Uterocervical Angle Research Articles

The predictive role of uterocervical angle in labor outcomes: a narrative review.

Uterocervical angle (UCA) is the angle between the anterior or posterior uterine wall and the cervical canal, and it has become an unique ultrasonographic marker in the recent years. The predictive role of the UCA in spontaneous preterm births (sPTB) has been examined by numerous authors, however few data are available on UCA as predictor of labor outcome at term of pregnancy. Therefore, the purpose of this review is to evaluate the effectiveness of transvaginal ultrasound measurement of UCA at term, and its clinical implications in obstetrics' practice. A literature search was conducted including all studies regarding the predictive role of ultrasonographic evaluation of the UCA on labor outcomes from 1990 to 2023. A narrative synthesis was subsequently performed dividing studies that considered posterior and anterior UCA. Five studies were included for the anterior UCA, and ten for the posterior UCA. UCA was then evaluated as predictor of prolonged latent phase and predictor of the onset and mode of delivery. It is likely that the combination of multiple cervical parameters, rather than UCA assessment alone, together with clinical information, can achieve higher levels of accuracy in predicting delivery outcomes. Future prospective studies are needed to define with greater certainty the role of UCA as a useful screening tool before laboring, but, until then, the use of UCA as a screening test to predict labor outcome should remain investigational.

Differential use of various types of pessaries in isthmic-cervical insufficiency for prevention of preterm birth: A randomized prospective trial

Background. Obstetric pessary comprises one of the methods for treatment of isthmic-cervical insufficiency. Despite the variety of pessaries produced, the common purpose of their use consists in preventing premature birth. Various types of pessaries correct different cervical parameters, which is not always taken into account by doctors when choosing a pessary and reduces their potential effectiveness. Objective. To substantiate a differentiated approach to the selection of pessary type for correcting isthmic-cervical insufficiency and preventing preterm birth based on the evaluation of cervical parameters. Methods. A randomized prospective study enrolled 90 pregnant women diagnosed with isthmic-cervical insufficiency (ICD-10 code — О.34.3) at 19–24 weeks of gestation. Of these, 41 women underwent correction of isthmic-cervical insufficiency with an obstetric unloading pessary and 49 women — with a perforated cervical pessary. Transvaginal ultrasound cervicometry evaluated the parameters of the cervix before correcting isthmic-cervical insufficiency and in dynamics (once every 4 weeks) after inserting various types of pessaries. Statistical data processing was carried out using Statistica 10.0 (StatSoft, Tulsa, USA) and MedCalc 10.2.0.0 (MedCalc, Mariakerke, Belgium). The differences were considered to be statistically significant at p <0.05. Results. Inserting an obstetric unloading pessary in isthmic-cervical insufficiency decreased the uterocervical angle from 115 (110; 130)° to 100 (90; 115)° (p = 0.021). A decrease in the uterocervical angle was observed during 16-week-use of obstetric unloading pessary. After insertion of perforated cervical pessaries, the length of the closed part of the cervical region increased from 23 (21; 24) mm to 25 (21; 27) mm (p = 0.009) for a period of 4 weeks with a subsequent decrease in this parameter. The effectiveness of both types of pessaries in preventing preterm birth was found to be identical. Urgent delivery occurred in 61% of cases of using an obstetric unloading pessary and in 64.7% of cases of using a perforated cervical pessary (p = 0.993). The gestational age at preterm birth against the background of the use of obstetric unloading pessaries and perforated cervical pessaries was found comparable and amounted to 247 (230; 253) days and 245 (225; 254) days, respectively (p = 0.870). Conclusion. A differentiated approach to selecting a type of pessary for the prevention of premature birth in isthmic-cervical insufficiency is determined by the initial ultrasound parameters of the cervix. Thus, an increase in the uterocervical angle serves as an indication for an obstetric unloading pessary, while a shortened part of the cervical region without an increase in the utero-cervical angle determines the use of a perforated cervical pessary. Additional dynamic ultrasound control after inserting pessaries of any type allows such complications as pessary displacement, cervical edema, amniotic fluid sludge, prolapse of fetal membranes in the vagina, and increased myometrial tone to be timely diagnosed and corrected, thereby increasing the effectiveness of using pessaries.

