Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Fellowship of Minimally Invasive Gynecology Surgery, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Matern Fetal Neonatal Med. 2024 Dec;37(1):2406344. doi: 10.1080/14767058.2024.2406344. Epub 2024 Sep 19.
Various techniques have been proposed to predict and evaluate the timing and conditions of childbirth in pregnant women at different stages of pregnancy. Providing precise methods for forecasting childbirth status can reduce the burden on the healthcare system. This study aimed to evaluate the predictive value of transvaginal sonography of cervical length (CL) and cervical angle (CA) on full-term delivery outcomes.
This cohort study analyzed 151 pregnant women between 37 and 42 weeks of gestational age who were treated at Rasoul Akram Hospital affiliated with Iran University of Medical Sciences from June 2023 to January 2024. All Participants received transvaginal examinations. This study evaluated the accuracy of CL and CA by transvaginal sonography in predicting outcomes like vaginal delivery, cesarean section, necessity for labor induction, and the rate of Premature Rupture of Membranes (PROM). The study used the Receiver Operating Characteristic (ROC) curve to determine the optimal cutoff for predicting birth outcomes.
The mean age of the pregnant women was 28.9 ± 4.22 years, while the average duration of pregnancy was 39.8 ± 2.11 weeks. Cesarean delivery was performed on 45 individuals (29.8%) and 106 (70.1%) underwent vaginal delivery. The mean CL overall stood at 21.2 ± 6.4 mm. PROM was observed in 41 cases (27.1%) among full-term pregnancies. A significant difference was noted in mean CL between the cesarean and vaginal delivery groups (24.2 ± 2.4 vs. 20.1 ± 2.1 mm, = 0.001). The predictive value of a CL measuring 21 mm for cesarean delivery was 72.2% sensitive and 79.1% specific. Similarly, a CL of 22 mm showed 66.6% sensitivity and 80.2% specificity for labor induction. Regarding PROM in full-term pregnancies, a CL assessment demonstrated 59.8% sensitivity and 69.1% specificity. Finally, a CA of 115.2° exhibited 70.3% sensitivity and 78.4% specificity in predicting vaginal delivery.
The present study showed that evaluating CL and CA via transvaginal sonography demonstrated adequate diagnostic accuracy in predicting spontaneous birth, need for labor induction, cesarean delivery, and incidence of PROM in full-term pregnant women. This method is suggested to be an accurate and appropriate way to predict delivery results.
为了预测和评估孕妇在不同妊娠阶段分娩的时间和条件，已经提出了各种技术。提供准确的分娩状态预测方法可以减轻医疗保健系统的负担。本研究旨在评估经阴道超声测量宫颈长度（CL）和宫颈角度（CA）对足月分娩结局的预测价值。
本队列研究分析了 2023 年 6 月至 2024 年 1 月在伊朗医科大学 Rasoul Akram 医院就诊的 151 名 37 至 42 周妊娠的孕妇。所有参与者均接受经阴道检查。本研究通过经阴道超声评估 CL 和 CA 对阴道分娩、剖宫产、引产必要性和胎膜早破（PROM）发生率等结局的预测准确性。研究使用受试者工作特征（ROC）曲线确定预测分娩结局的最佳截断值。
孕妇的平均年龄为 28.9±4.22 岁，平均妊娠时间为 39.8±2.11 周。45 人（29.8%）行剖宫产，106 人（70.1%）行阴道分娩。总的 CL 平均值为 21.2±6.4mm。41 例（27.1%）足月妊娠发生 PROM。剖宫产组与阴道分娩组的平均 CL 差异有统计学意义（24.2±2.4 vs. 20.1±2.1mm，P=0.001）。CL 测量值为 21mm 时预测剖宫产的预测值为 72.2%敏感和 79.1%特异性。同样，CL 为 22mm 时预测引产的敏感性和特异性分别为 66.6%和 80.2%。关于足月妊娠的 PROM，CL 评估的敏感性和特异性分别为 59.8%和 69.1%。最后，CA 为 115.2°时预测阴道分娩的敏感性和特异性分别为 70.3%和 78.4%。
本研究表明，经阴道超声评估 CL 和 CA 对预测足月孕妇自发性分娩、引产需求、剖宫产和 PROM 的发生具有足够的诊断准确性。该方法被建议为预测分娩结果的一种准确和适当的方法。
