Obstetrics, Gynecology and Reproduction

Advanced search

A role of comprehensive cervix assessment in the first trimester of pregnancy for predicting preterm delivery

Full Text:


Aim: to improve efficacy of predicting preterm labor in the first trimester of pregnancy by combining diverse parameters of cervical ultrasound examination.

Materials and methods. A prospective cohort study of 1517 women with uncomplicated pregnancy was performed. Inclusion criteria were: females underwent cervicometry at 11–14 weeks of gestation, singleton pregnancy, revealing no complaints at the onset of examination. All women were subdivided into four groups: Group 1 – 27 pregnant women with shortened cervix (less than 30 mm); Group 2 – 24 pregnant women without cervical gland area (СGA); Group 3 – 30 pregnant women with two risk factors (shortened cervix less than 30 mm and lacked СGA); Group 4 (control) consisted of 1436 pregnant women with cervix length exceeding 30 mm and presence of СGA.

Results. Average delivery term in Group 1 was 35.7 weeks (95 % CI = 34.7–36.8), in Group 2 – 34.7 weeks (95 % CI = 33.59–35.0), in Group 3 – 33.23 weeks (95 % CI = 31.6–34.8), in Group 4 (control) – 38.11 weeks (95 % CI = 38.06–38.17). A significant moderate correlation (Rxy = 0.534) between shortened cervix, absence of СGA and delivery term was found (p < 0.001). A regression model consisting of cervical length and presence of СGA was simulated based upon 50.8 % factors underlying probability of preterm birth, revealing 42.6 % sensitivity, 99.1 % specificity, and 96.6 % overall diagnostic value. The area under the ROC curve was 0.902 ± 0.022 (95 % CI = 0.860–0.945). The data obtained reflect diverse biochemical changes such as collagen decomposition, altered glucosamine level and fluid amount within cervical tissues. Such processes result in shortened, softened and expanded (matured) cervix. Uncovering markers for preterm cervical maturation underlies a logical strategy to predict miscarriage.

Conclusion. Untrasound cervical measurement in the first trimester of pregnancy allows for revealing valuable miscarriage predictors (shortened cervix and absence of GI). Risk assessment by combining diverse ultrasound cervix parameters would allow to improve overall predictive efficacy.

About the Authors

V. G. Volkov
Tula State University
Russian Federation

Valeriy G. Volkov – MD, Dr Sci Med, Professor, Head of the Department of Obstetrics and Gynecology, Medical Institute

92 Lenin Avе., Tula 300012

Scopus Author ID: 7402984134

Researcher ID: B-1181-2014

Researcher ID: D-3547-2016.

O. V. Chursina
Tula State University; Tula Regional Perinatal Center
Russian Federation

Olga V. Chursina – MD, Postgraduate Student, Department of Obstetrics and Gynecology, Medical Institute, Tula State University; Ultrasound Diagnostics Doctor, Obstetrician-Gynecologist, Head of Department of Radiation Diagnostics, Tula Regional Perinatal Center

92 Lenin Avе., Tula 300012, 

19 2nd Gastello Lane, Tula 300053


1. Purisch S.E., Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol. 2017;41(7):387–91. DOI: 10.1053/j.semperi.2017.07.009.

2. Sergeeva A.V., Kovalishena O.V., Katkova N.Yu. et al. Predictors of preterm labor: case-control study. [Prediktory prezhdevremennyh rodov: issledovanie «sluchaj–kontrol’»]. Epidemiologiya i vakcinoprofilaktika. 2019;18(3):98–104. (In Russ.). DOI: 10.31631/2073-3046-2019-18-3-98-104.

3. Vink J., Feltovich H. Cervical etiology of spontaneous preterm birth. Semin Fetal Neonatal Med. 2016;21(2):106–12. DOI: 10.1016/j.siny.2015.12.009.

4. Volkov V.G., Zaikina F.Ya., Kultigina S.V. Modern approaches to forecasting of beginning of premature sort. [Sovremennye podhody k prognozirovaniyu vozniknoveniya prezhdevremennyh rodov]. Vestnik novyh medicinskih tekhnologij. 2009;16(4):112–3. (In Russ.).

5. Martynenko P.G., Volkov V.G. Prediction of preterm labor from the identification of the most significant risk factors. [Prognozirovanie prezhdevremennyh rodov na osnove vyyavleniya naibolee znachimyh faktorov riska]. Akusherstvo i ginekologiya. 2012;(1):103–7.

6. Kaplan Yu.D., Zakharenkova T.N. The comparative analysis of the methods of diagnostics of the state of the cervix during pregnancy. [Sravnitel’nyj analiz metodov diagnostiki sostoyaniya shejki matki vo vremya beremennosti]. Problemy zdorov’ya i ekologii. 2017;(1):6–13. (In Russ.).

7. Volkov V.G., Chursina O.V. New ultrasound marker to assess the cervix when predicting preterm birth in the first trimester of pregnancy. [Novyj ul’trazvukovoj marker dlya ocenki shejki matki pri prognozirovanii prezhdevremennyh rodov v I trimestre beremennosti]. Prenatal’naya diagnostika. 2019;18(1):48–53. (In Russ.). DOI: 10.21516/2413-1458-2019-18-1-48-53.

