Uterocervical Angle Research Articles

Uterocervical angle versus cervical length in the prediction of spontaneous preterm birth in women with history of spontaneous preterm birth: a prospective observational study

BackgroundPreterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth.Patients and MethodsThis was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcome.ResultsThe incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.ConclusionUterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided.Trial registrationNCT05632003 (First posted date: 30/11/2022).

Investigating the predictive role of uterocervical angle in predicting preterm labor in singleton pregnancies: a meta-analysis.

In this meta-analysis, we aimedto demonstrate the relationship between uterocervical angle and preterm labor in singleton pregnancies more clearly and reliablywith this meta-analysis. In this study, we use keywords such as "uterocervical angle," "cervical angle," "angle," "cervix," "cervical," "preterm," and "preterm labour." We searched various databases, including PubMed, MEDLINE, ClinicalKey, Scopus, ScienceDirect, Web of Science, and Google Scholar. The search encompassed the period from January 1, 2010, to December 27, 2020. As a result of the literature review, a total of 585 articles were identified. After the screening and selection process, six studies met the inclusion criteria and were included in the analysis. These six studies were deemed relevant and provided valuable information on the research topic. When the Egger test (p = 0.020) and Begg test (p = 0.188) were performed, no significant publication bias was found in the studies examined. These statistical tests assess publication bias, and the resulting p-values indicate a low probability of bias in the included studies. Cochran's Q test revealed the presence of heterogeneity among the included studies. Heterogeneity indicates variability in the results beyond what would be expected by chance alone. This finding suggests that the studies may differ in methodologies, populations, or other factors, which could impact the overall results and require further investigation. There was a significant difference between the patient and control groups (p < 0.001). This result provides strong evidence to support the importance of the difference between the two groups compared. Based on the findings of this study, a wider uterocervical angle appeared to be significantly associated with an increased risk of preterm delivery in overall effect. It concluded that a wide uterocervical angle may be a potential risk factor for preterm delivery. Moreover, the study revealed a significant association between wider uterocervical angles and an elevated risk of preterm labour in singleton pregnancies. In this study, the definition of preterm birth accepts as birth before 37 weeks of gestation. These results highlight the potential significance of evaluating the uterocervical angle as a meaningful predictor for identifying the propensity of preterm labour in singleton pregnancies.

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

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&lt;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).

Measuring Cervical Length and Uterocervical Angle as a Tool to Predict Preterm Labor in Pregnant Women

Measuring Cervical Length and Uterocervical Angle as a Tool to Predict Preterm Labor in Pregnant Women

P-315 To study the efficacy of Transvaginal ultrasound-guided Embryo Transfer over Transabdominal ultrasound-guided Embryo Transfer in transfers with poor visibility due to obesity or marked retroversion

