Fetal Adrenal Gland Volume Estimation in Prediction of Preterm Birth
|Study Design:||Observational Model: Case-Only
Time Perspective: Prospective
|Official Title:||Three - Dimensional Ultrasound Estimation of Fetal Adrenal Gland Enlargement Compared to Assessment of Cervical Changes Alone & Prediction of Impending Preterm Birth|
- Accurate prediction of impending preterm birth using 3D ultrasound estimation of fetal adrenal gland volume [ Time Frame: within 7 days of ultrasound scan ] [ Designated as safety issue: No ]If we could prove that three -dimensional ultrasound measurement of fetal adrenal gland volume can accurately predict the likelihood of preterm birth in patients having symptoms and signs of PTL , we would be able to use it as a valuable component for assessment and early management of high risk pregnant women for PTB which can be positively reflected on the risk of neonatal morbidity and mortality in those patients.
- accurecy of measuring cervical length in prediction of impending preterm birth [ Time Frame: 7 days of ultrasound scan ] [ Designated as safety issue: No ]
|Study Start Date:||August 2014|
|Estimated Study Completion Date:||February 2015|
|Estimated Primary Completion Date:||January 2015 (Final data collection date for primary outcome measure)|
threatened preterm labour
Women who are diagnosed as having threatened preterm labour based on the American college of obstetricians and gynaecologists guidelines (ACOG,2003) :
Device: Ultrasound imaging
Preterm birth ( PTB) is one of the leading causes of neonatal morbidity and mortality (Goldenberg et al., 2008) Early PTB (≤ 34 weeks' gestation) carries a 7-fold increased risk of Neonatal death . Following PTB, survivors can experience significant long term cognitive, behavioral, emotional, sensory, and motor deficits. Hence, there is growing interest in the identification of women who are at Risk for spontaneous PTB. Many biophysical and biochemical markers have been discovered to identify those women who are at risk for spontaneous PTB.
(Honest et al., 2009)
Unfortunately, none of the various maternal and fetal biomarkers such as:
cytokines, CRH, C-reactive protein, fetal fibronectin ,…. etc. are sufficiently sensitive or specific to be used alone or in combination to help decrease the rate of preterm births. (Ozhan et al., 2007) Obviously, there's a need for an accurate method with high sensitivity and specificity for prediction of preterm labor. So that an appropriate management or referral to a higher center can be done to women likely to have PTB. Whereas unnecessary tocolytic therapy can be avoided in women who are unlikely to have PTB. (Rengaraj et al., 2009) Convincing data have shown that 2-dimensional (2D) ultrasound measurement of cervical length (CL) can identify women at risk for PTB.
Accordingly, CL is now widely used in clinical practice for risk estimation. ( Crane et al., 1997) However, as understanding of the mechanisms of preterm labor (PTL) have evolved, obstetricians have learned that, in some women, cervical shortening is a phenomenon that carries no increased risk for prematurity. Therefore, the search for early and accurate markers that distinguish between physiologic processes and abnormal activation of the labor cascade has been ongoing.
Literature has suggested that activation of the fetal hypothalamic-pituitary-adrenal axis play a crucial rule in commencement of labor. (Norwitz et al, 1999) A previous study demonstrated that three -dimensional ultrasound measurement of fetal adrenal gland volume (AGV) may identify women at risk for impending PTB. (Turan et al, 2007) In a more recent study receiver operator characteristics (ROC) curve analysis revealed that three -dimensional ultrasound measurement of (AGV) was superior to two-dimensional ultrasound measurement of (AGV) for anticipation of PTB within 7 days of the scan. (Turan et al, 2012) The aim of this study is to investigate the utility of 3D fetal adrenal gland volume measurement in the early prediction of PTB and to determine whether these measurements could be combined with 2D ultrasound cervical assessment to improve the early prediction of PTB.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02339623
|Contact: Rania A Rizk, M.B, B.Chfirstname.lastname@example.org|
|Contact: Wessam M Abouelghar, MDemail@example.com|
|Ain Shams Maternity Hospital||Recruiting|
|Contact: Wessam M Abouelghar, MD 002-01227460679 firstname.lastname@example.org|
|Principal Investigator: Rania A Rizk, M.B, B.Ch|
|Study Chair:||Wessam Ma Abouelghar, MD||Ain Shams Maternity Hospital|