Evaluation of Effectiveness of adding Uterocervical Angle Measurement by Transvaginal Ultrasound to Bishop Scoring in Prediction of Successful Induction of Labor.

Evaluation of Effectiveness of adding Uterocervical Angle Measurement by Transvaginal Ultrasound to Bishop Scoring in Prediction of Successful Induction of Labor.

The value of real-time shear wave elastography in spontaneous preterm birth.

This study aimed to investigate the predictive value of real-time shear wave elastography (SWE) for spontaneous preterm birth (SPB). This study prospectively selected 175 women with singleton pregnancies at 16 to 36 weeks of gestation. Cervical length (CL) and uterocervical angle (UCA) were measured using transvaginal ultrasonography. Real-time shear wave elastography was used to measure Young's modulus values, including the average Young's modulus (Emean) and the maximum Young's modulus (Emax) at 4 points: point A on the inner lip of the cervical os, point B on the outer lip of the cervical os, point C on the inner lip of the external os, and point D on the outer lip of the external os. Receiver operating characteristic (ROC) curve analysis was performed to compare the accuracy of Young's modulus values at the 4 points, CL, and UCA in predicting SPB. Significant variables were used to construct a binary logistic regression model to predict the multifactorial predictive value of SPB, which was evaluated using an ROC curve. A total 176 valid cases, including 160 full-term pregnancies and 16 SPB, were included in this study. Receiver operating characteristic curve analysis revealed that Emean at point A, as well as Emean and Emax at point D, had a relatively high accuracy in diagnosing SPB, with area under the curve values of 0.704, 0.708, and 0.706, respectively followed by CL (0.670), SWE at point C (Emean 0.615, Emax 0.565), SWE at point B (Emean 0.577, Emax 0.584), and UCA (0.476). Binary logistic regression analysis showed that comorbidities during pregnancy (including diabetes mellitus, hypertension, cholestasis and thyroid dysfunction), CL, and Emean at point A were independent predictors of preterm birth. In addition, the AUC value of the logistic regression model's ROC curve was 0.892 (95% CI: 0.804-0.981), with a sensitivity of 0.867, specificity of 0.792, and Youden's index of 0.659, indicating that the regression model has good predictive ability for SPB. Real-time shear wave elastography showed a higher predictive value for SPB than CL and UCA. The SWE combined with CL and comorbidities during pregnancy model has a good predictive ability for SPB.

Uterocervical angle and cervical length measurements for spontaneous preterm birth prediction in low-risk singleton pregnant women: a prospective cohort study.

Preterm birth is the leading cause of early neonatal morbidity and mortality. Strategies to predict preterm birth risk can help improve pregnancy outcomes. Even pregnant women without known risk factors for preterm birth can also experience it. This study aimed to evaluate the ability of the uterocervical angle and cervical length to predict spontaneous preterm birth in low-risk singleton pregnant women. A prospective study on 1107 singleton pregnant women between 16+0 and 23+6weeks gestation at low risk for spontaneous preterm birth who were treated at the Haiphong Hospital of Obstetrics and Gynecology, Vietnam, between September 2020 and September 2021 was conducted. A single sonographer assessed the cervical length and the uterocervical angle using transvaginal ultrasonography. The patients were followed up until delivery to determine the main pregnancy outcome (spontaneous preterm birth before 37weeks gestation). The cut-off points for the uterocervical angle and cervical length were established by analyzing the receiver operating characteristic curve. The sensitivity, specificity, likelihood ratio, positive and negative predictive values, and accuracy of the uterocervical angle and cervical length for predicting spontaneous preterm birth were determined. A uterocervical angle ≥ 99° predicted spontaneous preterm birth at < 37weeks, with a sensitivity and specificity of 91% and 76%, respectively. A cervical length ≤ 33.8mm predicted preterm birth at < 37weeks with a sensitivity and specificity of 25% and 66%, respectively. A uterocervical angle ≥ 99° combined with a cervical length ≤ 33.8mm yielded the sensitivity, specificity, positive predictive value, likelihood ratio, and accuracy of spontaneous preterm birth prediction of 66%, 93%, 36%, 9, and 91%, respectively; thus provided a significant increase of specificity with an acceptable reduction of sensitivity as compared to cervical length alone. Besides the cervical length, the uterocervical angle can be considered a valuable ultrasound parameter for predicting spontaneous preterm birth in low-risk singleton pregnant women. Combining the uterocervical angle and cervical length yielded stronger spontaneous preterm birth prediction values.

Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study

ObjectiveTo compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methodsPelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. ResultsPuborectal hiatus distance was higher in the HD group (59.2 ​± ​8.7 ​mm vs. 55.5 ​± ​7.1 ​mm, p ​= ​0.03). Similarly, the distance to the M line was greater in the HD group (18.3 ​± ​4.8 ​mm vs. 16 ​± ​4.6 ​mm, p ​= ​0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 ​± ​291.4 ​mm2 vs. 1897.5 ​± ​352.5 ​mm2, p ​= ​0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p ​= ​0.03). There was a negative correlation between birthweight and obturator internus muscle area (r ​= ​−0.388, p ​= ​0.02), and a positive correlation with M line distance (r ​= ​0.344, p ​= ​0.04). ConclusionLevator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.

Utero-cervical angle to predict the risk of spontaneous preterm birth: a review of literature.

The aim of this paper was to evaluate the predictive role of the uterocervical angle (UCA) in spontaneous preterm birth (sPTB). A systematic review of the literature was performed including all studies reporting the association between UCA and sPTB. Searches were performed with the use of a combination of keywords: "cervical length," "uterocervical angle," and "preterm birth" from inception of each database to March 2022. The statistical evaluations were carried out using the Comprehensive Meta-Analysis version 3 (Biostat Inc. USA). Sixteen studies all conducted on the second trimester UCA as well as its association with sPTB were included in this study. In all studies the measurements of cervical length (CL) and UCA were performer in the second trimester, except in one that in the third trimester. In most studies the CL is greater than 30 mm and the UCA is greater than 110 °. In seven studies women with symptoms were considered while in 8 studies the women were asymptomatic. It is too early for it to reach a firm conclusion on UCA utilization in clinical settings. A higher UCA measurement (greater than 150°) is an important risk factor for deliveries before 37 weeks' gestation. It provides a higher diagnostic performance in high risk patients than the CL measurement. However, the most relevant ultrasound parameter for the prediction of delivery within the next few data in women with preterm delivery remains the cervical length. There is a need to consider both markers and create protocols so that the values obtained with UCA and those with CL can make a real contribution to decisions to be made rather than using only CL.

Changes of uterocervical angle and cervical length in early and mid-pregnancy and their value in predicting spontaneous preterm birth.

