Cervical Gland Area Research Articles

Assessing the multifaceted cervix: examining cervical gland area at cervical length screening to predict spontaneous preterm birth

BACKGROUNDBiologically active cervical glands provide a mucous barrier while influencing the composition and biomechanical strength of the cervical extracellular matrix. Cervical remodeling during ripening may be reflected as loss of the sonographic cervical gland area. As sonographic cervical length remains suboptimal for universal screening, adjunctive evaluation of other facets of the mid-trimester cervix may impart additional screening benefit. OBJECTIVETo sonographically assess the cervical gland area at universal cervical length screening for preterm birth. STUDY DESIGNWe performed a retrospective cohort study of singletons with transvaginal cervical length screening universally performed during anatomic survey between 18 0/7 and 23 6/7 weeks and subsequent live delivery at a single institution in 2018. Uterine anomalies, cerclage, suboptimal imaging, or medically indicated preterm birth were excluded. Ultrasound images were assessed for cervical length and cervical gland area (with quantitative measurements when present). The primary outcome was spontaneous preterm birth <37 weeks. Absent and present gland groups were compared using χ2, Fisher's exact, T-test, and multivariate logistic regression (adjusting for parity and progesterone use, as well as the gestational age, cervical length, and gland absence at screening ultrasound). Gland measurements were evaluated using the Mann-Whitney-U Test and Spearman's correlation. RESULTSAmong the cohort of 772 patients, absent and present CGA groups were overall similar. Patients were on average 33 years old, ∼20 weeks gestation at screening ultrasound, and overall, 2.5% had history of prior spontaneous preterm birth. The absent gland group was more likely to have been taking progesterone (17% vs 4%, P=.04). Overall rate of preterm birth was 2.6%. However, the 2.3% of patients with absent cervical gland area were significantly more likely to deliver <37 weeks (aOR 23.9, 95% CI 6.4–89, P<.001). Multivariate logistic regression demonstrated better performance of a cervical length screening model for preterm birth prediction with the addition of qualitative gland evaluation (P<.001). Qualitative gland assessment was reproducible (PABAK 0.89), but quantitative gland measurements did not correlate with preterm birth. CONCLUSIONQualitative gland absence at mid-gestation cervical length screening was associated with subsequent spontaneous preterm birth, whereas quantitative gland measurements were not. Multifaceted ultrasound screening may be needed to adequately evaluate the multiple biologic functions of the cervix.

Gestational age‐related changes in cervical gland length in normal singleton pregnancies from 17 to 36 weeks of gestation

To determine the gestational age-related changes in cervical gland length in relation to cervical length (CL) in normal singleton pregnancies. We studied 363 women with an uncomplicated singleton pregnancy (188 nulliparous and 175 multiparous women with one or more previous transvaginal deliveries). A total of 1138 cervical gland and CLs were measured longitudinally at 17-36 weeks of gestation using transvaginal ultrasonography along the curvature from the external os to the lower uterine segment and the internal end of the cervical gland area (CGA), respectively. Gestational age-related changes in cervical gland and CLs and their relationships were analyzed using a linear mixed model. Cervical gland and CLs decreased in different ways with advancing gestation depending on parity, and their changes were related to each other. The CGAs in nulliparous women were longer than those in multiparous women at 17-25 weeks of gestation (p < 0.05), but with no differences thereafter. CLs in multiparous women were different from those in nulliparous women at 17-23 and 35-36 weeks (p < 0.05), but there were no differences at 24-34 weeks. The cervix did not shorten compared with the CGA throughout the observational periods in nulliparous and multiparous women. Shortening of the cervix indicates changes to the lower uterine segment in normal pregnancies. The cervical gland region can be a useful marker representing the true cervix beyond 25 weeks of gestation, irrespective of parity.