Abstract Study question Why is Transvaginal guided embryo transfer,understudied and underutilised in difficult cases of embryo transfers with compromised visibility of uterine canal in Transabdominal ultrasound ? Summary answer In patients with poor visibility of uterine canal using TAUS due Obesity, retroveted uterus,PID,pelvic adhesions, endometriosis, TVUS-ET gives significantly higher clinical Pregnancy rates. What is known already TAUS-ET is most popular method of Embryo transfer worldwide. Despite the benefits , this procedure also presents some important drawbacks. Firstly, TAUS-guided ET requires an assistant to operate the transducer while physician performs ET procedure. Moreover, patient needs to fill her urinary bladder to enable visualization of uterine canal, which causes discomfort and sometimes uterine cramping during ET, which in turn can negatively impact implantation rates.TVUS is the main technique used in all other gynecological investigations. Because of high frequency and close proximity to target area, TVUS transducers provide better resolution of the uterocervical angle and improved overall image quality. Study design, size, duration This retrospective study was conducted to compare efficacy of TVUS-guided ET to conventional TAUS-guided ET in difficult transfers, who underwent treatment at Triveni IVF, Darbhanga, India between November 2020 to December 2022. It was based on data extracted from records of all women who underwent difficult TAUS-ET procedure between Nov 2020 to Nov 2021.Data from records of matching number of women who underwent TVUS-ET procedure between Dec 2021 to Dec 2022 were used for comparison. Participants/materials, setting, methods All were ICSI and FET transfers. Inclusion criteria: (1) All included between 25–35 years of age with difficult visualisation of uterine canal during TAUS-Mock ET in previous cycle (2) BMI ≥ 30; (3) Retroverted uterus due to any underlying pathology 4)All pts included had good ovarian reserve; (4) unexplained infertility &amp;gt;3 years. Exclusion criteria: (1) severe male factor infertility, (2) any intrauterine factor of infertility (3) ovarian endometrioma or PCOS and (5) multiple ICSI failure (&amp;gt;3 trials). Main results and the role of chance Total of 123 cycles,61 guided by TVUS (Group 1) and 62 TAUS (Group 2) were included. Our results showed significantly higher Clinical Pregnancy rate in TVUS group as compared to TAUS group, in difficult transfers (43.3% vs. 36.1 % p = 0.0045). VAS (visual analog scale) of the pain during ET was significantly less in TVUS group in comparison to TAUS group (17% vs 64% p = 0.0001), also the abdominal discomfort was significantly less in TVUS group in comparison to TAUS group (11% vs. 69 % p = 0.0001). TVUS-ET group showed significantly higher CPR as it has better resolution due to proximity to target organs allowing proper visualization of catheter tip especially in cases with obesity and marked uterine retroversion.TVUS has superior role in cases with difficult transfer because it can easily analyze the cause of difficult transfers as endocervical crypts, marked anteverted uterus, cervical canal tortuosity. Another advantage of TVUS is requiring emptied urinary bladder in contrast to TAUS. Full bladder is both time consuming and causes abdominal discomfort and uterine cramps leading to increased patient anxiety.As regards to abdominal discomfort and uterine cramps, there was extremely high statistical significance between the two groups in our study. Limitations, reasons for caution Despite the wide benefits,TVUS-ET has not been widely adopted, on account of difficulty in manipulating ET catheter and vaginal transducer simultaneously in very constricted area.Other comfortable approaches that may assist physicians such as inner catheter can be pushed by embryologist while physician holds TVS-probe and outer catheter in place. Wider implications of the findings The results suggested that TVUS-guided ET was better in difficult transfers with poor visibility of uterine canal in studied sample. This technique presented deserves consideration for wider use since it can offer better visualization, excellent comfort to patients during the procedure, and requires only one operator. Trial registration number Not applicable

Distribution of uterocervical angles of pregnant women at 16+ 0 to 23+ 6 weeks gestation with low risk for preterm birth: first vietnamese cohort of women with singleton pregnancies

BackgroundCervical length (CL) measured by ultrasound in the second trimester is a predictor of spontaneous preterm birth (sPTB). The uterocervical angle (UCA) has recently been suggested as a predictor to identify women at risk of sPTB. The aim of this study was to investigate the UCAs’ distribution in singleton pregnant women at 16+ 0 − 23+ 6 weeks of gestation with low risk for sPTB.MethodsThis was a prospective cohort study of 1,051 pregnant women with singleton pregnancies at low risk for preterm delivery. Pregnant women with a viable singleton fetus at 16+ 0 − 23+ 6 weeks of gestation were enrolled in the study conducted at the Haiphong Hospital of Obstetrics and Gynecology, Vietnam, from 09/2019 to 09/2020. CL and the UCA were assessed using transvaginal ultrasonography (TVS) by a single sonographer. Subjects were followed-up until the end of pregnancy, and maternal and neonatal outcomes were recorded. The UCAs’ range and their relationship with gestational age were evaluated using regression analysis. P < 0.05 was considered statistically significant.ResultsThe normal range of the UCA (5th − 95th percentiles) was 46.47° (95% CI, 40.27°-51.81°) to 127.06° (95% CI, 123.02° − 130.71°). The UCAs in the preterm birth (< 37 weeks) and full-term groups were 117.86° ± 20.25° and 83.80° ± 24.18°, respectively (p < 0.001). Linear regression analysis showed a significant change in the UCA range from 16+ 0 to 23+ 6 weeks of gestation (2.51 degrees per week, p < 0.001). The linear function yielded the highest correlation coefficient in the variation rule of the UCA values (r = 0.22). A total of 42/63 (66.7%) patients with preterm birth < 37 weeks had a UCA above the 75th percentile. The majority of women with preterm birth had a UCA ≥ 95° compared with those with full-term delivery (88.9% vs. 31.3%, p < 0.001).ConclusionsThe results of this study present background information about the normal range of UCA values in singleton pregnant women at 16+ 0 to 23+ 6 weeks at low risk for sPTB in this Vietnamese cohort. In this study population at low risk for sPTB, pregnant women with a UCA value ≥ 95o were also considered at risk for preterm birth.