Objective: To explore the feasibility of transvaginal ultrasound measurement of uterocervical angle (UCA) and cervical length (CL) in early and mid-pregnancy and evaluate their combined prediction of spontaneous preterm birth (sPTB) in singleton pregnancies. Patients and Methods: This retrospective study comprised 274 pregnant women who underwent transvaginal ultrasound measurement of CL in mid-pregnancy (15-23+6weeks); in 75 among them, CL also had been measured in early-pregnancy (<14 weeks). These 274 pregnant women were further divided into a preterm group (n = 149, <37weeks gestation) and a control group (n = 125, >37weeks gestation) according to delivery before or after 37weeks, respectively. In the preterm group, 35 patients delivered before 34weeks and the remaining 114 delivered between 34 and 37weeks. Results: The optimal threshold of CL to predict preterm birth risk in women with <37weeks gestation was 3.38cm, and the optimal threshold of the UCA to predict preterm birth risk in the same group of women was 96°. The optimal threshold of CL to predict preterm birth risk in women with <34weeks gestation was 2.54cm, while that of the UCA in the same group of patients was 106°. The area under the curve for predicting preterm birth by combining the UCA and CL measurements was greater than that by using the UCA or CL alone (p < 0.01). The sensitivity and specificity for predicting preterm birth at <34 weeks gestation was 71.7% and 86.4%, respectively; and the sensitivity and specificity for predicting preterm birth at <37weeks gestation was 87.6% and 80.6%, respectively. The difference between the two groups in CL and UCA were not significant in early pregnancy (p > 0.01), but only in mid-pregnancy (p < 0.01). There was a negative correlation between UCA and gestational week at delivery (r = -0.361, p < 0.001) and a positive correlation between CL and gestational week at delivery (r = 0.346, p < 0.001) in mid-pregnancy. The proportion of deliveries at <34 weeks was highest when the UCA was >105°, and the proportion of deliveries between 35 and 37weeks was highest when the UCA was between 95° and 105°. The proportion of deliveries at <34weeks was highest when the CL was <2.5cm. Conclusion: The combination of UCA and CL has a better ability to predict preterm birth than either measurement alone. A more obtuse UCA or a shorter CL is associated with an earlier spontaneous preterm birth. The UCA increases from early to mid-pregnancy, while the CL decreases from early to mid-pregnancy.

The utility of combined utero-cervical ındex in predicting preterm delivery in pregnant women with preterm uterine contractions.

To evaluate the utility of a novel ultrasound index "combined utero-cervical index (CUCI)" in the prediction of preterm delivery. The present prospective cohort study was conducted in Ankara Bilkent City Hospital Perinatology Clinic between January 1, 2023, and March 31, 2023. Pregnant women with uterine contractions between 24 and 36th gestational weeks but did not have dilatation or effacement were included. CUCI was calculated as: (utero-cervical angle)/(anterior cervical lip thickness + fundal thickness + lower uterine segment thickness + cervical length). In the presence of cervical funneling, one point was added to the final result. A ROC analysis was conducted to determine the potential of CUCI in predicting delivery <37weeks of gestation, <34weeks of gestation, and <4weeks after the first admission to the hospital for uterine contractions, respectively. Optimal cut-off values of CUCI were found to be 1.4 (67.1% sensitivity, 67.2% specificity) for predicting delivery at <37th weeks, 1.7 (72.7% sensitivity, 65.7% specificity) for predicting delivery at <34th weeks, and 1.4 (62.5% sensitivity, 61.7% specificity) for predicting delivery at <4weeks. CUCI may be used in the prediction of preterm delivery for pregnant women admitted to hospital with preterm uterine contractions.

The Effect of Uterocervical Angle on Treatment Efficacy in First-Trimester Pregnancy Terminations

Aim: We aimed to evaluate the effectiveness and usability of the uterocervical angle, which we examined ultrasonographically before misoprostol treatment, which we used in first-trimester pregnancy terminations, and its relationship with the abortion time.&#x0D; Material and Method: This prospective study includes 207 pregnant women diagnosed with an ex-fetus in utero hospitalized for medical termination in a single center. These patients were divided into two groups patients whose treatment was completed in the first cycle and who needed additional cycles. The characteristics of all pregnant women, abortion times, and misoprostol doses used were compared with uterocervical angle and cervical length and analyzed between groups.&#x0D; Results: The mean age of the patients in the entire study group was 30.1±6.3, the median uterocervical angle was 112 degrees, and the cervical length was 36 mm. Increasing cesarean number and increasing uterocervical angle degree were positively correlated with increasing abortion time. The number of cesarean sections and the degree of uterocervical angle differ significantly between the group whose treatment was completed in the first cycle and the groups that needed additional cycles. In the treatment groups with elevated uterocervical angle degrees, the first cycle was higher than the successful group. Additional dose and cycle requirements arise if the uterocervical angle is &gt;110 degrees.&#x0D; Conclusion: Evaluation of the uterocervical angle in first-trimester medical terminations may guide the clinician in the early completion of treatment. With this evaluation before medical treatment, the duration of hospitalization can be shortened, and the need for surgical intervention for patients can be reduced.