Evaluation of Cervical Gland Area as Sonographic Predictor of Preterm Labor

Evaluation of Cervical Gland Area as Sonographic Predictor of Preterm Labor

Role of cervical gland area as a predictor of preterm labor

Cervical gland area (CGA) is a relatively recent ultrasonographic measure proposed for the prediction of preterm birth. During an ultrasonography examination, the cervical mucosa is often characterised by a hyperechoic or hypoechoic segment, which may or may not correspond to the presence of mucosal glands in the cervical canal. Preterm birth may be predicted by determining whether or not these glands have developed by the end of the second trimester. As a result, the primary purpose of this research was to assess the validity of transvaginal ultrasonography for predicting cervical gland area and, by extension, premature labour. Methods: Benha University Hospitals' Obstetrics and Gynecology Departments recruited 160 pregnant women for this prospective cohort research. Women who tested positive for CGA during pregnancy were placed in Group A, whereas those who did not were placed in Group B. (pregnant women with absent CGA by TVUS). As a result, 78.1% of individuals had CGA and 21.9% did not. With a sensitivity of 64.6%, a specificity of 96.4%, and an accuracy of 86.9%, the presence of CGA is a strong predictor of premature labour. Because of the requirement for specialised prenatal care, it is crucial to accurately predict preterm and extremely preterm birth (gestational age 32 weeks). It would seem that CGA detection is a useful signal for this. CGA should be studied in conjunction with other markers to see which ones are most useful for predicting the likelihood of a premature birth.

916 The association between preterm birth and ultrasound visualization of the cervical gland area

Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. Yet, transvaginal ultrasound (TVUS) cervical length (CL) screening suboptimally predicts spontaneous PTB (SPTB). Abnormal remodeling of glandular crypts along the cervical canal may contribute to increased PTB risk via premature cervical ripening, which may correspond to no visualizable cervical gland area (CGA) on TVUS (Figure 1). This study aims to determine if no visualizable (“absent”) CGA at CL screening is predictive of PTB. We performed a retrospective cohort study of pregnant women carrying a singleton gestation who had CL screening between 180/7 – 236/7 weeks gestation and delivered a live neonate at a single academic institution between 1/1/18 and 12/31/18. 1000 of the most recent deliveries in 2018 were screened for inclusion. Patients with uterine anomalies, cerclage, suboptimal imaging, or with indicated preterm delivery were excluded. TVUS images were assessed for CL, CGA visualization, and if present, quantitative CGA measurements were performed. The primary outcome was SPTB prior to 37 weeks. Absent and present CGA groups were compared using χ2, Fischer’s exact, T-test, and logistic regression with significance at p<0.05. 784 women were included. Demographic and medical characteristics of the sonographically absent and present CGA groups were similar. The absent CGA group was more likely parous and to receive progesterone supplementation (77 vs 40% and 17 vs 4% respectively, p=0.03). Overall PTB rate was 2.7% and rate of absent CGA was 2.3%. Absent CGA was significantly associated with delivery <37, <34, and <32 weeks (p<0.005) (Table 1). Quantitative CGA width, length, and area did not individually correlate with PTB. A multiple logistic regression model demonstrated 8% improvement for prediction of PTB <37 weeks with the addition of CGA evaluation compared to CL alone (p<0.001). Patients with no visualizable CGA were more likely to experience spontaneous preterm delivery. Assessment of CGA visualization may improve the performance of CL screening for predicting SPTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A role of comprehensive cervix assessment in the first trimester of pregnancy for predicting preterm delivery

