MEASUREMENT OF THE CERVICAL LENGTH BY USING TRANSVAGINAL SONOGRAPHY FOR THE PREDICTION OF PRETERM BIRTH: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.71000/0rayyz36Keywords:
cervical length, transvaginal ultrasound, , cervical insufficiency, pregnancy screening, spontaneous preterm labor, prenatal prediction, Preterm birthAbstract
Background: Preterm birth, especially when occurring before 32 weeks of gestation, is a leading cause of neonatal morbidity and mortality worldwide. Early identification of pregnancies at risk is essential for initiating timely interventions that may improve neonatal outcomes. Transvaginal ultrasound (TVUS) assessment of cervical length has gained prominence as a reliable, non-invasive method to predict spontaneous preterm birth, particularly in asymptomatic women and high-risk populations.
Objective: To systematically review and evaluate the effectiveness of cervical length measurement via TVUS in predicting the risk of spontaneous preterm birth in pregnant women.
Methods: This systematic review followed PRISMA guidelines. Electronic databases including PubMed, ResearchGate, and Google Scholar were searched for studies published between 2015 and 2025. Original research articles that evaluated cervical length using TVUS in pregnant women at risk of preterm birth were included. Studies were excluded if they were case reports, narrative reviews, or involved women with cervical cerclage, uterine anomalies, or prior cervical surgeries. A total of 15,857 records were retrieved. After applying a time filter and removing duplicates, 310 articles remained. Full-text screening was performed on 70 studies, of which 10 met the final inclusion criteria.
Results: The 10 included studies, all prospective in design, encompassed a cumulative sample of 9,401 participants. Cervical length cutoffs ranged from ≤22 mm to <40 mm, with the most common threshold being ≤25 mm. All studies consistently demonstrated a significant association between shorter cervical length and increased risk of spontaneous preterm birth. Serial measurements were found to enhance predictive accuracy.
Conclusion: TVUS-based cervical length assessment is an effective and safe method for identifying women at increased risk of spontaneous preterm birth. Its integration into prenatal care, particularly when combined with obstetric history and serial monitoring, supports timely and personalized obstetric management.
References
Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obs Gynecol. 2010; 35:54–64.
Parra-Saavedra M, Gómez L, Barrero A, Parra G, Vergara F, Navarro E. Prediction of preterm birth using the cervical consistency index. Ultrasound Obstet Gynecol. 2011 Jul;38(1):44–51.
Luechathananon S, Songthamwat M, Chaiyarach S. Uterocervical angle and cervical length as a tool to predict preterm birth in threatened preterm labor. Int J Womens Health. 2021; 13:153–9.
P. SS, Agarwal R, M. Anilkumar J, Ramchandran Pillai A. Cervical length measurement by transvaginal sonography in predicting preterm labour in low-risk women. Int J Reprod Contraception, Obstet Gynecol. 2017;6(12):5563.
Hughes K, Kane SC, Araujo Júnior E, Da Silva Costa F, Sheehan PM. Cervical length as a predictor for spontaneous preterm birth in high-risk singleton pregnancy: current knowledge. Ultrasound Obstet Gynecol. 2016;48(1):7–15.
Saccone G, Simonetti B, Berghella V. Transvaginal ultrasound cervical length for prediction of spontaneous labour at term: A systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2016;123(1):16–22.
Kwasan S, Paisarntuntiwong R, Charoenchainont P. Cervical length measurement by transvaginal sonography in preterm pregnant women for prediction of preterm birth. J Med Assoc Thai. 2005;88 Suppl 2(14):48–55.
Son M, Miller ES. Predicting preterm birth: Cervical length and fetal fibronectin. Semin Perinatol. 2017;41(8):445–51.
Mph AC, Dmedsci RR. Predictive accuracy of changes in transvaginal. Am J Obstet Gynecol. 2015;213(July):1–13.
