Document Type : original article
Authors
- Soghra Khazardoost 1
- Mahdieh Sadat Modarresi 2
- Masoumeh Shafaat 2
- Seyedeh Mojgan Ghalandarpoor-Attar 2
- Seyedeh Mahya Modaresi 2
1 Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2 Department of Perinatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: This study aimed to assess the diagnostic value of novel ultrasonographic markers, Anterior Uterocervical Angle (AUA), Cervical Consistency Index (CCI) and Cervical Glandular Area (CGA) in the Prediction of Preterm Birth (PTB), in a general population.
Methods: We conducted a prospective cohort study on singleton gestations between 16 -24 weeks undergoing transvaginal sonography for Cervical Length (CL) screening. AUA, CCI and CGA were evaluated. The primary outcome was prediction of spontaneous PTB before 37 weeks’ gestation by UCA, CCI and CGA. The secondary outcome was evaluating performance of these markers alone and in combination with CL to predict PTB.
Results: A total of 310 women were studied. The rate of PTB in this population was 10.6 % for delivery before 37 weeks. In the PTB group, the shorter CL, the wider AUA and the lower CCI were significant, but the CGA width and area were not significantly different in term and PTB groups. The optimal cut-off based on the ROC curve was 33.15 mm for CL (sensitivity: 57%; specificity: 68%), 102.5 degrees for AUA (sensitivity: 50%; specificity: 80%), and 60.3% for CCI (sensitivity: 43%; specificity: 68%).
Conclusions: Our data indicate that the combination of CL and CCI (positive likelihood ratio:3; negative likelihood ratio:0.7) and the combination of CL and AUA (positive likelihood ratio:4.8; negative likelihood ratio:0.76) are better methods for the prediction of spontaneous PTB before 37 weeks; and can be used as a screening tool in the second trimester.
Keywords
- Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gülmezoglu M. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modeling analysis. Lancet Glob Health. 2019 Jan; 7(1): e37-e46.
- Vakilian K, Ranjbaran M, Khorsandi M, Sharafkhani N, Khodadost M. Prevalence of preterm labor in Iran: A systematic review and meta-analysis. Int J Reprod Biomed. 2015 Dec; 13(12):743-8.
- Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D'Antonio F, Feltovich H, Salomon LJ, Sheehan P, Napolitano R, Berghella V, Costa FdS. ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2022 Sep; 60(3):435-456.
- Jung EY, Park JW, Ryu A, Lee SY, Cho SH, Park KH. Prediction of impending preterm delivery based on sonographic cervical length and different cytokine levels in cervicovaginal fluid in preterm labor. J Obstet Gynaecol Res. 2016 Feb; 42(2):158-65. doi: 10.1111/jog.12882. Epub 2015 Nov 10. PMID: 26556477.
- Iams J. D., Goldenberg R. L., Meis P. J., et al. The Length of the Cervix and the Risk of Spontaneous Premature Delivery. The New England Journal of Medicine. 1996; 334(9):567–573.
- Kahyaoglu S, Kahyaoglu I, Kaymak O, Sagnic S, Mollamahmutoglu L, Danisman N. 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. J Matern Fetal Neonatal Med. 2013 Jun; 26(9):920-5.
- Myers KM, Feltovich H, Mazza E, Vink J, Bajka M, Wapner RJ, Hall TJ, House M. The mechanical role of the cervix in pregnancy. J Biomech. 2015 Jun 25; 48(9):1511-23.
- Oskovi Kaplan ZA, Ozgu-Erdinc AS. Prediction of Preterm Birth: Maternal Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overview. J Pregnancy. 2018 Oct 10; 2018:8367571.
- Sekiya T, Ishihara K, Yoshimatsu K, Fukami T, Kikuchi S, Araki T. Detection rate of the cervical gland area during pregnancy by transvaginal sonography in the assessment of cervical maturation. Ultrasound Obstet Gynecol. 1998 Nov; 12(5):328-33.
- Dziadosz M, Bennett TA, Dolin C, West Honart A, Pham A, Lee SS, Lee SS, Pivo S, Roman AS. Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol. 2016 Sep; 215(3):376. e 1-7.
- Sochacki-Wójcicka N, Wojcicki J, Bomba-Opon D, Wielgos M. Anterior cervical angle as a new biophysical ultrasound marker for prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2015 Sep; 46(3):377-8.
- Farràs Llobet A, Regincós Martí L, Higueras T, Calero Fernández IZ, Gascón Portalés A, Goya Canino MM, Moratonas EC. The uterocervical angle and its relationship with preterm birth. J Matern Fetal Neonatal Med. 2018 Jul; 31(14):1881-1884.
- Sawaddisan R, Kor-Anantakul O, Pruksanusak N, Geater A. Uterocervical angle measurement for preterm birth prediction in singleton pregnant women with no history of preterm birth and normal cervical length: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2020 Sep; 252:30-35.
- Farràs Llobet A, Higueras T, Calero IZ, Regincós Martí L, Maiz N, Goya MM, Carreras E. Prospective evaluation of the uterocervical angle as a predictor of spontaneous preterm birth. Acta Obstet Gynecol Scand. 2020 Nov; 99(11):1511-1518.
- Khamees RE, Khattab BM, Elshahat AM, Taha OT, Aboelroose AA. Uterocervical angle versus cervical length in the prediction of spontaneous preterm birth in singleton pregnancy. Int J Gynaecol Obstet. 2022 Feb; 156(2):304-308.
- Parra-Saavedra M, Gómez L, Barrero A, Parra G, Vergara F, Navarro E. Prediction of preterm birth using the cervical consistency index. Ultrasound Obstet Gynecol. 2011 Jul; 38(1):44-51.
- Baños N, Murillo-Bravo C, Julià C, Migliorelli F, Perez-Moreno A, Ríos J, Gratacós E, Valentin L, Palacio M. Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low-risk population. Ultrasound Obstet Gynecol. 2018 May; 51(5):629-636.
- Baños N, Julià C, Lorente N, Ferrero S, Cobo T, Gratacos E, Palacio M. Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population. AJP Rep. 2018 Jan; 8(1): e43-e50.
- Van der Merwe J, Couck I, Russo F, Burgos-Artizzu XP, Deprest J, Palacio M, Lewi L. The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study. J Clin Med. 2020 Jun 8; 9(6):1784.
- Fukami T, Ishihara K, Sekiya T, Araki T. Is transvaginal ultrasonography at mid-trimester useful for predicting early spontaneous preterm birth? J Nippon Med Sch. 2003 Apr; 70(2):135-40.
- Pires CR, Moron AF, Mattar R, Diniz AL, Andrade SG, Bussamra LC. Cervical gland area as an ultrasonographic marker for preterm delivery. Int J Gynaecol Obstet. 2006 Jun; 93(3):214-9.
- Grgic O, Matijevic R, Vasilj O. Qualitative glandular cervical score as a potential new song morphological parameter in screening for preterm delivery. Ultrasound Med Biol. 2006 Mar; 32(3):333-8.
- Bortoletto TG, Silva TV, Borovac-Pinheiro A, Pereira CM, Silva AD, França MS, Hatanaka AR, Argenton JP, Passini Jr R, Mol BW, Cecatti JG, Pacagnella RC. Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis. PLoS One. 2021 Feb 16; 16(2): e0245746.
- Vink J, Feltovich H. Cervical etiology of spontaneous preterm birth. Semin Fetal Neonatal Med 2016; 21(02):106–112.
)