Aim: to improve efficacy of predicting preterm labor in the first trimester of pregnancy by combining diverse parameters of cervical ultrasound examination.Materials and methods. A prospective cohort study of 1517 women with uncomplicated pregnancy was performed. Inclusion criteria were: females underwent cervicometry at 11–14 weeks of gestation, singleton pregnancy, revealing no complaints at the onset of examination. All women were subdivided into four groups: Group 1 – 27 pregnant women with shortened cervix (less than 30 mm); Group 2 – 24 pregnant women without cervical gland area (СGA); Group 3 – 30 pregnant women with two risk factors (shortened cervix less than 30 mm and lacked СGA); Group 4 (control) consisted of 1436 pregnant women with cervix length exceeding 30 mm and presence of СGA.Results. Average delivery term in Group 1 was 35.7 weeks (95 % CI = 34.7–36.8), in Group 2 – 34.7 weeks (95 % CI = 33.59–35.0), in Group 3 – 33.23 weeks (95 % CI = 31.6–34.8), in Group 4 (control) – 38.11 weeks (95 % CI = 38.06–38.17). A significant moderate correlation (Rxy = 0.534) between shortened cervix, absence of СGA and delivery term was found (p &lt; 0.001). A regression model consisting of cervical length and presence of СGA was simulated based upon 50.8 % factors underlying probability of preterm birth, revealing 42.6 % sensitivity, 99.1 % specificity, and 96.6 % overall diagnostic value. The area under the ROC curve was 0.902 ± 0.022 (95 % CI = 0.860–0.945). The data obtained reflect diverse biochemical changes such as collagen decomposition, altered glucosamine level and fluid amount within cervical tissues. Such processes result in shortened, softened and expanded (matured) cervix. Uncovering markers for preterm cervical maturation underlies a logical strategy to predict miscarriage.Conclusion. Untrasound cervical measurement in the first trimester of pregnancy allows for revealing valuable miscarriage predictors (shortened cervix and absence of GI). Risk assessment by combining diverse ultrasound cervix parameters would allow to improve overall predictive efficacy.

Evolving cervical imaging technologies to predict preterm birth.

Preterm birth, defined as delivery at less than 37weeks' gestation, increases maternal-fetal morbidity and mortality and places heavy financial and emotional burdens on families and society. Although premature cervical remodeling is a major factor in many preterm deliveries, how and why this occurs is poorly understood. This review describes existing and emerging imaging techniques and their advantages and disadvantages in assessing cervical remodeling. Brightness mode (B-mode) ultrasound is used to measure the cervical length, currently the gold standard for determining risk of preterm birth. Several new B-mode ultrasound techniques are being developed, including measuring attenuation, cervical gland area, and the cervical consistency index. Shear wave speed can differentiate between soft (ripe) and firm (unripe) cervices by measuring the speed of ultrasound through a tissue. Elastography provides qualitative information regarding cervical stiffness by compressing the tissue with the ultrasound probe. Raman spectroscopy uses a fiber optic probe to assess the biochemical composition of the cervix throughout pregnancy. Second harmonic generation microscopy uses light to quantify changes in collagen fiber structure and size during cervical maturation. Finally, photoacoustic endoscopy records light-induced sound to determine optical characteristics of cervical tissue. In the long term, a combination of several imaging approaches, combined with consideration of clinical epidemiologic characteristics, will likely be required to accurately predict preterm birth.

Ultrasound Evaluation of the Cervix to Predict Failed Labor Induction.

Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.

Cervical gland area as an ultrasound marker for prediction of preterm delivery: A cohort study

Preterm labor is a major cause of perinatal morbidity and mortality and it might be predicted by assessing the cervical change. To assess the association between absence of cervical gland area (CGA) and spontaneous preterm labor (SPTL). This prospective cohort study was performed on 200 singleton pregnant women with a history of SPTL, second-trimester abortion in the previous pregnancy or lower abdominal pain in current pregnancy. Each patient underwent one transvaginal ultrasound examination between 14-28 wk of gestation. Cervical length was measured and CGA was identified and their relationship with SPTL before 35 and 37 wk gestation was evaluated using STATA software version 10. The mean of cervical length was 36.5 mm (SD=8.4), the shortest measurement was 9 mm, and the longest one was 61 mm. Short cervical length (≤18mm) was significantly associated with SPTL before 35 and 37 wk gestation.Cervical gland area (the hypoechogenic or echogenic area around the cervical canal) was present in 189 (94.5%) patients. Absent of CGA had a significant relationship with SPTL before 35 and 37 wk gestation (p=0.01 and p<0.001, respectively). Cervical length was shorter in women with absent CGA in comparison with subjects with present CGA: 37±10 mm in CGA present group and 23±9 mm in CGA absent group (p<0.001). Our study showed that cervical gland area might be an important predictor of SPTL which should be confirmed with further researches.

