title: Cervical length versus vaginal PH in the second trimester as preterm birth predictor.
abstract: OBJECTIVE
  To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor (PTL) predictor.
  
  
  METHODS
  During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively.
  
  
  RESULTS
  Vaginal pH of 5 and above was found in 162/438 women (37%) while cervical length <30mm was found in 38/438 (8.7%). The incidence of PTL < 37 weeks was 87/438 (19.9%) while the incidence of early (PTL <34 weeks) was 51/438 (11.6%). Predictive value of higher vaginal PH was significantly more (31%) than vaginal PH<5 (13%) in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor (OR=3.06). Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth (OR=13.9).
  
  
  CONCLUSIONS
  Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL (<34 weeks).
authors.affiliation: Fatemeh Foroozanfard, Department of Gynaecology and Obstetrics, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Foroozanfard
authors.affiliation: Zohreh Tabassi, Department of Gynaecology and Obstetrics, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Tabasi
authors.affiliation: Elaheh Mesdaghinia, Department of Gynaecology and Obstetrics, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Elaheh
authors.initials: E
authors.lastname: Mesdaghinia
authors.affiliation: Mojtaba Sehat, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Sehat
authors.affiliation: Mehrdad Mahdian, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Mahdian
authors.initials: M
authors.lastname: Mehrdad
keywords: Bacterial vaginosis; Cervical length measurement; Preterm birth; Second trimester