Maternal and Fetal Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Maternal and Fetal Medicine Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Acta Obstet Gynecol Scand. 2020 Nov;99(11):1511-1518. doi: 10.1111/aogs.13879. Epub 2020 Jun 3.
The uterocervical angle has been proposed as an ultrasound marker to predict spontaneous preterm birth; however, the studies that provided this evidence were retrospective and their results heterogeneous. This study aimed to assess the ability of the uterocervical angle to predict spontaneous preterm birth before 34 and 37 weeks of gestation.
A prospective cohort study with singleton pregnancies between 19.0 and 22.6 weeks of gestation. Uterocervical angle and cervical length were measured by transvaginal ultrasound. Maternal history and pregnancy data were recorded. Delivery data were subsequently collected.
The final analysis included 1453 singleton pregnancies. Spontaneous preterm birth before 37 weeks occurred in 52 cases (3.6%) and before 34 weeks in 17 (1.2%). For the prediction of spontaneous preterm birth before 34 weeks, the area under the curve for the uterocervical angle was 0.67 (95% CI 0.54-0.79) and the detection rates were 5.9% and 23.5% for fixed false-positive rates of 5% and 10%, respectively. For the prediction of spontaneous preterm birth before 37 weeks, the area under the curve was 0.58 (95% CI 0.50-0.67) and the detection rates were 5.8% and 18% for fixed false-positive rates of 5% and 10%, respectively. Combined predictive models were studied. To predict spontaneous preterm birth before 34 weeks, the best model was provided by a combination of uterocervical angle and cervical length (area under the curve 0.72; 95% CI 0.58-0.86). The detection rates of this model were 35.3% and 41.2% for fixed false-positive rates of 5% and 10%, respectively. To predict spontaneous preterm birth before 37 weeks of gestation, the best model was provided by a combination of uterocervical angle, cervical length, and previous history of spontaneous preterm birth (area under the curve 0.64; 95% CI 0.55-0.72). The detection rates of this model were 15.4% and 30.8% for fixed false-positive rates of 5% and 10%, respectively. Obese women and those with a history of cesarean section had a wider uterocervical angle.
The uterocervical angle, measured mid-trimester, is a poor predictor of spontaneous preterm birth.
子宫颈角已被提出作为预测自发性早产的超声标志物；然而，提供这一证据的研究是回顾性的，其结果存在异质性。本研究旨在评估子宫颈角在妊娠 34 周和 37 周前预测自发性早产的能力。
一项前瞻性队列研究，纳入 19.0 至 22.6 周妊娠的单胎妊娠。通过经阴道超声测量子宫颈角和宫颈长度。记录产妇病史和妊娠数据。随后收集分娩数据。
最终分析包括 1453 例单胎妊娠。37 周前自发性早产 52 例（3.6%），34 周前早产 17 例（1.2%）。对于预测 34 周前自发性早产，子宫颈角的曲线下面积为 0.67（95%置信区间 0.54-0.79），固定假阳性率为 5%和 10%时，检测率分别为 5.9%和 23.5%。对于预测 37 周前自发性早产，曲线下面积为 0.58（95%置信区间 0.50-0.67），固定假阳性率为 5%和 10%时，检测率分别为 5.8%和 18%。研究了联合预测模型。为预测 34 周前自发性早产，最佳模型是由子宫颈角和宫颈长度的联合提供（曲线下面积 0.72；95%置信区间 0.58-0.86）。该模型固定假阳性率为 5%和 10%时的检测率分别为 35.3%和 41.2%。为预测妊娠 37 周前自发性早产，最佳模型是由子宫颈角、宫颈长度和自发性早产史的联合提供（曲线下面积 0.64；95%置信区间 0.55-0.72）。该模型固定假阳性率为 5%和 10%时的检测率分别为 15.4%和 30.8%。肥胖妇女和有剖宫产史的妇女子宫颈角较宽。
妊娠中期测量的子宫颈角是自发性早产的一个较差的预测指标。
