الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Preterm labor is considered a syndrome with multiple
etiologies resulting in the activation of the common terminal
pathway of parturition (membrane activation, myometrial
contractility and cervical ripening ) a number of different pathogenic
mechanisms (infection, hemorrhage, stress) Although may initiate
preterm labor, all appear to involve disruption of the chorionic
decidual interface .
The incidence of preterm birth (PTB) in high- and low-income
countries is 7%–12% and 22%–26%, respectively . PTB is directly
responsible for 75% to 95% of neonatal deaths .Despite considerable
research into preterm birth, the incidence rate has been steadily
increasing .
The membranous structure that surrounds the developing fetus
and forms the amniotic cavity is derived from fetal tissue and is
composed of two layers: the amnion (inner layer) and the chorion
(outer layer). The amnion is a translucent structure adjacent to the
amniotic fluid, which provides necessary nutrients to the amnion
cells . The chorion is a more opaque membrane that is attached to
the decidua (ie, maternal tissue that lines the uterus during
pregnancy). The amnion and chorion are separated by the
exocelomic cavity until approximately 12 weeks gestation, when
they become fused. Intact, healthy fetal membranes are required for
an optimal pregnancy outcome.
Summary
New ultrasound technology may provide a solution for the
prediction of preterm delivery High-frequency ultrasonic probes
make it possible to achieve a near-light microscopic level of image
resolution with an accuracy of less than 0-1 mm. precise
measurement of membrane thickness is possible.
An improved method of prediction would have a fundamental
impact on the management of preterm delivery could lead to a
decrease in the number of preterm deliveries and in the ensuing
morbidity and mortality.
SEVERI et al 2008 has found that prematurely thickened
membranes precede preterm delivery by up to 70 days, allowing
early identification of women at risk. The sensitivity of this
approach was high (100%) and the specificity was good (69.5%):
women with thickened membranes have a high risk (likelihood ratio,
3.3) of delivering preterm and the risk increases as membrane
thickness increases. When the sonographic thickness was below the
cut-off (1.2 mm) identified by ROC curve analysis, premature
delivery did not occur, even when women were complaining of
contractions. In the group of patients presenting other risk factors for
preterm delivery this approach could be useful to better identify
those who need to be monitored intensively and, eventually,
hospitalized.
Summary
This study was carried out in the Department of Obstetrics and
Gynecology at Menoufiya University Hospital from October 2010 to
April 2011 .This study included ( 142 ) pregnant women Came to out
patient clinic at Menoufiya university hospital at Gestational age
between 28 wk -36wk.
The number of pregnant women is chosen according to sample size
which is calculated according to ( population size , response distribution
and confidence level 95% )( Morton et al., 2001: ”Medical statistics”).
Inclusion criteria
Pregnant female with:
1- Past history of preterm labour
2- Past history of cervical surgery
3- Uterine anomalies
4- First trimester vaginal bleeding
- No symptoms or signs of preterm labour
- Singleton pregnancy.
- Gestational age between 28 wk -36wk
Exclusion criteria:
- Pregnancy with
Cercelage
Placenta-previa
Major fetal anomalies
Multifetal pregnancy.
premature rupture of membrane.
polyhyadramnios.
urinary tract infection.
medical disorder with pregnancy.
Summary
Consent was obtained from all patients Prior to enrolment .
Abdominal Ultrasonography for measurement of the fetal
membrane thickness In this study, each woman underwent one ultrasound
evaluation between28 and36 weeks of gestation, during which the
thickness of the fetal membranes was measured Ultrasound examinations
were performed by Ultrasound machine, equipped with 2.5 – 6.6 MHZ
transabdominal probe. The transducer was positioned perpendicular to the
maternal abdomen. The region of interest was magnified to occupy >
75% of the screen) and the measurement will be taken at about 3cm from
the umbilical cord insertion. Positioning the lower border of the
horizontal line of the upper caliper on the line that defines the external
margin of the chorion and the upper border of the horizontal line of the
lower caliper on the line that defines the external margin of the amnion. .
This study included ( 142 ) pregnant women Came to out patient
clinic at Menoufiya university hospital of gestational age (28 wk-36wk).
These cases underwent abdominal ultrasound for measurement of fetal
membrane thickness and followed up weekly for prediction of preterm
labour. from these 142 pregnant women 15 cases developed PTL.
In this study we have shown that women who later undergo PTL
have thicker fetal membranes which was (1.64±0.19 mm) versus cases
who didn’t develop PTL was (1.05 ± 0.06 mm). our cut of point 1.15 mm.
This is similar to (F.M.SEVERI et al., 2008) who studied the
measurement of fetal membrane thickness as a prediction of PTL. His
study was on 158 pregnant women at gestational age (18-35 weeks) he
found that women who delivered preterm had a greater membrane
thickness (1.67± 0.77 mm) than did those who delivered at term (1.14 ±
0.030 mm). his cut of point by ROC curve analysis (fetal membrane
thickness of 1.2 mm).