Abstract Background Preterm birth is one of the major clinical problems in obstetrics and neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. It is reported that more than 80% of all neonatal mortality and morbidity is due to preterm birth. Objective In this study fetal adrenal gland volume and fetal zone measurement were used as a predictors for occurrence of labor in singleton pregnancies complicated by threatened preterm labor in comparison to cervical length and cervicovaginal fetal fibronectin. Methodology The study was carried out at Ain Shams University Maternity Hospital. The current study include 88 pregnant women who presented with symptoms or signs of threatened preterm labor (PTL). All women were subjected to full history taking, full general, abdominal, pelvic examination, in addition to ultrasound fetal biometry, measurement of cervical length, measurement of fetal fibronectin, fetal adrenal gland volume AGV and fetal zone acquisitions. Results Our results showed high statistically significant difference between the two groups of women regarding CL measurement, FZE and cAGV with P values < 0.001 suggesting that ultrasound examination of fetal adrenal gland and assessment of FZE at time of evaluation for symptoms of PTL may be clinically beneficial in predicting the occurrence of labor in pregnant women at risk of preterm labor. Conclusion Our results demonstrate that in women presenting with threatened preterm labor, cAGV and FZE measured by 3-dimensional ultrasound seem to be significant predictors of delivery within 7 days, when compared to CL and cervicovaginal fetal fibronectin.