The Novel Ultrasonographic Marker of Uterocervical Angle for Prediction of Spontaneous Preterm Birth in Singleton and Twin Pregnancies: A Systematic Review and Meta-Analysis

Abstract

The alteration of the uterocervical angle (UCA) has been proposed to play an important role in spontaneous preterm birth (sPTB). The aim of this systematic review and meta-analysis was to evaluate the evidence on the UCA predictive role in sPTB. In this study, PubMed, Web of Science, Scopus, and Google scholar were systematically searched from inception up to June 2020. Inter-study heterogeneity was also assessed using Cochrane’s Q test and the I² statistic. Afterward, the random-effects model was used to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Eleven articles that reported second-trimester UCA of 5,061 pregnancies were included in this study. Our meta-analysis results indicate that a wider UCA significantly increases the risk of sPTB in following cases: all pregnancies (WMD = 15.25, 95% CI: 11.78–18.72, p < 0.001; I² = 75.9%, p < 0.001), singleton (WMD = 14.43, 95% CI: 8.79–20.06, p < 0.001; I² = 82.4%, p < 0.001), and twin pregnancies (WMD = 15.14, 95% CI: 13.42–16.87, p < 0.001; I² = 0.0%, p = 0.464). A wider ultrasound-measured UCA in the second trimester seems to be associated with the increased risk of sPTB in both singleton and twin pregnancies, which reinforces the clinical evidence that UCA has the potential to be used as a predictive marker of sPTB.