BACKGROUND & AIMS:
:Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0-22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72-0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57-0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.
背景与目标:
:已提出了新颖的经阴道超声(TVU)标记来改善自发性早产(sPTB)的预测。子宫颈一致性指数(CCI),子宫颈角(UCA)和子宫颈质地(CTx)的初步结果令人鼓舞。但是,在双胞胎怀孕中,结果并不一致。在这项对18 0-22 0周之间无症状双胎妊娠的前瞻性队列研究中,我们评估了TVU衍生的宫颈长度(CL),CCI,UCA和CTx,以预测sPTB <34 0周。排除所有医源性PTB。在最后63例孕妇中,sPTB率<34 0为16.3%。 sPTB <34 0周组的CCI,UCA和CTx(包括CL)显着不同。 sPTB <34 0周的接收器工作特性曲线(AUC)之下的最佳面积是通过CCI 0.82(95%CI,0.72-0.93)实现的,其次是UCA的AUC 0.72(95%CI,0.57-0.87) 。结合奇偶性,绒毛膜性,CCI和UCA的逻辑回归模型得出的AUC为0.91,对sPTB <34 0的敏感性为55.3%,特异性为88.1%。与其他TVU标记相比,CCI的表现更好,预测sPTB <34在双胎妊娠中为0,并且通过奇偶校验,绒毛膜性,CCI和UCA的组合获得了最佳的诊断准确性。