ≤ 5cm and cervical length ≤ 2 cm), out of them, 22(75.86%) delivered with 7 days. The sensitivity, specificity, positive and negative predictive value of combination of both in predicting delivery within 7 days were 73%,55%,77% and 49% respectively. The PPV of cervical length ≤ 2cm and AFI ≤ 5cm alone in predicting delivery within 7 days were 76% and 70.15%, whereas combination of both is 77%. For AFI > 5 the total number of women who had not delivered within 7 days were 36 out of which 29 women (80.56% ) had CL of > 2 cm. The NPV of AFI > 5 cm and TVCL > 2cm was 82%, means women with these two characteristics would remains undelivered within 7 days. Conclusion: This study concluded that cervical length and amniotic fluid index both independently predict the delivery latency period following preterm premature rupture of membranes and combination of both factors improves predictive ability