Absent Cervical Gland, Cervical Length and Amniotic Fluid Sludge as Predictive Markers of Preterm Birth

Background and Objective Preterm birth is one of the leading causes of neonatal and childhood death worldwide. Despite medical advancements, we often fail to predict and prevent preterm birth. The aim of this study is to evaluate the relationship between three cervical markers: cervical length, absent cervical gland area, and amniotic fluid sludge with the incidence of preterm birth. Material and Methods A prospective, correlational research study, was conducted at the Department of Medical Imaging, Obstetrical Ultrasound Unit, London Health Sciences Centre Victoria Hospital Campus, London, Ontario, Canada from April 1 2014-June 1 2015. The target population was pregnant women, 18 to 45 years of age, who may or may not have a history of preterm labour. The inclusion criteria were singleton pregnancies between 16 and 23 weeks gestation. Participants were excluded if they had a multiple gestation, a fetal demise, fetal anomalies, previous surgeries of the cervix, (i.e. Loop Electrosurgical Excision procedure, cone biopsy), cervical cerclage, placenta previa, and/or any other indication for preterm delivery other than spontaneous labour. Participants were recruited at their antenatal visits or ultrasound appointments and informed consent was obtained. Transvaginal ultrasound of the cervix was performed to assess for cervical length, absent cervical gland area and amniotic fluid sludge and correlated with the incidence of preterm birth. Results Two-hundred and fifteen women participated in this study. Thirteen were removed from the final analysis. The final sampling totalled 202 participants. Twenty-five participants met the criteria for preterm birth, delivering less than 37 weeks gestational age. The prevalence of short cervical length, measuring less than 2.5 cm was 2.3% (4/177) in participants delivered full term and 12% (3/25) among participants that delivered preterm. Absent cervical gland area was 10.2% (18/177) in participants that delivered full term and 16.0% (4/25) among participants that delivered preterm. The prevalence of amniotic fluid sludge was 6.8% (12/177) in participants that delivered full term and 16% (4/25) among participants that delivered preterm. Conclusion Cervical length measurement less than 2.5 cm did prove to be statistically significant with the incidence of preterm birth. Absent cervical gland area and amniotic fluid sludge, however, did not demonstrate a statistically significant correlation. Cervical length measurement, absent cervical gland area and amniotic fluid sludge did not demonstrate an association with chorioamnionitis.

Reference ranges for the uterine arteries Doppler and cervical length measurement at 11–13(+6) weeks of gestation in a Brazilian population

Objective: To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11–13(+6) weeks of gestation in a Brazilian population.Methods: We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84 mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean ± standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values.Results: We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58 mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL = 30.790 + 0.057 × CRL and UtA PI = 2.411−0.011 × CRL.Conclusion: References ranges for the mean UtA PI Doppler and CL measurement at 11–13(+6) weeks of gestation in a Brazilian population were established.

Relationship between detection of the cervical gland area during the late third trimester and necessity for induction of labor to prevent post-term delivery.

With the maturation of the cervical canal during pregnancy, the cervical gland area (CGA) as observed on transvaginal ultrasonography is gradually obscured. The aim of this study was to elucidate the significance of CGA in the late third trimester as a determinant of the outcome of labor. We investigated 123 primiparous women with singleton pregnancies at 36-41weeks' gestation. The women were divided into two groups: a normal delivery group (93 women), which had vaginal delivery without medical intervention, and an induction of labor group (30 women), which required induction of labor after 41weeks and 0day. At outpatient prenatal checkups, the Bishop score (BS) was assessed by pelvic examination, and cervical length (CL) and CGA were evaluated by transvaginal ultrasonography. The relationship between each parameter and induction of labor was retrospectively determined and compared. Time-dependent assessment of each outcome determinant showed that the CGA detection rate was higher and the CL was longer in the induction of labor group from 3weeks to 1week before delivery at a significant level (P<0.05); however, the BS was significantly lower in the induction of labor group only at 1week before delivery (P<0.05). When multiple logistic regression analysis of the necessity of induction of labor was conducted using BS, CL, and CGA parameters as explanatory variables at 1week before delivery, CGA alone was shown to be an independent predictor of induction of labor (OR=6.1, 95% CI 2.3-16.2). The present study suggests that in the late third trimester, evaluation of CGA with transvaginal ultrasonography is most useful in predicting the necessity of induction of labor to prevent post-term delivery.

