Causes
and
detection
Premature delivery is a complex topic whose cause cannot be reduced to a single aspect since it is multi-factorial and complex problem [3]. A distinction is made between maternal and foetal causes. While the foetal causes are mainly malformations that can trigger premature birth, there are many different components with the mother. Recognised risk factors are premature contractions or premature birth in a previous pregnancy, diabetes mellitus, vaginal or urinary tract infections, placental insufficiency, hypertensive diseases during pregnancy, nicotine, or drug misuse and young or high maternal age. All these (and other) criteria increase the risk of premature birth [4].
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Due to the various factors for premature birth, identifying pregnant women at risk of premature birth is a big challenge in obstetrics. In addition to this, the majority of women with spontaneous premature births do not exhibit any of the known risk factors for possible premature birth [4].
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The ability of the cervix to fulfil its different roles during gestation is fundamental to ensure a timely and successful delivery, and therefore there is a strong clinical interest in evaluating its condition. Digitally palpating the cervix during a pelvic exam has been the primary way to assess cervical status in ancient times, by evaluation of cervical stiffness, length and dilation [5].
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Since the introduction of ultrasound, the length of the cervix has become, to a certain extent, a measurable parameter for the estimation of the risk of premature birth. However, cervical stiffness remained a subjective evaluation, strongly dependent upon the experience of the examiner [6]. In addition, cervical length measured using ultrasound alone is inexact [7], consequently, examination of other parameters was already started quite some time ago. Among others, a research team showed in 2011 that the significance of cervical stiffness is better than its length in regard to a possible premature birth [8].
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Pregnolia has developed the first device for an exact measurement of cervical stiffness, in order to improve the prediction of possible premature birth together with other parameters so that individualised therapies can be implemented at an early stage if needed.
References
[3] Amylidi-Mohr, S. & Müller, M. (2018) Biomarker und Ultraschall zur Frühgeburtsdiagnostik: Wo stehen wir heute? Gynäkologie; 2:6–11
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[4] Caren G. Solomon, M.D., M.P.H., Editor Prevention of Preterm Parturition Jay D. lams. M.D. N Engl J Med 2014; 370:254- 261January 16, 2014DOI: 10.1056/NEJMcp1103640)
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[5] Feltovich H., Cervical evaluation, Obstet Gynecol. 2017;130:51-63.
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[6] Badir, S., Bernardi, L., Delgado, F. F., Quack Loetscher, K., Hebisch, G. & Hösli, I. (2020) Aspiration technique-based device is more reliable in cervical stiffness assessment than digital palpation. BMC Pregnancy and Childbirth.
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[7] Iams, J. D., Goldenberg, R. L., Meis, P. J., Mercer, B. M., Moawad, A., Das, A., Thom, E., McNellis, D., Copper, R. L., Johnson, F. & Roberts, J. M. und das National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network (1996) The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med.; 334:567–72.
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[8] Parra-Saavedra, M., Gómez, L., Barrero, A., Parra, G., Vergara, F. & Navarro, E. (2011) Prediction of preterm birth using the cervical consistency index. Ultrasound Obstet Gynecol; 38:44–51.