8. Marsoosi V., Pirjani R., Asghari Jafarabadi M. et al. Cervical gland area as an ultrasound marker for prediction of preterm delivery: A cohort study. Int J Reprod Biomed (Yazd). 2017;15(11):729–34.

9. Afzali N., Mohajeri M., Malek A., Alamatian A. Cervical gland area: a new sonographic marker in predicting preterm delivery. Arch Gynecol Obstet. 2012;285(1):255–8. DOI: 10.1007/s00404-011-1986-7.

10. Kahyaoglu S., Kahyaoglu I., Kaymak O. et al. Can transvaginal ultrasonographic evaluation of the endocervical glandular area predict preterm labor among patients who received tocolytic therapy for threatened labor: a cross-sectional study. J Matern Fetal Neonatal Med. 2013;26(9):920–5. DOI: 10.3109/14767058.2013.766703.

11. Sadykova G.K. Evaluation of effeciency of cervicometry in the first trimester of pregnancy. [Ocenka effektivnosti cervikometrii v pervom trimestre beremennosti]. Tavricheskij mediko-biologicheskij vestnik. 2018;21(2–2):126–30. (In Russ.).

12. Sekiya T., Ishihara K., Yoshimatsu K. et al. Detection rate of the cervical gland area during pregnancy by transvaginal sonography in the assessment of cervical maturation. Ultrasound Obstet Gynecol. 1998;12(5):328–33. DOI: 10.1046/j.1469-0705.1998.12050328.x.

13. Martynenko P.G., Volkov V.G., Zaikina F.Ya. Clinical efficiency scrinning of cervical condition for prevention of spontaneous premature birth. [Klinicheskaya effektivnost’ skrininga sostoyaniya shejki matki dlya preduprezhdeniya spontannyh prezhdevremennyh rodov]. Vestnik novyh medicinskih tekhnologij. 2011;18(1):46–7. (In Russ.).

14. Romero R., Dey S.K., Fisher S.J. Preterm labor: one syndrome, many causes. Science. 2014;345(6198):760–5. DOI: 10.1126/science.1251816.

15. Goldenberg R.L., Gravett M.G., Iams J. et al. The preterm birth syndrome: issues to consider in creating a classification system. Am J Obstet Gynecol. 2012;206(2):113–8. DOI: 10.1016/j.ajog.2011.10.865.

16. Morrison A.S. Screening. In: Modern Epidemiology. Eds. K.J. Rothman, S. Greenland. Philadelphia, PA: Lippincott-Raven Publishers, 1998. 499–518.

17. Son M., Grobman W.A., Ayala N.K., Miller E.S. A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate. Am J Obstet Gynecol. 2016;214(3):365.e1-5. DOI: 10.1016/j.ajog.2015.12.020.

18. Berghella V., Baxter J.K., Hendrix N.W. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 2013;(1):CD007235. DOI: 10.1002/14651858.CD007235.pub3.

19. Volkov V.G., Chursina O.V. Ultrasound assessment of cervical length in the first trimester of pregnancy to predict preterm birth. Int J Biomed. 2018;8(4):321–23. DOI: 10.21103/Article8(4)_OA10.

20. Barros-Silva J., Pedrosa A.C., Matias A. Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review. J Perinat Med. 2014;42(3):281–93. DOI: 10.1515/jpm-2013-0115.

21. Subtil D., Brabant G., Tilloy E. et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet. 2018;392(10160):2171–9. DOI: 10.1016/S0140-6736(18)31617-9.

22. Tateyama N., Asakura H., Takeshita T. Correlation between an absence of cervical gland area on transvaginal sonography and cervical mucus hyaluronic acid levels in women with threatened preterm delivery. J Perinatal Med. 2012;41(2):151–7. DOI: 10.1515/jpm-2012-0112.

23. Romero R., Nicolaides K.H., Conde-Agudelo A. et al. Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study. Ultrasound Obstet Gynecol. 2016;48(3):308–17. DOI: 10.1002/uog.15953.

24. Romero R., Conde-Agudelo A., Da Fonseca E. et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol. 2018;218(2):161–80. DOI: 10.1016/j.ajog.2017.11.576.

25. Manuhin I.B., Dobrohotova Yu.E., Kuleshov V.M. et al. Therapy for threatened miscarriage with micronized progesterone and dydrogesterone (results of multicenter open prospective comparative non-interventional study). [Lechenie ugrozhayushchego vykidysha preparatami mikronizirovannogo progesterona i didrogesterona (rezul’taty mnogocentrovogo otkrytogo prospektivnogo sravnitel’nogo neintervencionnogo issledovaniya)]. Problemy reprodukcii. 2018;24(3):34–42. (In Russ.). DOI: 10.17116/repro201824334.

26. Coomarasamy A., Devall A.J., Cheed V. et al. А randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815–24. DOI: 10.1056/NEJMoa1813730.


For citations:

Volkov V.G., Chursina O.V. A role of comprehensive cervix assessment in the first trimester of pregnancy for predicting preterm delivery. Obstetrics, Gynecology and Reproduction. 2020;14(2):174-181. (In Russ.)

Views: 505

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)