Prediction of Preterm Birth with the Uterocervical Angle in Singleton Pregnancies Treated with a Cervical Pessary

Background Cervical pessaries are an established therapy option for patients at risk for spontaneous preterm birth (sPTB). The uterocervical angle (UCA) remains a promising sPTB predictor. However, its clinical significance has yet to be described in patients treated with a pessary.Methods This study analyzed data of patients treated with a pessary because of cervical shortening in singleton pregnancies. The patients were divided into 2 groups according to transvaginal ultrasound findings: the funneling group (n = 68) and the no-funneling group (n = 42). Moreover, we analyzed patients within these prespecified groups according to the UCA < 95 degrees and >= 95 degrees.Results Delivery occurred significantly earlier in patients treated with a pessary and with a high UCA >= 95 degrees(p = 0.006). The median gestational age at delivery in patients treated with a pessary and with no funneling and a UCA < 95 degrees vs. >= 95 degrees were 39.00 and 36.14 weeks, respectively (p = 0.005). In cases with funneling and a UCA < 95 degrees vs. >= 95 degrees the mean gestational age at delivery was 38.14 and 38.07 weeks respectively (p=1,00). There was a significant negative linear correlation between UCA and the gestational age at delivery in all patients (p = 0.04), which was even profound in the group without funneling (p = 0.0002). However, we found no significant correlation between cervical length and gestational age at delivery in all patients (p = 0.42) as well as in the group without funneling (p = 0.28).Conclusion In spite of pessary treatment, patients with UCA >= 95 degrees presented with a higher risk of sPTB compared to patients with UCA < 95 degrees. This suggests that the UCA seems to be a better predictor of sPTB than the cervical length in patients receiving pessary treatment.