Nomogram Incorporating Multimodal Transvaginal Ultrasound Assessment at 20 to 24 Weeks’ Gestation for Predicting Spontaneous Preterm Delivery in Low-Risk Women

Abstract

Lingli Jiang,1,* Lei Peng,1,* Miaoling Rong,2 Xiaozhi Liu,3 Qinxia Pang,1 Huaping Li,1 Ying Wang,1 Zhou Liu1 1Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of China; 2Department of Obstetrics and Gynecology, First Maternity and Infant Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 3Department of Ultrasound, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhou Liu, Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No. 1500, Zhouyuan Road, Pudong New Area, Shanghai, 201318, People’s Republic of China, Tel [phone], Email [email protected]: The majority of women who experience spontaneous preterm delivery (SPTD) have low-risk, asymptomatic pregnancies with a cervical length (CL) ≥ 25mm and no clear risk factors. Despite the fact that cervical elastography is a potential tool for predicting SPTD, there is currently no feasible solution to make a reliable prediction for preventing SPTD.Objective: The aim of this study was to construct a nomogram including multimodal transvaginal ultrasound parameters during the second trimester to predict SPTD in low-risk women.Methods: This multi-center study enrolled 1260 women with singleton pregnancies between 20 and 24 weeks’ gestation. CL and cervical elastography data were obtained when they were undergoing the second-trimester anomaly scan. Univariate and multivariate Logistic regression were utilized to screen predictors independently related to SPTD from the maternal characteristics and multimodal ultrasound data. Then construct a nomogram to determine the likelihood of SPTD in pregnant women.Results: A total of 66 pregnancies in the training cohort (7.8%, 66/842) and 37 pregnancies (8.9%, 37/418) in the validation cohort ended in SPTD. Age, uterine curettage, CL, and strain in the anterior lip of internal os were the independent predictors of SPTD (P < 0.001, < 0.001, = 0.007, and < 0.001, respectively). These predictors constituted a nomogram to predict the probability of SPTD for a pregnant woman in her second trimester. It showed good discrimination (C-index = 0.898 and 0.839), calibration (P = 0.258 and 0.115), and yielded net benefits both in the training and validation cohorts.Conclusion: The nomogram including data of multimodal transvaginal ultrasound at 20 to 24 weeks’ gestation is expected to identify women with SPTD in the low-risk, asymptomatic population.Keywords: cervical length measurement, elasticity imaging techniques, nomograms, pregnancy trimester, second, premature birth

Keywords

• cervical length measurement
• elasticity imaging techniques
• nomograms
• pregnancy trimester
• second
• premature birth