European journal of obstetrics, gynecology, and reproductive biology · 2026
Cervical length surveillance for predicting spontaneous preterm birth in women with congenital uterine anomalies: A systematic review and diagnostic accuracy meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Kadam Nikit, Raouf Sanaria, Jones Nia Wyn, Jayaprakasan Kanna
Аннотация
BACKGROUND: The role of transvaginal cervical length surveillance in predicting spontaneous preterm birth (sPTB) in women with congenital uterine anomalies (CUA) remains unclear. This study is a systematic review and diagnostic accuracy meta-analysis of its predictive value in this population.
METHODS: A literature review of MEDLINE, EMBASE and Cochrane Library was conducted from inception to December 2025. Observational studies assessing second-trimester cervical length measurement in pregnant women with CUAs were included. Statistical analyses using Review Manager and Meta-Disc generated pooled odds ratios, sensitivity, specificity, likelihood ratios, and SROC curves with a random-effects model.
RESULTS: 5 studies (624 women) met the inclusion criteria. sPTB was more frequent with a short cervix than with normal cervical length (52 % vs. 13.2 %; OR 8.05, [4.52-14.35]). A short cervix increased the risk of sPTB before 37 weeks (OR 6.68, [3.68-12.11]) and before 35 weeks (OR 28.16, [5.64-140.48]). The association was strongest for bicornuate uterus (OR 40.98, [4.27-393.10]), though estimates were imprecise. At a 25 mm cervical length, sensitivity was low and specificity was high; a 30 mm threshold improved sensitivity but reduced specificity, reflecting sparse data. The SROC curve indicated moderate-to-good discriminatory performance.
CONCLUSION: Cervical length measurement aids risk stratification when a short cervix is identified. At a 25 mm threshold, high specificity but limited sensitivity makes it better for confirming risk than excluding it. Although higher thresholds may improve detection, optimal cut-offs remain uncertain, and larger prospective studies are needed to define the role of cervical length-guided management in this high-risk population.
METHODS: A literature review of MEDLINE, EMBASE and Cochrane Library was conducted from inception to December 2025. Observational studies assessing second-trimester cervical length measurement in pregnant women with CUAs were included. Statistical analyses using Review Manager and Meta-Disc generated pooled odds ratios, sensitivity, specificity, likelihood ratios, and SROC curves with a random-effects model.
RESULTS: 5 studies (624 women) met the inclusion criteria. sPTB was more frequent with a short cervix than with normal cervical length (52 % vs. 13.2 %; OR 8.05, [4.52-14.35]). A short cervix increased the risk of sPTB before 37 weeks (OR 6.68, [3.68-12.11]) and before 35 weeks (OR 28.16, [5.64-140.48]). The association was strongest for bicornuate uterus (OR 40.98, [4.27-393.10]), though estimates were imprecise. At a 25 mm cervical length, sensitivity was low and specificity was high; a 30 mm threshold improved sensitivity but reduced specificity, reflecting sparse data. The SROC curve indicated moderate-to-good discriminatory performance.
CONCLUSION: Cervical length measurement aids risk stratification when a short cervix is identified. At a 25 mm threshold, high specificity but limited sensitivity makes it better for confirming risk than excluding it. Although higher thresholds may improve detection, optimal cut-offs remain uncertain, and larger prospective studies are needed to define the role of cervical length-guided management in this high-risk population.