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DOI: 10.1055/s-0043-57000
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.
Authors' Contributions
All authors contributed to the study conception and design. Sumathi Natarajan, Saira Rajan, and Amudhavalli Subramani helped in material preparation, data collection, and analysis. Ezhilmathi Alavandar, Ravindar Kashyap, and Dhivakar Muthusamy wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Ethical Approval
Approval was obtained from the ethics committee of Kovai Medical Centre and Hospitals. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Consent for Publication
Patients signed informed consent regarding publishing their data and photographs.
Publication History
Article published online:
12 May 2023
© 2023. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Sur B, Misra S, Dash S. Evaluation of the anterior cervical angle of the uterus to predict spontaneous preterm birth. Int J Reprod Contracept Obstet Gynecol 2017; 6 (06) 2323
- 2 Suff N, Story L, Shennan A. The prediction of preterm delivery: what is new?. Semin Fetal Neonatal Med 2019; 24 (01) 27-32
- 3 Wozniak S, Czuczwar P, Szkodziak P, Milart P, Wozniakowska E, Paszkowski T. Elastography in predicting preterm delivery in asymptomatic, low-risk women: a prospective observational study. BMC Pregnancy Childbirth 2014; 14 (01) 238
- 4 Crane JMG, Hutchens D. Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk: a systematic review. Ultrasound Obstet Gynecol 2008; 31 (05) 579-587
- 5 Banicevic AC, Popovic M, Ceric A. Cervical length measured by transvaginal ultrasonography and cervicovaginal infection as predictor of preterm birth risk. Acta Inform Med 2014; 22 (02) 128-132
- 6 Guzman ER, Walters C, Ananth CV. et al. A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations. Ultrasound Obstet Gynecol 2001; 18 (03) 204-210
- 7 Köbbing K, Fruscalzo A, Hammer K. et al. Quantitative elastography of the uterine cervix as a predictor of preterm delivery. J Perinatol 2014; 34 (10) 774-780
- 8 Iams JD. Prediction and early detection of preterm labor. Obstet Gynecol 2003; 101 (02) 402-412
- 9 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; 46 (03) 377-378
- 10 Dziadosz M, Bennett T-A, Dolin C. et al. Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol 2016; 215 (03) 376.e1-376.e7
- 11 Sepúlveda-Martínez A, Díaz F, Muñoz H, Valdés E, Parra-Cordero M. Second-trimester anterior cervical angle in a low-risk population as a marker for spontaneous preterm delivery. Fetal Diagn Ther 2017; 41 (03) 220-225
- 12 Farràs Llobet A, Regincós Martí L, Higueras T. et al. The uterocervical angle and its relationship with preterm birth. J Matern Fetal Neonatal Med 2018; 31 (14) 1881-1884
- 13 Lynch TA, Szlachetka K, Seligman NS. Ultrasonographic change in uterocervical angle is not a risk factor for preterm birth in women with a short cervix. Am J Perinatol 2017; 34 (11) 1058-1064
- 14 Bafali O, Kiyak H, Ince O, Baskiran Y. The prediction of preterm birth threat by anterior uterocervical angle. Perinat J 2018; 26 (01) 11-17
- 15 Suthasmalee S, Moungmaithong S. Cervical shear wave elastography as a predictor of preterm delivery during 18-24 weeks of pregnancy. J Obstet Gynaecol Res 2019; 45 (11) 2158-2168
- 16 Ogawa M, Nagao D, Mori K. et al. Elastography for differentiation of subchorionic hematoma and placenta previa. Ultrasound Obstet Gynecol 2012; 39 (01) 112-114
- 17 Fruscalzo A, Londero AP, Fröhlich C, Möllmann U, Schmitz R. Quantitative elastography for cervical stiffness assessment during pregnancy. BioMed Res Int 2014; 2014: 826535
- 18 Mishrikotkar P, Jaju V, Saoji K. Role of transvaginal ultrasound elastography in assessing the stiffness of uterine cervix during pregnancy. Int J Curr Med Appl Sci 2018; 19 (01) 10-15
- 19 Yamaguchi S, Kamei Y, Kozuma S, Taketani Y. Tissue elastography imaging of the uterine cervix during pregnancy. J Med Ultrason 2007; 34 (04) 209-210
- 20 Swiatkowska-Freund M, Traczyk-Łoś A, Preis K, Łukaszuk M, Zielińska K. Prognostic value of elastography in predicting premature delivery. Ginekol Pol 2014; 85 (03) 204-207
- 21 Park HS, Kwon H, Kwak DW. et al; Korean Society of Ultrasound in Obstetrics and Gynecology Research Group. Addition of cervical elastography may increase preterm delivery prediction performance in pregnant women with short cervix: a prospective study. J Korean Med Sci 2019; 34 (09) e68
- 22 Wang B, Zhang Y, Chen S. et al. Diagnostic accuracy of cervical elastography in predicting preterm delivery: a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98 (29) e16449
- 23 Hernandez-Andrade E, Romero R, Korzeniewski SJ. et al. Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery. J Perinat Med 2014; 42 (02) 159-169
- 24 Fuchs T, Woytoń R, Pomorski M. et al. Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women - preliminary report. Ginekol Pol 2013; 84 (01) 12-16