THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH

Abstract

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Crossref Member Badge Erfolgreich durch internationale Zusammenarbeit OBSTETRICS DOI 10.35630/2023/13/4.817 Received 11 July 2023; Accepted 19 July 2023, Published 15 August 2023 THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH Ufuk Atlıhan orcid id logo , Umit Derundere orcid id logo Private Karatas Hospital, Izmir, Turkey download article (pdf) cfl.ufuk@gmail.com ABSTRACT Preterm labor is one of the leading causes of perinatal morbidity and mortality and is thought to complicate approximately 10-12% of pregnancies. Defined as birth before 37 weeks of gestation, preterm labor is one of the most common obstetric complications worldwide. Although the pathogenesis of preterm labor is not fully understood, intraamniotic infection or hemorrhage, uteroplacental ischemia, uterine overstretching and immunologic processes have been proposed in its etiology. However, there is still no definitive prediction tool. Sonographic assessment of the cervical structure by measuring cervical length (CL) has been used as a popular prediction tool to predict preterm labor. The uterocervical angle (UCA) is defined as the angle between the lower anterior uterine segment and the endocervical canal. Recently, UCA has been proposed as an alternative to CL for predicting preterm labor. In recent years, several studies have investigated the potential impact of UCA for preterm labor prediction. Our study aimed to determine whether the uterocervical angle, a new ultrasonographic marker for predicting preterm labor, is associated with the risk of spontaneous preterm delivery. The present study included 186 singleton pregnant women who gave birth in our hospital between January 2018 and December 2022. The data of the included patients were retrospectively evaluated from the hospital database and patient files. Regarding the primary outcome of our study, we found that there was a statistically significant difference in UCA and cervical length between women who delivered spontaneously preterm and women who delivered at term (p<0.05). In the second trimester ultrasonography evaluation, the mean UCA was wider and the mean cervical length was shorter in the preterm group. Contrary to other studies in the literature, smoking and history of preterm delivery as risk factors were not included in our study. The exact reasons for some of the differences between our findings and the studies reported in the literature are not clear, but may be attributed to several factors. First, the patient type was heterogeneously selected in the cited studies. There are large differences in terms of sample size and studies that may be attributed to such heterogeneity. In conclusion, wider UCA and shorter cervical length in the second trimester are associated with spontaneous preterm delivery. Measurement of UCA is a reproducible technique and the UCA value was found to increase from the first trimester to the second trimester. We recommend the inclusion of UCA in current clinical practice in addition to cervical length measurement as a predictive factor that can be used in decision-making regarding the management of women at risk of preterm delivery. However, future studies are needed to assess the diagnostic accuracy of this index and should specifically consider the use of thresholds and related outcomes (preterm birth rates based on specific gestational weeks).