The uterocervical angle-cervical length ratio: A promising predictor of preterm birth?

To predict spontaneous preterm birth (sPTB) (labor before 37 weeks of pregnancy) in low-risk singleton pregnancies during the second trimester, using ultrasound markers: uterocervical angle (UCA) and cervical length (CL). In a prospective observational cohort study, we followed primigravid women with singleton pregnancies without known risk factors for sPTB from 16+0-23+6 weeks of pregnancy until birth. Transvaginal ultrasonography on admission revealed the UCA and CL, and maternal history was obtained from submitted patient profiles. Logistic regression models disclosed significant predictive variables, and receiver operating curves (ROCs) demonstrated optimal cut-offs and test accuracy indices. Predictive functions of variables were compared using positive and negative likelihood ratios. In a sample of 357 participants, 41 (11.5%) experienced sPTB. UCA and CL were significantly associated with sPTB when adjusting for other variables (adjusted odds ratio: UCA 1.05, 95% confidence interval [CI] 1.02-1.07 and CL 0.82, 95% CI 0.75-0.90). Optimal cut-offs were estimated to be 106° and 33 mm for UCA and CL, respectively. We devised the novel index UCA/CL with an area under the ROC of 0.781 (95% CI 0.734-0.823), cut-off = 3.09°/mm, and improved likelihood ratios (positive: 3.18, 2.47, and 4.22; negative: 0.63, 0.52, and 0.51 for UCA, CL, and UCA/CL, respectively). The second-trimester UCA/CL was found to be a promising index to predict sPTB in low-risk singleton pregnancies. Further multicenter studies may generalize this conclusion to other gestational ages or risk groups and make it more comprehensive by considering other risk factors.

Prediction of Preterm Birth with the Uterocervical Angle in Singleton Pregnancies Treated with a Cervical Pessary.

Cervical pessaries are an established therapy option for patients at risk for spontaneous preterm birth (sPTB). The uterocervical angle (UCA) remains a promising sPTB predictor. However, its clinical significance has yet to be described in patients treated with a pessary. This study analyzed data of patients treated with a pessary because of cervical shortening in singleton pregnancies. The patients were divided into 2 groups according to transvaginal ultrasound findings: the funneling group (n = 68) and the no-funneling group (n = 42). Moreover, we analyzed patients within these prespecified groups according to the UCA < 95° and ≥ 95°. Delivery occurred significantly earlier in patients treated with a pessary and with a high UCA ≥ 95°(p = 0.006). The median gestational age at delivery in patients treated with a pessary and with no funneling and a UCA < 95° vs. ≥ 95° were 39.00 and 36.14 weeks, respectively (p = 0.005). In cases with funneling and a UCA < 95° vs. ≥ 95° the mean gestational age at delivery was 38.14 and 38.07 weeks respectively (p=1,00). There was a significant negative linear correlation between UCA and the gestational age at delivery in all patients (p = 0.04), which was even profound in the group without funneling (p = 0.0002). However, we found no significant correlation between cervical length and gestational age at delivery in all patients (p = 0.42) as well as in the group without funneling (p = 0.28). In spite of pessary treatment, patients with UCA ≥ 95° presented with a higher risk of sPTB compared to patients with UCA < 95°. This suggests that the UCA seems to be a better predictor of sPTB than the cervical length in patients receiving pessary treatment.

