PREDICTION OF EARLY PRETERM LABOR BY SALIVARY PROGESTERONE AND CERVICAL LENGTH IN ASYMPTOMATIC HIGH RISK WOMEN

Abstract

reterm labor is defined as regular uterine contractions associated with cervical change occurring between 20 and 37 weeks gestational age(Emily et al., 2007) . Preterm labor is classified as early preterm labor which is delivery before 34weeks of gestation and late preterm labor which is delivery after 34weeks of gestation but before 37 weeks of gestation (Wen et al., 2004). Preterm labor is one of the most serious problems in obstetrics. Preterm labor is the leading cause of neonatal morbidity and mortality (Emily et al., 2007). Neonatal mortality also increases with declining gestational age at delivery. The incidence of spontaneous preterm birth continues to rise (Erol and Thomas, 2007). The pathophysiologic mechanisms are complex and multifactorial (Lachelin et al., 2009). Despite advances in diagnostics, the exact etiology of PTB remains elusive (Emily et al., 2007) Many risk factors antedate the diagnosis of preterm labor, but these factors are not very specific. This lack of specificity is further compounded by the inability to accurately diagnose preterm labor (Erol and Thomas, 2007). In the study of Serra et al., 2012 they found that :In singleton pregnancies, progesterone supplements have only helped to prevent preterm deliveries and improved neonatal outcomes in high-risk women. This was also proved by studies made by Fonseca et al., 2007 &Hassan et al., 2011). Salivary progesterone is related to serum progesterone as proved by studies . In the study made by Meulenberg and Hofman, 1989,they found that during pregnancy the increase in total progesterone concentrations in plasma is reflected both in the proportion that is free in plasma and in the concentrations in saliva .Serum progesterone cross reacted 100% with salivary progesterone ELISA kits. Normative data for a range of salivary steroids during pregnancy are not yet available, especially for the sex steroids, (Hampson et al., 2013). There are many interpretations to determine the level of salivary progesterone during pregnancy .A study made by Gandara et al., 2002 revealed normal salivary progesterone level as follows: At 3 months 456 pmol/L,