Multidimensional screening for a multifunctional cervix: Examining cervical gland area at cervical length screening to predict spontaneous preterm birth.

Abstract

OBJECTIVE: To sonographically characterize the cervical gland area (CGA) and determine if its evaluation at the time of cervical length (CL) screening can be useful for preterm birth (PTB) prediction. DESIGN: Pilot retrospective cohort study. SETTING: Academic medical center (NYU Langone Health Tisch Hospital). POPULATION: Singleton gestations with universal CL screening performed between 18 – 23 weeks with subsequent live neonate delivery. METHODS: Transvaginal ultrasound (TVUS) cervical images and clinical data were reviewed, comparing sonographically present and absent CGA groups. MAIN OUTCOME MEASURES: Spontaneous PTB <37 weeks and quantitative CGA measurements. RESULTS: The cohort of 772 patients demonstrated similar characteristics when stratified by absent and present CGA. Rates of PTB and absent CGA were 2.6% and 2.3%, respectively. Absent CGA was significantly associated with delivery <37, <34, and <32 weeks (p<0.001), but gland measurements did not correlate with gestational age at delivery. There was good agreement between reviewers for qualitative CGA (PABAK 0.89). Multiple logistic regression modeling demonstrated better performance of CL screening for PTB prediction with the addition of qualitative CGA evaluation (p<0.001). CONCLUSIONS: Qualitative evaluation of the CGA on mid-gestation TVUS may improve CL screening for PTB. Given the biologic activity of the cervical glands, optimal screening in populations with various risk profiles may warrant a multimodal approach that evaluates the mechanical and biological functions of the cervix.