Correlation of Cervical Length, Anterior Uterocervical Angle, and Cervical Elastography with the Incidence of Preterm Labor

Abstract Objectives The aim of this study is to find the correlation of cervical length, anterior uterocervical angle, and cervical elastography with the incidence of preterm labor through evaluation by transvaginal ultrasonography during routine anomaly scan and to analyze the correlation of the parameters with each other. Methods Cross-sectional comparative study was undertaken on singleton pregnant women coming for anomaly scan between 18 and 24 weeks. Cervical length and anterior uterocervical angle were measured in the mid-sagittal section. Strain elastography was used for measuring cervical strain. Color map was obtained for the entire cervix and the color code for the degree of cervical stiffness was noted. Results Though the mean value of cervical length was significantly lower in preterm group (3.2 cm) than in term group (3.6 cm), it was more than the cutoff value of 2.5 cm, below which it is routinely considered as short cervix indicative of preterm labor. Mean value of anterior uterocervical angle was significantly higher in women with preterm (112.3 degrees) delivery than those with term (82.2 degrees) delivery. Mean strain values of cervical elastography were significantly different in term (0.130) and preterm groups (0.179). Color code in elastography was independent of preterm labor. There was a significant positive correlation of cervical length with gestational age at delivery (GAD). A significant negative correlation was observed between acute anterior uterocervical angle with the GAD. Conclusion Anterior uterocervical angle has a definitive role in the prediction of preterm labor and so it can be combined with the conventional cervical length screening in identifying women with normal cervical length who are at high risk of preterm labor. Cervical elastography assesses the cervical consistency and also has the potential for identifying high-risk women.

Uterocervical Angle Anterior, Posterior, and Cervical Length Ultrasound as a Predictors for Successful Delay in Labor of Pregnant Women with Threatened Preterm Birth (PTB)

Introduction: To determine whether the examination of the uterocervical angle anterior, posterior, cervical length, and combination can be used as a predictor of successful delay in labor in patients with threatened preterm birth (PTB). Methods: This is a prospective cohort analytical observational study of 44 women admitted to our hospital gestational age 28-36 weeks diagnosed with threatened preterm birth. Cervical length, anterior uterocervical angle, and posterior uterocervical angle examinations were performed. Patient then observed for 2x24 hours whether there was a delay in labor or not. If there is a delay, the patient followed until delivery. Results: CL cut off value > 2.66 cm delaying labor for 2x24 hours and > 2.81 cm delaying labor until term. UCA posterior cut off value < 113.2o delaying labor for 2x24 hours and < 107.8o delaying labor until term. Anterior UCA cut off values < 103.2o delaying labor for 2x24 hours and < 93.1o delaying labor until term. Statistical Analysis showed that CL was significant as a single tool for predictor of delayed labor either 2x24 hours or up to term, while posterior and anterior UCA was not. But if this 3 single tools combinate, CL, anterior UCA, and posterior UCA was statistically significant as a predictor of delay in labor either 2x24 hours or until term, with the best predictive value is a combination of CL and posterior UCA of 25.2% for predicting delay of labor 2x24 hours and the combination of CL, posterior, and anterior UCA was 24.6% for predicting delay labor until term. Conclusion: Cervical length ultrasound examination and the combination of CL, anterior UCA, and posterior UCA can be predictors of delayed labor in patients with threatened preterm birth but not for anterior and posterior uterocervical angle as a single tool.

How does the type of delivery affect pelvic floor structure? MRI parameter-based anatomical study.

The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI). This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared. Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019). These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.

Osteopathic Manual Therapy along with Cranial Electric Stimulation in Primary Dysmenorrhoea

Primary dysmenorrhoea is described as lower abdominal discomfort that occurs soon before or during menstruation but pathology is called secondary dysmenorrhoea. Gynaecological dysfunctions are routinely treated using osteopathy and other physiotherapy treatments. The case report determines pre and postuterocervical angle, pain, physical activity level and psychological state after osteopathy manual therapy and conservative management on primary dysmenorrhoea. A 22-year-old female was diagnosed with primary dysmenorrhoea and was referred to the physiotherapy Outpatient Department (OPD) for conservative management. Physiotherapy assessment included Visual Analog Scale (VAS) for pain, International Physical Activity Questionnaires (IPAQ) for physical activity and Depression, Anxiety and Stress Scale-21 Items (DASS-21) for psychological assessment at baseline. She received Cranial Electric Stimulation (CES), osteopathic manual therapy, deep breathing exercise, core strengthening exercise, lower limb stretching exercises and music therapy for relaxation. She received intervention for seven days a month for four consecutive months during menstruation cycles. After four months, her pain and psychological status improved significantly, uterocervical angle increased and there was an increase in physical activity. Thus, CES with osteopathic manual therapy along with conventional therapy helps reduce pain, increase physical functions, improve psychological status and even has a positive effect on uterocervical angle.

