Diagnostic Accuracy of Mid-Pregnancy Transvaginal Ultrasonography of the Cervical Length in Predicting Caesarean Section Risk in Primigravida Females

Abstract

Background: Caesarean section is considered a safer surgical procedure compared to other procedures, however, the risk of maternal and fetal morbidity and mortality is greater in case of emergency caesarean section compared to elective caesarean section. Objective: To assess the diagnostic accuracy of mid-pregnancy transvaginal ultrasonography of the cervical length in predicting caesarean section risk in primigravida females at term,in an effort to properly council patients for optimal labour and delivery management during antenatal period. Methods: This cross sectional study was carried out at Lady Willingdon Hospital, Lahore. For a duration of 6 months. The non-probability, consecutive sampling was used. Demographic information was recorded after informed consent. Measurement of cervical length was performed at 20-24 weeks of gestation using TVS scan by the senior ultrasonologist. Patients were followed until delivery and mode of delivery was decided by senior most obstetrician. The mode of delivery was noted and results were compared with cervical length through TVS scan at mid pregnancy. Data was entered and analyzed by using SPSS version 17. 2x2 table was generated to find sensitivity, specificity, PPV, NPV and diagnostic accuracy of cervical length on TVS. Results: The mean gestational age was21.97±1.41 weeks. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of CL on TVS was 94.21%, 89.87%, 93.44%, 91.03% and 92.5% respectively. Conclusion: Our study results showed that the transvaginal ultrasonography of the cervical length has a high sensitivity, specificity and diagnostic accuracy in predicting caesarean section in primigravida females.