Abstract:Objetivo. Comparar el ángulo uterocervical con la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas. Diseño. Estudio de casoscontroles. Institución. Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Participantes. Pacientes con parto pretérmino en los siguientes 7 días (grupo A) y embarazadas con parto pretérmino más allá de los 7 días (grupo B). Métodos. Al momento del diagnóstico, las pacientes fueron evaluadas utilizando ecografía transvaginal y fueron seguida… Show more
“…After excluding duplicates and ineligible studies, 22 studies were included in the qualitative analysis, including 11 prospective cohort studies, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 7 retrospective cohort studies, 24 , 25 , 26 , 27 , 28 , 29 , 30 and 4 case-control studies. 31 , 32 , 33 , 34 Of note, 1 study was not included in the meta-analysis because of incomplete data. 28 Figure 1 MOOSE flow diagram for new systematic reviews of observational studies Adapted from Stroup.…”
Section: Resultsmentioning
confidence: 99%
“…All 22 studies included in the qualitative analysis compared UCA in sPTB and term births, with 18 studies showing a statistically significant difference 13 , 15 , 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 29 , 30 , 31 , 32 , 33 , 34 and 4 studies showing no difference. 14 , 17 , 26 , 28 Of note, 21 studies were included in the quantitative analysis, as shown in Figure 2 .…”
Section: Resultsmentioning
confidence: 99%
“… 14 , 17 , 26 , 28 Of note, 21 studies were included in the quantitative analysis, as shown in Figure 2 . 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 Of the 6895 patients included, UCA was significantly larger in the sPTB group than in the term birth controls (MD, 13.76; 95% confidence interval [CI], 10.61–16.91; P <.00001; I 2 =90%). There was significant heterogeneity in GA cutoffs for PTB, GA at the initial US, and both number of gestations and whether patients had symptoms of preterm labor.…”
Section: Resultsmentioning
confidence: 99%
“…Of note, 16 studies included in the qualitative analysis compared UCA in sPTBs and term births in singleton pregnancies, 13 , 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 26 , 28 , 30 , 31 , 32 , 33 , 34 with 14 studies showing a statistically significant difference 13 , 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 26 , 28 , 30 , 31 , 32 , 33 , 34 and 2 studies showing no difference. 14 , 26 Of the 16 studies, 15 were included in the quantitative analysis, as shown in Figure 3 .…”
“…After excluding duplicates and ineligible studies, 22 studies were included in the qualitative analysis, including 11 prospective cohort studies, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 7 retrospective cohort studies, 24 , 25 , 26 , 27 , 28 , 29 , 30 and 4 case-control studies. 31 , 32 , 33 , 34 Of note, 1 study was not included in the meta-analysis because of incomplete data. 28 Figure 1 MOOSE flow diagram for new systematic reviews of observational studies Adapted from Stroup.…”
Section: Resultsmentioning
confidence: 99%
“…All 22 studies included in the qualitative analysis compared UCA in sPTB and term births, with 18 studies showing a statistically significant difference 13 , 15 , 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 29 , 30 , 31 , 32 , 33 , 34 and 4 studies showing no difference. 14 , 17 , 26 , 28 Of note, 21 studies were included in the quantitative analysis, as shown in Figure 2 .…”
Section: Resultsmentioning
confidence: 99%
“… 14 , 17 , 26 , 28 Of note, 21 studies were included in the quantitative analysis, as shown in Figure 2 . 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 Of the 6895 patients included, UCA was significantly larger in the sPTB group than in the term birth controls (MD, 13.76; 95% confidence interval [CI], 10.61–16.91; P <.00001; I 2 =90%). There was significant heterogeneity in GA cutoffs for PTB, GA at the initial US, and both number of gestations and whether patients had symptoms of preterm labor.…”
Section: Resultsmentioning
confidence: 99%
“…Of note, 16 studies included in the qualitative analysis compared UCA in sPTBs and term births in singleton pregnancies, 13 , 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 26 , 28 , 30 , 31 , 32 , 33 , 34 with 14 studies showing a statistically significant difference 13 , 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 26 , 28 , 30 , 31 , 32 , 33 , 34 and 2 studies showing no difference. 14 , 26 Of the 16 studies, 15 were included in the quantitative analysis, as shown in Figure 3 .…”
“…The higher sensitivity compared to our results obtained from the measures of our 1st visit can be attributed to the gestational age when the measures were taken being higher than our study (median gestational age was 33 weeks) while the sensitivity was very close when measures were compared with the second visit (72.1% vs 68.1%). Regarding the uterocervical angle, an acute angle reinforces the closure of the endocervical canal, while a more obtuse angle may facilitate the opening of the cervix (23); this could be the reason why Luechathananon et al, obtained a higher cutoff value compared to our study (110.97 ° vs 89.81 ° or 81) (22). In contrast to our study, results obtained by Wagner et al, showed that the uterocervical angle is not a useful measure for the prediction of preterm birth, the included patients in this study accounted for that difference as they included patients with regular uterine contractions and cervical length less than 25mm which indicated a very high risk for preterm delivery; an obtuse uterocervical angle was predominant in the three study groups that were delivery within 2 days, 3-7 days and after 7 days with corresponding median UCA angle of 108.5, 108°, and 107.3° (24).…”
Background Preterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth. Patients andMethods This was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcomeResults The incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.Conclusion Uterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided. Keywords: Preterm birth, anterior uterocervical angle, cervical lengthClinicalTrials.gov ID: NCT05632003 (First posted date: 30/11/2022)
Background
Preterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth.
Patients and Methods
This was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcome.
Results
The incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.
Conclusion
Uterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided.
Trial registration
NCT05632003 (First posted date: 30/11/2022).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