The predictive role of second trimester uterocervical angle measurement in obstetric outcomes.

Objective:Uterocervical angle has been suggested as a marker to predict preterm birth. However, the literature has limited data about its predictive role in preterm delivery. Moreover, no evidence is present to clarify the role of second-trimester uterocervical angle in induction success and postpartum hemorrhage. Here, it was aimed to compare the role of uterocervical angle with cervical length in predicting preterm labor and assess the utility of the second-trimester uterocervical angle in induction success and postpartum hemorrhage.Materials and Methods:A total of 125 pregnant women, hospitalized with a diagnosis of preterm labor were included in the study. Sonographic measurements of cervical length and uterocervical angle were performed between 16 and 24 weeks of gestation. The demographic, obstetric, laboratory, and sonographic features of the participants were recorded. Patients were divided into subgroups as preterm and term; with and without induction success; with and without postpartum hemorrhage. Additionally, preterm cases were divided into subgroups as early and late preterm. Variables were evaluated between the groups.Results:Cervical length was shorter in the preterm group (30.74±6.37 and 39.19±5.36, p<0.001). The uterocervical angle was 100.85 (85.2-147) in preterm and 88 (70-131) degrees in terms that were statistically significant (p<0.001). Furthermore, the uterocervical angle was wider [126 (100.7-147) and 98 (85.2-114), p<0.001] in the early preterm group. When the groups with and without postpartum bleeding were compared, no significant difference was detected in terms of uterocervical angle [96.5 (71-131) and 88 (70-147), p=0.164]. Additionally, the uterocervical angle was wider in the successful induction group (p<0.001). An a uterocervical angle >85 degrees predicted preterm delivery with 100% sensitivity and 45.54% specificity [area under the curve (AUC)=0.743, p<0.001]. When the cervical length and uterocervical angle were evaluated together to predict preterm delivery, no significant difference was found (p=0.086). An a uterocervical angle >88 degrees predicted induction success with 84.78% sensitivity and 79.75% specificity (AUC=0.887, p<0.001).Conclusion:Our study revealed that the uterocervical angle can be a useful marker in predicting preterm labor and induction success, although it does not predict postpartum hemorrhage.

Assessment of Communication AFI and Uterocervical Angle with Pregnancy Duration in Patients with Pretem Premature Rupture of Membranes 24-34 Weeks

Background & Objective: Premature rupture of membranes (PROM) and preterm delivery are the most important problems observed in pregnancies that can cause many consequences. The present study investigated the relationship between amniotic fluid index (AFI) and uterocervical angle in patients with PROM between 24 and 34 weeks of gestation.Materials & Methods: This study was a cohort study carried out on 50 pregnant women with PROM. Inclusion criteria were 24 to 34 weeks of gestation and singleton deliveries. Demographic characteristics and pregnancy history of the subjects were determined through interviews and examinations. Moreover, AFI and uterocervical angle were determined based on ultrasound results. Subjects were followed up until delivery.Results: Mean age of the patients was 25.14±5.32 years; 23 patients (46%) had delivery latency less than 7 days. The mean uterocervical angle in the delivery latency group ≤7 was significantly higher than that in the group more than 7 days (P < /i> <0.001). Moreover, the mean AFI in the delivery latency group ≤7 was significantly higher (P < /i> <0.001). The uterocervical angle above 107.7 with a sensitivity of 87% and a specificity of 88.9% had a predictive power and its area under curve (AUC) was 0.912 (P < /i> <0.001). The mean AFI below 5.4 with a sensitivity of 81.5% and a specificity of 65.5% had a predictive power (AUC: 0.866, P < /i> <0.001). Conclusion: Uteroservical angle and AFI can be good predictors for assessing delivery latency in women with PROM. Furthermore, the mean uterocervical angle in the delivery latency group ≤7 days is significantly higher than that in the group more than 7 days, but conversely AFI is less.