Association of Progesterone, Pessary, and Antibiotic for Treating Pregnant Woman with Short Cervix Syndrome: Importance of Magnetic Resonance Imaging in the Assessment of Pessary Position

Preterm delivery (PD) is the most important cause of neonatal mortality, particularly before the 32nd week of pregnancy. A short cervix is the most important quantitative marker for predicting PD. However, there are other qualitative markers such as cervical gland area, cervical funneling, and sludge. We present the case of a pregnant woman who was diagnosed with a short cervix at 14-weeks and demonstrate the use of triple therapy, which helped to achieve a good perinatal result. A 37-year-old pregnant woman (G3P0) was referred to our service at 14-weeks of pregnancy presenting with a short cervix (20 mm) and a positive sludge sign. She was hospitalized; a pessary was inserted, and started on antibiotic therapy (clindamycin and cefalotin for 10 days). At 20 weeks, she was again admitted to the hospital, and this time presented with a further shortened cervix (9 mm), cervical funneling, and a positive sludge sign, with the pessary in position. The following procedures were performed: Amniocentesis on the sludge (negative bacterioscopy), another cycle of antibiotics, administration of oral progesterone, and imaging to determine retention of pessary position. The patient was placed in the Trendelenburg position and remained hospitalized for 82 days. At 32 + 1 weeks, the fetus presented distress (tachycardia). C-section was performed, producing a live female newborn weighing 2,180 g and presenting Apgar indexes of 8/8. This case report demonstrates the importance of magnetic resonance imaging to assess the position of pessary in a pregnant woman with short cervix.

Can transvaginal ultrasonographic evaluation of the endocervical glandular area predict preterm labor among patients who received tocolytic therapy for threatened labor: a cross-sectional study

Objective: Increased neonatal morbidity and mortality rates resulting from preterm delivery (PTD) remain as a problem despite increasing evidence about the physiology of uterine contractility process. More predictive signs of preterm labor detected on prenatal ultrasonography like the presence of cervical gland area (CGA) on transvaginal ultrasonography can be a reassuring finding among patients with threatened labor risk.Methods: In this prospective study, 85 pregnant patients at 24–34 weeks of gestation who attended to our high risk pregnancy clinic for threatened labor between March 2011 and March 2012 have been examined by transvaginal ultrasonography to evaluate CGA located around the endocervical canal. Following discharge, the gestational week at birth, birth weight and birth route of patients have been recorded.Results: Among patients with a cervical length (CL) <30 mm and ≥30 mm measured by transvaginal ultrasonography on admission, 82.4% of the patients with a short cervix exhibiting echolucent endocervical glandular area and 42.3% of the patients with short cervix exhibiting echogen endocervical glandular area on sonography delivered at term (p = 0.013).Conclusion: The presence of CGA detected on transvaginal ultrasonography especially when combined with the evaluation of CL during the management of patients with threatened labor can be a reassuring sign for actual probability of PTD.

Short cervix syndrome: current knowledge from etiology to the control

Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery. To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies. Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary. We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20-24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix. The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.

