Abstract：
Biologically active cervical glands provide a mucous barrier while influencing the composition and biomechanical strength of the cervical extracellular matrix. Cervical remodeling during ripening may be reflected as loss of the sonographic cervical gland area. As sonographic cervical length remains suboptimal for universal screening, adjunctive evaluation of other facets of the mid-trimester cervix may impart additional screening benefit.
To sonographically assess the cervical gland area at universal cervical length screening for preterm birth.
We performed a retrospective cohort study of singletons with transvaginal cervical length screening universally performed during anatomic survey between 18 0/7 and 23 6/7 weeks and subsequent live delivery at a single institution in 2018. Uterine anomalies, cerclage, suboptimal imaging, or medically indicated preterm birth were excluded. Ultrasound images were assessed for cervical length and cervical gland area (with quantitative measurements when present). The primary outcome was spontaneous preterm birth <37 weeks. Absent and present gland groups were compared using χ2, Fisher\'s exact, T-test, and multivariate logistic regression (adjusting for parity and progesterone use, as well as the gestational age, cervical length, and gland absence at screening ultrasound). Gland measurements were evaluated using the Mann-Whitney-U Test and Spearman\'s correlation.
Among the cohort of 772 patients, absent and present CGA groups were overall similar. Patients were on average 33 years old, ∼20 weeks gestation at screening ultrasound, and overall, 2.5% had history of prior spontaneous preterm birth. The absent gland group was more likely to have been taking progesterone (17% vs 4%, P=.04). Overall rate of preterm birth was 2.6%. However, the 2.3% of patients with absent cervical gland area were significantly more likely to deliver <37 weeks (aOR 23.9, 95% CI 6.4-89, P<.001). Multivariate logistic regression demonstrated better performance of a cervical length screening model for preterm birth prediction with the addition of qualitative gland evaluation (P<.001). Qualitative gland assessment was reproducible (PABAK 0.89), but quantitative gland measurements did not correlate with preterm birth.
Qualitative gland absence at mid-gestation cervical length screening was associated with subsequent spontaneous preterm birth, whereas quantitative gland measurements were not. Multifaceted ultrasound screening may be needed to adequately evaluate the multiple biologic functions of the cervix.
To sonographically assess the cervical gland area at universal cervical length screening for preterm birth.
We performed a retrospective cohort study of singletons with transvaginal cervical length screening universally performed during anatomic survey between 18 0/7 and 23 6/7 weeks and subsequent live delivery at a single institution in 2018. Uterine anomalies, cerclage, suboptimal imaging, or medically indicated preterm birth were excluded. Ultrasound images were assessed for cervical length and cervical gland area (with quantitative measurements when present). The primary outcome was spontaneous preterm birth <37 weeks. Absent and present gland groups were compared using χ2, Fisher\'s exact, T-test, and multivariate logistic regression (adjusting for parity and progesterone use, as well as the gestational age, cervical length, and gland absence at screening ultrasound). Gland measurements were evaluated using the Mann-Whitney-U Test and Spearman\'s correlation.
Among the cohort of 772 patients, absent and present CGA groups were overall similar. Patients were on average 33 years old, ∼20 weeks gestation at screening ultrasound, and overall, 2.5% had history of prior spontaneous preterm birth. The absent gland group was more likely to have been taking progesterone (17% vs 4%, P=.04). Overall rate of preterm birth was 2.6%. However, the 2.3% of patients with absent cervical gland area were significantly more likely to deliver <37 weeks (aOR 23.9, 95% CI 6.4-89, P<.001). Multivariate logistic regression demonstrated better performance of a cervical length screening model for preterm birth prediction with the addition of qualitative gland evaluation (P<.001). Qualitative gland assessment was reproducible (PABAK 0.89), but quantitative gland measurements did not correlate with preterm birth.
Qualitative gland absence at mid-gestation cervical length screening was associated with subsequent spontaneous preterm birth, whereas quantitative gland measurements were not. Multifaceted ultrasound screening may be needed to adequately evaluate the multiple biologic functions of the cervix.
摘要：
背景：生物活性宫颈腺体提供粘液屏障，同时影响宫颈细胞外基质的组成和生物力学强度。成熟过程中的宫颈重塑可能反映为超声检查宫颈腺体区域的丢失。由于超声检查的宫颈长度对于普遍筛查来说仍然是次优的，对中期宫颈其他方面的辅助评估可能会带来额外的筛查益处.
目的：在普及宫颈长度筛查早产时，超声评估宫颈腺区。
方法：我们进行了一项回顾性队列研究，对180/7至236/7周解剖调查期间普遍进行的经阴道宫颈长度筛查的单例患者进行了回顾性队列研究，随后在2018年在一家机构进行了现场分娩。子宫异常,环扎术,次优成像，或医学上表明的早产被排除。评估超声图像的宫颈长度和宫颈面积（存在时进行定量测量）。主要结果是自发性早产<37周。不存在和存在的腺组使用χ2，Fisher精确，T检验,和多变量逻辑回归(调整胎次和孕酮的使用，以及胎龄，宫颈长度,筛查超声时腺体缺失)。使用Mann-Whitney-U检验和Spearman相关性评估腺体测量值。
结果：在772名患者中，不存在和目前的CGA组总体相似。患者平均年龄33岁,筛查超声检查时妊娠20周，总的来说,2.5%曾有自发性早产史。腺体缺失组更有可能服用孕酮(17%vs4%，p=0.04)。总的早产率为2.6%。然而,2.3%的宫颈腺区缺失患者分娩<37周的可能性显著增加(aOR23.9,95%CI6.4-89,p<0.001).多变量logistic回归显示宫颈长度筛查模型在早产预测中的性能更好，增加了定性腺体评估（p<0.001）。定性腺体评估是可重复的(PABAK0.89)，但是定量腺体测量与早产无关。
结论：妊娠中期宫颈长度筛查时的性腺缺失与随后的自发性早产有关，而定量腺体测量则没有。可能需要进行多方面的超声筛查，以充分评估子宫颈的多种生物学功能。
目的：在普及宫颈长度筛查早产时，超声评估宫颈腺区。
方法：我们进行了一项回顾性队列研究，对180/7至236/7周解剖调查期间普遍进行的经阴道宫颈长度筛查的单例患者进行了回顾性队列研究，随后在2018年在一家机构进行了现场分娩。子宫异常,环扎术,次优成像，或医学上表明的早产被排除。评估超声图像的宫颈长度和宫颈面积（存在时进行定量测量）。主要结果是自发性早产<37周。不存在和存在的腺组使用χ2，Fisher精确，T检验,和多变量逻辑回归(调整胎次和孕酮的使用，以及胎龄，宫颈长度,筛查超声时腺体缺失)。使用Mann-Whitney-U检验和Spearman相关性评估腺体测量值。
结果：在772名患者中，不存在和目前的CGA组总体相似。患者平均年龄33岁,筛查超声检查时妊娠20周，总的来说,2.5%曾有自发性早产史。腺体缺失组更有可能服用孕酮(17%vs4%，p=0.04)。总的早产率为2.6%。然而,2.3%的宫颈腺区缺失患者分娩<37周的可能性显著增加(aOR23.9,95%CI6.4-89,p<0.001).多变量logistic回归显示宫颈长度筛查模型在早产预测中的性能更好，增加了定性腺体评估（p<0.001）。定性腺体评估是可重复的(PABAK0.89)，但是定量腺体测量与早产无关。
结论：妊娠中期宫颈长度筛查时的性腺缺失与随后的自发性早产有关，而定量腺体测量则没有。可能需要进行多方面的超声筛查，以充分评估子宫颈的多种生物学功能。
