Objective To determine if change in uterocervical angle (UCA) is associated with an increased rate of preterm birth (less than 37 weeks) for women with a short cervix. Study Design A retrospective study was performed from January 2013 to March 2016 of singleton pregnancies undergoing universal cervical length screening. The difference between the UCA for the first cervical length ≤ 2.5 cm and last recorded cervical length < 25 weeks was defined as the change in UCA. The primary outcome was the rate of preterm birth at < 37 weeks of gestation. Results A total of 176 women met the inclusion criteria. There was no difference in the rate of preterm birth at < 34 weeks (23.3 vs. 16.7%, p = 0.27) or at < 37 weeks (34.9 vs. 37.8%, p = 0.69) based on a change in UCA (i.e., decreased/no change or increased UCA). However, women with a final UCA ≥105 degrees had an increased risk of preterm birth at less than 34 weeks (24.2 vs. 6.8%, p = 0.01). Conclusion A change in UCA was not associated with an increased risk of preterm birth. Instead, a final absolute UCA ≥ 105 degrees measured < 25 weeks was associated with an increased risk of preterm birth at < 34 weeks of gestation for women with a short cervix ≤ 2.5 cm.

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Background Point-of-care ultrasound (POC-US) is a diagnostic test conducted at the site of patient care with direct interpretation by the clinician, providing immediate results. POC-US for gynecologic application is not well characterized by current literature yet has the potential to increase access in limited resource settings. We compared the diagnostics of three POC-US devices for gynecologic (GYN) pathology and then performed evaluation of sensitivity and specificity of a single best POC-US device for intended use in a low resource setting. Methods This is prospective, pilot descriptive study of 60 subjects. In part 1, comparison of three POC-US devices was performed. Twenty subjects underwent POC-US with three test units [GE Vscan (Vscan), Sonosite Iviz (Iviz), Philips Lumify (Lumify)] followed by diagnostic ultrasound (Dx-US) for reference imaging. Image quality and correlation for devices was scored by blinded reviewers and quantitative measurements of GYN pathology were compared. In part 2, forty subjects underwent POC-US validation with the highest scoring device (Lumify) and Dx-US for reference imaging. Concordance of POC-US operator-interpreted diagnosis with reference imaging interpretation were assessed by Cohen’s unweighted kappa coefficient. Accuracy and agreement of POC-US were assessed by linear regression and Bland–Altman plot analysis. Sensitivity and specificity of POC-US for gynecologic pathologies were calculated. Results In aggregate qualitative measurements, Lumify and Iviz units performed superiorly to Vscan. There was no statistically significant difference in quantitative measurements between devices, but a trend towards lower mean error was seen for Lumify and Iviz as compared to Vscan. Lumify device had highest overall scoring and was selected for further testing. In validation comparison of Lumify to Dx-US, no statistically significant differences were found for measurements of endometrium, uterus, ovaries, adnexal pathology, or leiomyomata, (P < 0.02) with excellent agreement in operator-interpreted diagnosis (Kappa > 0.7). Sensitivity and specificity of detecting pathology was 80–100% with PPV and NPV 76–100%. Conclusion Among three POC-US devices, Lumify and Iviz devices show highest potential for successful application to clinical gynecologic ultrasound. Clinician-performed POC-US has high diagnostic accuracy, sensitivity, and specificity for basic GYN anatomy and pathology. POC-US is an acceptable and feasible diagnostic tool with potential for future application in a low resource setting to increase access to ultrasound.

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OBJECTIVE: Uterocervical angle (UCA) is the angle between the lower uterine segment and cervical canal. UCA angles >95 and >105 have been shown to correlate with an increased risk for spontaneous preterm birth (sPTB) in singletons. However, there is no data on the use of UCA for the prediction of sPTB in twins. Our objective was to determine the relationship between UCA and risk of sPTB <37wks in twins. STUDY DESIGN: We performed a retrospective study from 2014-2017 of twins who underwent CL screening at a major urban university hospital. Women who had at least one CL between 14 to 24 6/7 wks were included. Monochorionic monoamniotic twins were excluded. Post-hoc UCA measurements were obtained using methods described by Dziadosz et al. Wide UCA was defined as an angle >95 and >105. The primary outcome was the risk of sPTB at <37wks. Secondary outcomes were sPTB<32wks and performance metrics. RESULTS: 137 women were studied (118 (86.1%) dichorionic diamniotic and 19 (13.9%) monochorionic diamniotic). Median gestational age was 18.0wks (IQR 17.0-19.0wks) and median CL was 3.7cm (IQR 3.2-4.2cm). 7.3% of women had a CL<2.5cm. 52.6% of women had a sPTB <37wks and 19.0% <32wks. The median UCA was 124.0 (IQR 104.5-142.5). UCA > 95 and >105 were both associated with an increased risk of sPTB<37wks (55.9% vs 31.6%, p¼0.05 and 58.3% vs 35.3%, p¼0.02, respectively). There was a trend between UCA >95 and >105 and increased risk of sPTB<32wks. In the subgroup of women with dichorionic twins, UCA > 95 and >105 was associated with a trend towards an increased risk of sPTB<37wks, although this did not reach statistical significance. (table 1) Evaluating performance metrics, UCA was a better screening test and was not improved with the addition of CL<2.5cm. (table 2). CONCLUSION: A UCA >95 and >105 was associated with an increased risk of sPTB <37wks in twins. These findings enhance our understanding of the cervical changes associated with sPTB. As a screening tool in twins, second trimester UCA outperformed CL for the prediction of sPTB <37 wks.