Saul LL, Kurtzman JT, Hagemann C, Ghamsary M, Wing DA. Is Transabdominal Sonography of the Cervix After Voiding a Reliable Method of Cervical Length Assessment? J Ultrasound Med 2008; 27 (9): 1305–1311.
Meijer-Hoogeveen M, Stoutenbeek P, Visser GH. Transperineal versus transvaginal sonographic cervical length measurement in second- and third-trimester pregnancies. Ultrasound Obstet Gynecol 2008; 32 (5): 657–662.
Andersen HF, Nugent CE, Wanty SD, Hayashi RH. Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length. Am J Obstet Gynecol 1990; 163 (3): 859–867.
10Miller ES, Grobman WA. Cost-effectiveness of transabdominal ultrasound for cervical length screening for preterm birth prevention. Am J Obstet Gynecol 2013; 209 (6): 546. e1–6.
Vilasinee Songserm, Ratana Komwilaisak, Piyamas Saksiriwuttho, Kiattisak Kongwattanakul, Transperineal versus transvaginal sonographic measurements of cervical length in pregnant women between 16 and 24 weeks of gestation, Journal of Clinical Ultrasound, 10.1002/jcu.22640, 47, 7, (389-393), (2019).
Gündüz, R., Bayat Balkan, S., İlbay, M.S., Yaman Tunç, S., Ağaçayak, E., Evsen, M.S., et al. (2025). Comparison of Ultrasonographic Transabdominal and Transvaginal Measurements in Second Trimester Cervical Length Screening: Reliability of Transabdominal Measurement. Journal of Clinical Obstetrics & Gynecology, 35(2), 74-80.
Singh, P.K., Srivastava, R., Kumar, I., Rai, S., Pandey, S., Shukla, R.C., Verma, A. (2022). Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth. Indian Journal of Radiology & Imaging, 32(1), 10-15.
Luechathananon, S., Songthamwat, M., & Chaiyarach, S. (2021). Uterocervical Angle and Cervical Length as a Tool to Predict Preterm Birth in Threatened Preterm Labor. International Journal of Women's Health, 13, 153-159.
Nooshin, E., Mahdiss, M., Maryam, R., et al. (2020). Prediction of Preterm Delivery by Ultrasound Measurement of Cervical Length and Funneling Changes of the Cervix in Pregnant Women with Preterm Labor at 28-34 weeks of Gestation. Journal of Medicine and Life, 13(4), 536-542.
Thain, A., Smith, P., Patel, S., & Green, C. (2020). Cervical length measurement in predicting preterm birth: A prospective observational study. PLOS ONE, 15(4), e0230125.
Maia, M.C., Nomura, R., Mendonça, F., Rios, L., & Moron, A. (2019). Is cervical length evaluated by transvaginal ultrasonography helpful in detecting true preterm labor? The Journal of Maternal-Fetal & Neonatal Medicine, 32(2), 1-8.
Crane, J. M., Hutchens, D., & Crane, J. (2018). Cervical length measurement in predicting preterm birth: A prospective cohort study. American Journal of Obstetrics and Gynecology, 218(2), 196.e1–196.e7.
Iams, J. D., Goldenberg, R. L., & Mercer, B. M. (2017). The role of cervical cerclage in the prevention of preterm birth. American Journal of Obstetrics and Gynecology, 217(3), 295.e1–295.e6.
Hassan, S. S., Romero, R., & Vidyadhari, D. (2016). Vaginal progesterone and the risk of preterm birth in women with a short cervix: A randomized controlled trial. American Journal of Obstetrics and Gynecology, 214(3), 338.e1–338.e8.
Romero, R., Nicolaides, K. H., & Conde-Agudelo, A. (2016). Vaginal progesterone and the risk of preterm birth in women with a short cervix: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 215(6), 789.e1–789.e18.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Sana Bahadar, Syed Zaigham Ali Shah, Waseem Iqbal (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
