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Purpose <p>Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pregnancy UCA and its longitudinal change is limited. We evaluated UCA in mid- and late-pregnancy and the % change (ΔUCA) as predictors of sPTB, and developed a pragmatic risk-stratification scheme using these parameters.</p> Methods <p>In a single-center retrospective study, 163 singleton pregnancies were analyzed. UCA was measured on transvaginal ultrasound at 16–24&#xa0;weeks (mid-pregnancy) and 25–33&#xa0;weeks (late-pregnancy). ΔUCA was calculated as the % change from mid to late-pregnancy. Predictive performance for sPTB (&lt; 37&#xa0;weeks) was assessed using logistic regression and receiver operating characteristic analysis.</p> Results <p>A mid-pregnancy UCA ≥ 105° had a sensitivity of 85.4%, specificity of 76.9%, and area under the curve (AUC) of 0.858 (95% CI 0.768–0.948) for prediction of sPTB. In contrast, CL &lt; 25&#xa0;mm had a sensitivity of 8.3% (mid-pregnancy) and 17.9% (late-pregnancy). A late-pregnancy UCA ≥ 112° had a sensitivity of 81.8%, specificity of 56.7%, and AUC of 0.728 (95% confidence interval [CI], 0.623–0.833), and ΔUCA ≥  + 12% predicted sPTB with a sensitivity of 81.2%, specificity of 66.7%, and AUC of 0.742 (95% CI 0.579–0.905). Using three criteria (mid-pregnancy UCA ≥ 105°, late-pregnancy UCA ≥ 112°, ΔUCA ≥  + 12%), preterm birth rates were 1.4% (low-risk: 0 points) vs. 46.2% (high-risk: 3 points) (p &lt; 0.001).</p> Conclusions <p>UCA in mid- and late-pregnancy and ΔUCA predict sPTB with higher sensitivity than CL shortening alone, offering a noninvasive complement to current screening. In particular, a mid-pregnancy UCA ≥ 105° and ΔUCA ≥  + 12% may identify clinically important high-risk cases.</p>

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Risk stratification of preterm birth using the uterocervical angle and its rate of change in mid- and late-pregnancy: a single-center retrospective study

  • 期刊论文

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  • 发表日期：

    2026年5月18日

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  • Naofumi Yamane,
  • Yusuke Matoba,
  • Takuto Uyama,
  • Yuka Enokizono,
  • Kousuke Nakamoto,
  • Yuko Teraoka,
  • Yuriko Oomori,
  • Katsuyuki Tomono,
  • Tomomi Yamazaki,
  • Yurika Mukai,
  • Kouji Banno,
  • Ken Yamaguchi

摘要

Purpose

Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pregnancy UCA and its longitudinal change is limited. We evaluated UCA in mid- and late-pregnancy and the % change (ΔUCA) as predictors of sPTB, and developed a pragmatic risk-stratification scheme using these parameters.

Methods

In a single-center retrospective study, 163 singleton pregnancies were analyzed. UCA was measured on transvaginal ultrasound at 16–24 weeks (mid-pregnancy) and 25–33 weeks (late-pregnancy). ΔUCA was calculated as the % change from mid to late-pregnancy. Predictive performance for sPTB (< 37 weeks) was assessed using logistic regression and receiver operating characteristic analysis.

Results

A mid-pregnancy UCA ≥ 105° had a sensitivity of 85.4%, specificity of 76.9%, and area under the curve (AUC) of 0.858 (95% CI 0.768–0.948) for prediction of sPTB. In contrast, CL < 25 mm had a sensitivity of 8.3% (mid-pregnancy) and 17.9% (late-pregnancy). A late-pregnancy UCA ≥ 112° had a sensitivity of 81.8%, specificity of 56.7%, and AUC of 0.728 (95% confidence interval [CI], 0.623–0.833), and ΔUCA ≥  + 12% predicted sPTB with a sensitivity of 81.2%, specificity of 66.7%, and AUC of 0.742 (95% CI 0.579–0.905). Using three criteria (mid-pregnancy UCA ≥ 105°, late-pregnancy UCA ≥ 112°, ΔUCA ≥  + 12%), preterm birth rates were 1.4% (low-risk: 0 points) vs. 46.2% (high-risk: 3 points) (p < 0.001).

Conclusions

UCA in mid- and late-pregnancy and ΔUCA predict sPTB with higher sensitivity than CL shortening alone, offering a noninvasive complement to current screening. In particular, a mid-pregnancy UCA ≥ 105° and ΔUCA ≥  + 12% may identify clinically important high-risk cases.