Assessment of Utero-Cervical Angle as an ultrasound screening tool to predict spontaneous preterm birth in singleton pregnancy

Introduction: Several attempts have been made from healthcare professionals around the world to determine the effective methods for early prediction and prevention of preterm birth. Aim of Work: The aim of this study was to determine the predictive value for spontaneous preterm birth by using transvaginal ultrasonography of the uterocervical angle (UCA) in pregnant women with singleton pregnancy. Subjects and methods: This study was a prospective Case-control study that was conducted at Obstetrics and Gynecology Department at Al-Zahraa University Hospital and Kafr Elshiekh General Hospital. Results:Utero Cervical angle (UCA) was significantly increased in preterm group&gt;95 degree compared to control group (p&lt; 0.001). Also, CL was significantly decreased in preterm group less than 27mm compared to control group .By using ROC-curve analysis, UC can predict preterm birth with accuracy (75.4%). The sensitivity, specificity, PPV and NPV was 70%, 76%, 74.47% and 71.7% respectively (p&lt; 0.001). CL can predict preterm birth with accuracy (66%). The sensitivity, specificity, PPV and NPV was 74%, 62%, 66.07% and 70.45% respectively (p= 0.003). Conclusion: Ultrasonographic measurement of uterocervical angle performed in routine vaginal ultrasound during second trimester is a useful strategy in the prediction of preterm birth in pregnancies and better than cervical length alone.

The role of obstetric pessary and micronized progesteron in early preterm birth prevention in patients with multiple pregnancy

Background. Multiple pregnancy is a well-established risk factor for preterm birth. Prevention of early termination of pregnancy is a priority problem in obstetric practice.The aim. To evaluate the role of an obstetric pessary and micronized progesterone in the prevention of early preterm labor in patients with multiple pregnancies.Materials and methods. A prospective controlled study was conducted with the inclusion of 146 pregnant women with multiple pregnancies, which, depending on the methods of treatment, were divided into three groups: Group I (n = 67) – pregnant women who received micronized progesterone in combination with an obstetric pessary; Group II (n = 57) included women who received micronized progesterone; Group III (n = 22) consisted of patients with multiple pregnancies without therapy.Results. In Group I, the complex of an obstetric pessary and micronized progesterone allowed to reduce the frequency of preterm birth by 2.3 times (p = 0.008) in comparison with Group III, the frequency of births at gestational age ≤ 34 weeks – by 8.1 times (p = 0.005) in compared with Group III and 2.7 times (p &lt; 0.01) compared with Group II. In 70.4 % of pregnant women, the use of a complex of an obstetric pessary with micronized progesterone made it possible to prevent the formation of isthmiccervical insufficiency, which, according to sonography, was expressed in the dynamics of the utero-cervical angle towards a more obtuse one.Conclusion. The use of an obstetric pessary with micronized progesterone made it possible to reduce the risks of isthmic-cervical insufficiency by 7.7 % compared with patients who received only micronized progesterone therapy, and by 17.1 % compared with pregnant women who did not receive therapy.

Influence of Utero-cervical Angle and Cervical Length on Labor Induction

Background: Successful labor induction is clearly related to the state of the cervix. The utero-cervical angle and cervical length represent novel ultrasonographic markers. Aim: To assess the relationship between utero-cervical angle and cervical length and satisfactory response to labor induction. Methods: Prospective cohort study was conducted in Al-Elwyia Maternity Teaching Hospital for a period of six months; 100 cases were enrolled in the study, and a pre-labor induction measurement of utero-cervical angle and cervical length using transvaginal ultrasound scanning was followed up till the end of labor to estimate the rate of success of induction of labor. Results: 65 patients had successful induction of labor and 35 failed to do so. No differences were found in demographic data and previous obstetric history. Short cervical length and wide utero-cervical angle were found in successful induction of labor. A significant negative correlation was found between utero-cervical angle and labor duration. At the cutoff point of 97.5 degrees of utero-cervical angle, the sensitivity was 83.12%, specificity was 71.4%, positive predictive value was 84.38%, negative predictive value was 69.45% and the accuracy was 88%. At a cutoff point of less than 29.5 mm of cervical length, the sensitivity was 92.3%, specificity was 80%, positive predictive value was 89.55%, negative predictive value was 84.84% and the accuracy was 88%. Conclusion: Utero-cervical angle and cervical length may be independent predictors of successful induction of labor.

