الفهرس 
Preterm BirthOnly 14 pages are availabe for public view
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Abstract
P
reterm birth (PTB) is a growing global public health problem. PTB is the leading cause of mortality in children under 5 years of age, and is a direct cause of at least 27% of all neonatal deaths. Current data also suggest that cervical length (CL) measurement may help identify these women as it may accurately predict pregnancies at risk of preterm birth. Uterocervical angle (UCA) represents a novel ultrasonographic marker. During the last years several studies investigated the potential impact of UCA for the prediction of preterm birth.
However, there is a scarcity in the published literature which determine whether the UCA correlates with the risk of spontaneous preterm birth PTB. Therefore, we performed the present prospective study in order to evaluate the ability of second trimester UCA to predict spontaneous PTB in at-risk singleton pregnant women.
In the present prospective, cohort, study, we included 197 singleton pregnant women at Ain shams university maternity hospital (outpatient obstetrics clinics and emergency department. The mean age of the included women was 28 ±4.0 years. The mean BMI was 27 ± 3Kg/m2.
In the present study, we found that there were statistically significant differences between both groups in cervical length <2.5, uterocervical angle, gestational age at delivery and neonatal death (<0.001).
With regard to the primary outcome of the present study, we found that there was statistically significant difference between women with spontaneous preterm labor and women with term deliveries regarding UCA (p =<0.001). Mean UCA in the second trimester was wider in the preterm group compared with the control group. The UCA was a significant discriminator of preterm labor. At cut-off value of ≥ 94, the GP37 yielded a sensitivity of 86.79% and specificity of 88.19% for the discrimination between preterm and term deliveries.
We acknowledge that the present study has a number of limitations. The sample size of the included patients was relatively small, which may affect the generalizability of our findings. Moreover, there were no long-term monitoring of the included women. We did not assess the clinical outcomes and its correlation with UCA as well.
In conclusion, wider UCA in the second trimester is related to spontaneous PTB. UCA measurement is a reproducible technique. UCA appears to increase from the first to the second trimester. We recommend the introduce UCA in current clinical practice as a predictive factor that may be used for decision-making regarding management of women at risk of delivering preterm. Nonetheless, future studies are needed to evaluate the diagnostic accuracy of this index, and these should specifically consider the use of cut-off values and outcomes of interest (preterm birth rates based on specific gestational weeks).