Distribution of uterocervical angles in singleton pregnancy at gestational age 16 - 24 weeks

The uterocervical angle (UCA) has recently been studied as a parameter to identify women at risk for spontaneous preterm birth (PTB). Objective: This study aimed to investigate the distribution of UCA values by transvaginal sonography (TVS) at gestational age (GA) 16 - 24 weeks of singleton pregnancy. Study design: TVS was performed in 1.039 singleton pregnancies, viable fetuses at gestational age (GA) 16 - 24 weeks, at the Department of Pregnancy Management &amp; Prenatal Diagnosis, Hai Phong Obstetric and Gynecology Hospital from September 2019 to June 2020. The UCA distribution by GA was visualized using a scatter plot. The range of UCA values and their relationship with GA were assessed using quantile regression analysis. P &lt; 0.05 was considered statistically significant. Results: The normal range of UCA (5th and 95th percentiles) was from 46.99 degrees (95% CI: 35.45o - 44.31o) to 125.38 degrees (95% CI: 128.92o – 139.32o) with significant changes during this GA period (2.0 degrees per week, p &lt; 0.001). Conclusion: The value of the UCA increases significantly with gestational age from 16-24 weeks, so it is advisable to monitor and evaluate the UCA, especially in pregnant women at high risk for PTB. Key words: uterocervical angle, preterm birth, singleton pregnancy

Uterocervical angle and cervical length as predictors for preterm birth in low-risk women

Uterocervical angle and cervical length as predictors for preterm birth in low-risk women

Anterior uterocervical angle: is it an ultrasonographic screening tool that estimates the latent phase duration in post term pregnancies?

In recent years, in addition to cervical length measurement, a new ultrasonographic parameter has been defined as uterocervical angle (UCA), which can be used in the prediction of preterm labor. In this study,we evaluated the place of uterocervical angle in predicting the latent phase duration in postterm pregnancies. This prospective study consists of 90 pregnant women aged between 18 to 40 years who were hospitalized with a diagnose of late term pregnancy. Pregnant women with a latent phase duration of 1200 minutes or less were defined as Group 1. Patients with latent phase duration over 1200 minutes were defined as Group 2. All patients' age, BMI, smoke, cervical length measurements, uterocervical angle, latent and active phase of labor durations, length of the third stage and delivery types were compared. The UCA median value of group 1 was 120 (94-147), and group 2 was 99 (94-105) (p < 0.001). CL medians of Groups 1 and 2 were 29 (17-43) and 28 (27-41) respectively (p: 0.871). UCA (AUC: 0.917, p < 0.0001) significantly predicted prolonged latent phase duration. Optimal cut off value was obtained at the value of 105 degree (100% sensitivity, 75% specificity) for UCA. Kaplan-Meier survival analysis showed that duration of labor was significantly higher in a group with low UCA (p: 0.013). UCA can be a successful tool that can be used to predict duration of labor in cases of postterm pregnancies with medical induction.

Assessment of utero-cervical angle and cervical length as predictors for threatened preterm delivery in singleton pregnancies.

The aim of this study was to evaluate the relationship between the cervix and the threat of preterm labor in singleton pregnancies between gestational weeks less than 37 and greater than 37 weeks in correlation with utero-cervical angle (UCA) and cervical length (CL) measurements. We conducted a prospective cohort study with UCA and CL measurements in patients with threatened preterm labor (TPL). Primary outcome was differences in UCA and CL measurements in relationship to maternal characteristics and perinatal outcome between groups. Secondary outcome evaluated measurement results and influencing factors for delivery within 7 days, between 1 and 4 weeks and beyond 4 weeks. Overall 152 patients were divided into as study/preterm group (<37 weeks; n = 56) and the control/term group (≥37 weeks; n = 96). Mean gestational age at admission was similar in both groups (30.98 ± 2.83 vs. 30.36 ± 2.63 weeks, p = 0.149) with similar CL (33.9 ± 6.34 vs. 32.02 ± 8.88 mm, p = 0.132), but wider UCA in the preterm group (81.65 ± 16.81° vs. 99.21 ± 22.33°, p < 0.001). Multivariate logistic regression analysis for preterm delivery was significant for nulliparity and UCA measurement. The factor for delivering before 37 gestational weeks within 7 days was the gestational week at admission (p = 0.046). UCA and CL measurements were statistically significant for distinguishing patients for delivery within 7 days and beyond 4 weeks (p = 0.001 for CL and p = 0.0001 for UCA). NPV was found 92.5, 92.2, and 92.3 for UCA >105°, CL ≤30 mm, and Bishop score >3, respectively. Combined measurement of TV UCA and CL represents stronger predictors for sPTB ultrasonographically, demonstrating the uterocervical sub-segment maturation before the active onset of labor.