Prediction of preterm delivery in threatened preterm labour with short cervical length

In this study, we evaluated the value of the uterocervical angle (UCA), myometrial thickness (MT), sICAM-1, sVCAM-1, soluble E-selectin (sE-selectin) and pentraxin 3 (PTX3) levels in women with threatened preterm labour (TPL) in predicting spontaneous preterm birth (sPTB) within 14 days in symptomatic women with cervical length (CL) measurements between 10 and 25 mm. Forty-six patients diagnosed with TPL, 47 healthy pregnant women were evaluated in a case-control study. sE-selectin (AUC = 0.744, p = .007) and PTX3 (AUC = 0.711, p = .019) were found to be effective in predicting preterm delivery within 14 days. In conclusion, maternal sE-selectin and PTX3 levels may be helpful in identifying pregnancies that will deliver within 14 days in symptomatic women with CL measurements between 10 and 25 mm. However, maternal sICAM-1 and sVCAM-1 levels, MT and UCA are not effective in the prediction of sPTB in TPL pregnancies. Impact Statement What is already known on this subject? Aetiology of spontaneous preterm birth (sPTB) is unclear and believed to be multifactorial, infection, inflammation, vascular endothelial dysfunction and uteroplacental ischaemia are all considered to be related to preterm delivery syndrome. Transvaginal cervical length (CL) measurement is a good indicator of increased risk of sPTB. Inflammation is accepted to have a central role in the process of labour. What do the results of this study add? soluble E-selectin (sE-selectin) and pentraxin 3 (PTX3) levels may be helpful in identifying pregnancies that will deliver within 14 days in symptomatic women with CL measurements between 10 and 25 mm. What are the implications of these findings for clinical practice and/or further research? This study will help understand the important role of the inflammatory process in predicting spontaneous preterm birth.

Uterocervical Angle as a Screening Tool to Predict Preterm Birth [A341

Uterocervical Angle as a Screening Tool to Predict Preterm Birth [A341

Evaluation of the predictive role of anterior uterocervical angle in preterm labor in twin gestation through meta-analysis: anterior uterocervical angle and preterm labor in twin gestation

Multiple gestations are high-risk pregnancies with increased obstetric and perinatal risks. Preterm labor occurs in about half of twin pregnancies. Thus, prediction of the time of delivery and prevention of premature birth are very important in multiple gestations. Anterior uterocervical angle is a successful tool that has been used in the prediction of preterm labor in recent years. However there is only limited data about this issue for twin pregnancies in the literature. Here, we aimed to demonstrate the relationship between uterocervical angle and preterm labor in twin pregnancies more clearly and reliably with this meta-analysis. In this context, “twin gestation, uterocervical angle, cervical angle, angle, cervix, cervical, preterm and preterm labor” keywords were used and PubMed, Medline, ClinicalKey, Scopus, Science Direct, Web of Science, and Google Scholar database were searched between 1 January 2010 and 27 December 2020. Finally, a total of three studies were included in the analysis. Here, we found that uterocervical angle was associated with a higher risk of preterm delivery in the overall effect.

The effect of anterior uterocervical angle and cervical length on the development of pelvic inflammatory disease.

This study aims to compare the uterine body longitudinal axis, uterine body transverse axis, uterine cervix longitudinal axis and anterior cervical axis angle measured ultrasonographically between women with pelvic inflammatory disease (PID) and healthy controls. Women aged 18-45 years with PID and healthy controls were included in the study. Demographic characteristics, uterine body long axis, uterine body transverse axis, uterine cervix long axis and anterior cervical axis angle of PID patients and healthy controls were evaluated. Gravida, parity, history of smoking were significantly higher in the PID group (n= 75) than the control group (n= 74). The uterine body longitudinal axis (p= 0.001) and transverse axis (p= 0.005) were significantly lower, and the cervix longitudinal axis (p< 0.001) and the anterior uterocervical angle (p< 0.001) were significantly higher in the PID group than the control group. Binary logistic regression analysis showed that uterine body (UTX) longitudinal axis (p= 0.005), uterine cervix longitudinal axis (p < 0.001) and UCA (p < 0.001) were significant predictors of PID. Uterine body longitudinal axis, uterine cervix longitudinal axis, and UCA can be associated to PID.

Uterocervical Angle Assessment in the Second Trimester of Pregnancy as a Predictor for Preterm Delivery

Uterocervical Angle Assessment in the Second Trimester of Pregnancy as a Predictor for Preterm Delivery