Correlation between an absence of cervical gland area on transvaginal sonography and cervical mucus hyaluronic acid levels in women with threatened preterm delivery

Transvaginal sonographic findings of an absent cervical gland area (CGA) and a short cervical length (CL) are frequently observed in patients with threatened preterm delivery. The present study aimed to clarify whether sonographic findings are due to active production of hyaluronic acid (HA)in the cervix. Possible relationships between sonographic findings of the presence or absence of the CGA and/or a short CL and cervical mucus HA concentration were investigated in 68 women with threatened preterm delivery at 22 – 31 weeks’ gestation and 136 women without threatened preterm delivery as controls. HA levels were higher in women with threatened preterm delivery (68.0 ng/mL) than in controls (39.0 ng/mL; P = 0.001). Similarly, HA levels were higher in women with preterm labor showing an absent CGA and a short CL than in women with threatened preterm delivery without such findings (P < 0.01). Stepwise multivariate logistic regression identified an absent CGA and threatened preterm delivery as independent predictors of high HA levels (P = 0.04). HA concentration was not predictive for preterm delivery. A sonographic finding of an absent CGA reflects high HA levels in the cervix with threatened preterm delivery.

Transvaginal Sonographic Evaluation of the Cervix in Asymptomatic Singleton Pregnancy and Management Options in Short Cervix

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

Cervical gland area: a new sonographic marker in predicting preterm delivery

Preterm delivery is one of the important causes of morbidity and mortality in newborns. Nowadays, a new sonographic marker is suggested for prediction of preterm delivery which is termed "Cervical Gland Area" (CGA). Absence of normal mucosal glands of the cervix can be utilized as a predictor in preterm delivery. This study was performed to evaluate the role of absence of CGA for the prediction of preterm delivery <37weeks. Trans-vaginal ultrasonography was performed on 600 pregnant women at 16-19weeks of gestational age. Cervical gland area and cervical length were evaluated. Women with cervical length <25mm were conducted to cerclage and excluded from the study. Age, number of pregnancies and history of previous preterm deliveries were recorded in questionnaires. The date of delivery was recorded. Statistical analysis was performed by version 18 SPSS and P value <0.05 was significant. Spontaneous preterm delivery was seen in 6.7% of all women. There was no significant difference in age, cervical length, the number of pregnancies and history of previous preterm deliveries between term pregnancies and preterm cases. CGA was detected in 77.1% of term pregnancies comparing with 55% in preterm group; which was significantly different (P value=0.002). Non detection of CGA at second trimester ultrasonography is a predictor of preterm delivery.

OC17.05: Cervical gland area as an ultrasonographic marker for predicting preterm delivery in high risk pregnant women

OC17.05: Cervical gland area as an ultrasonographic marker for predicting preterm delivery in high risk pregnant women

Transvaginal grey scale histogram of the cervix at 20-25 weeks of pregnancy

To assess the echogenicity of the cervical stroma and area surrounding the cervical canal (cervical gland area - CGA) using grey scale histogram (GSH) in pregnancies between 20 and 25 weeks. Cross-sectional study involving 149 pregnancies in the second trimester. Transvaginal sonography was performed to measure cervical length (biometric evaluation), assess the CGA and detect cervical funnelling (morphologic evaluation). The GSH was used for the objective assessment of the cervical stroma and CGA in the mid portion of the cervix. Mean, minimum, maximum and standard deviation measurements were obtained on the GSH and the CGA/stroma ratio was calculated. Intra-observer and inter-observer reproducibility were assessed using the intraclass correlation coefficient (ICC). Mean cervical length was 42.37 ± 7.05 mm (range 12-54 mm). Funnelling was detected in four women (2.7%) and one of these also had absent CGA. The mean GSH stroma value was 103 ± 25 (53-160) and the mean CGA value was 64.5 ± 23 (13-167). The mean CGA/stroma ratio was 0.62 ± 0.14 (0.24-1.29). Intra- and inter-observer reproducibility was excellent with ICC of 0.975 and 0.922 respectively. There are large differences in the texture of the cervical stroma and CGA on GSH allowing the objective differentiation of the two areas. The CGA/stroma ratio allows the objective assessment of the absence or presence of the CGA.