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DOI: 10.1055/a-2091-7179
Prediction of Preterm Birth with the Uterocervical Angle in Singleton Pregnancies Treated with a Cervical Pessary
Prädiktion der Frühgeburt mittels des uterozervikalen Winkels bei Einlingsschwangerschaften unter PessartherapieAbstract
Background 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.
Methods 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°.
Results 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).
Conclusion 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.
Zusammenfassung
Hintergrund Das zervikale Pessar ist eine etablierte Therapieoption für Patientinnen mit Frühgeburtsrisiko. Der uterozervikale Winkel (UCA) ist eine vielversprechende Screeningmethode zur Einschätzung des Frühgeburtsrisikos. Dennoch ist seine klinische Bedeutung bei Patientinnen unter Pessartherapie noch nicht untersucht worden.
Methoden In dieser Studie wurden die Daten von Patientinnen mit Einlingsschwangerschaften, welche mit einem Pessar wegen Zervixverkürzung behandelt wurden, analysiert. Die Patientinnen wurden nach dem transvaginalen Ultraschallbefund in 2 Gruppen eingeteilt: in die Gruppe mit Trichterbildung (n = 68) und die Gruppe ohne Trichterbildung (n = 42). Außerdem wurden die Patientinnen anhand des UCA < 95° und ≥ 95° untersucht.
Ergebnisse Die Entbindung erfolgte in der Gruppe ohne Trichterbildung signifikant früher bei Patientinnen unter Pessartherapie und mit einem UCA ≥ 95° (p = 0,006). Die Medianwerte der Schwangerschaftsdauer unter Pessar mit UCA < 95° und ≥ 95° waren 39,00 und 36,14 Wochen respektive (p = 0,005). In Fällen mit Trichterbildung und einem UCA < 95° vs. ≥ 95° war die Schwangerschaftsdauer 38.14 und 38.07 Wochen respektive (p=1,00). Es bestand eine signifikante negative lineare Korrelation zwischen dem UCA und der Schwangerschaftsdauer bei allen Patientinnen (p = 0,04) und eine noch stärkere Korrelation in der Gruppe ohne Trichter (p = 0,0002). Wir fanden jedoch keine signifikante Korrelation zwischen der Zervixlänge und der Schwangerschaftsdauer (p = 0,42).
Schlussfolgerungen Trotz einer Pessartherapie wiesen Patientinnen mit einem UCA ≥ 95° ein höheres Risiko für eine Frühgeburt im Vergleich zu Patientinnen mit einem UCA < 95° auf. Diese Ergebnisse legen nahe, dass der UCA bei Patientinnen unter Pessartherapie ein besserer sonografischer Prädiktor für eine Frühgeburt als die Zervixlänge zu sein scheint.
Publication History
Received: 08 May 2022
Accepted after revision: 11 May 2023
Accepted Manuscript online:
11 May 2023
Article published online:
08 December 2023
© 2023. Thieme. All rights reserved.
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