Role of Uterocervical Angle, Cervical Length, and Cervicovaginal Fetal Fibronectin in the Prediction of Preterm Birth

BACKGROUND:Cervical length measurement and fetal fibronectin (FFN) are widely used to estimate the risk of preterm birth. Another potential predictor of preterm birth is the uterocervical angle, and this additional measurement may improve the risk assessment. This study aimed to predict the onset of labor in women who present with preterm labor through cervical length, uterocervical angle, and FFN.METHODS:A prospective cohort study was carried out on 90 symptomatic women at high risk of preterm labor attending the Gynecology and Obstetrics department at Fayoum University Hospital. FFN in the cervicovaginal fluid was assessed by ELISA technique. The uterocervical angle and cervical length were measured by transvaginal ultrasound. Maternal history and pregnancy data were recorded. Delivery data were subsequently collected.RESULTS:The average age was 21.79 ± 3.3 years, and the average body mass index (BMI) was 24.6 ± 5.8 kg/m2. The mean gestational age (GA) was 32.83 ± 2.3 weeks. Twelve women in our cohort reported previous preterm labor. The cervical length and FFN showed better sensitivity and specificity compared with the uterocervical angle in predicting preterm birth. Logistic regression analysis demonstrated that preterm birth depended only on the cervical length and quantitative FFN.CONCLUSION:The combination of FFN and cervical length could improve preterm birth prediction accuracy.

Value of post-cerclage transvaginal ultrasound in predicting preterm birth at

Objective To evaluate the value of transvaginal ultrasound parameters before and after cerclage in twins in predicting spontaneous preterm birth (sPTB) before 28+0 weeks. Methods We retrospectively studied the medical records of twin-pregnant women who underwent ultrasound-indicated cerclage between January 2016 and February 2022 at our hospital. Recorded transvaginal ultrasound images before and after cerclage were reassessed for cervical length (CL), uterocervical angle (UCA), funneling, and sludge. Multivariate logistic and Cox regression analyses were performed to identify the independent risk factors associated with sPTB before 28 weeks. Results A total of 69 women were included. Among them, 17 women (24.64%) delivered before 28 weeks of age. Regression analysis revealed a significant association of post-cerclage CL, UCA, white blood cell (WBC) count, and gestational age (GA) at cerclage with sPTB before 28 weeks. The area under the curve of these predictors was 0.938 (95% confidence interval, 0.882–0.994; p < .001), with a sensitivity of 88.2%, specificity of 92.3%, positive predictive value of 78.9%, and negative predictive value of 96.0%. Cox analysis showed that post-cerclage UCA was an independent risk factor affecting the cerclage-to-delivery interval (hazard ratios, 1.026; 95% confidence interval (CI), 1.004–1.048; p = .019). Conclusions The combination of post-cerclage CL, UCA, WBC count, and GA at cerclage showed good performance in predicting sPTB at <28 weeks in twin pregnancy. Post-cerclage UCA is also associated with pregnancy latency. We found that post-cerclage cervical ultrasound may be useful to predict preterm birth before 28 weeks in twins who undergo ultrasound-indicated cerclage.

Anterior Uterocervical Angle and Prediction of Preterm Labor in Cases with an Inconclusive Cervical Length: A Prospective Cohort Pilot Study

Anterior Uterocervical Angle and Prediction of Preterm Labor in Cases with an Inconclusive Cervical Length: A Prospective Cohort Pilot Study

Role of Uterocervical Angle, Cervical Length and Cervicovaginal Fetal Fibronectin (FFN) for Prediction of Labor Onset in Women Who Present with Preterm Labor

Role of Uterocervical Angle, Cervical Length and Cervicovaginal Fetal Fibronectin (FFN) for Prediction of Labor Onset in Women Who Present with Preterm Labor