title: Evaluation of quantitative ultrasound tissue characterization of the cervix and cervical length in the prediction of premature delivery for patients with spontaneous preterm labor.
abstract: OBJECTIVE
  This study was to evaluate the predictive value of the uterine cervix tissue with the use of quantitative ultrasound gray level analysis for preterm delivery.
  
  
  METHODS
  Sixty-eight patients with preterm labor between 20 and 35 weeks of gestation were included. When two-dimensional transvaginal ultrasound measurement of cervical length was completed, a region of interest of constant size was defined in the midsection of the posterior wall, and the tissue-specific gray scale was determined. Preterm delivery of <37 weeks of gestation was sought.
  
  
  RESULTS
  Twenty-eight patients (41.2%) were delivered preterm. The risk for preterm delivery was increased significantly in patients with cervical length of </=2.5 cm (odds ratio, 7.67; 95% CI, 2.4-24.45), with Bishop score of >/=4 (odds ratio, 3.44; 95% CI, 1.21-9.75), and with decreased mean gray scale value (odds ratio, 12.13; 95% CI, 3.69-39.88). Parity and uterine contractions were not significant as predictors for preterm delivery, although the risk for preterm delivery increased with higher parity (odds ratio, 1.8; 95% CI, 0.68-4.79). The risk for preterm delivery remained nearly the same by uterine contractions (odds ratio, 0.92; 95% CI, 0.28-3.01). A mean scale value of </=6.54 had the best cutoff value for the prediction of preterm delivery. For preterm delivery, a mean gray value </=6.54 had a sensitivity of 82.1%, a specificity of 72.5%, a positive predictive value of 67.6%, and a negative predictive value 85.3%. Multiple logistic regression analysis indicated that, even when other variables are considered simultaneously, the mean gray scale value is the single best predictor of preterm delivery.
  
  
  CONCLUSIONS
  Quantitative ultrasound tissue characterization of the uterine cervix predicts premature delivery and provides additional information in the prediction of potential premature delivery.
authors.affiliation: Department of Obstetrics and Perinatal Medicine, Philipps University Marburg, Marburg, Germany. Ismail.Tekesin@med.uni-marburg.de
authors.forename: Ismail
authors.initials: I
authors.lastname: Tekesin
authors.forename: Lars
authors.initials: L
authors.lastname: Hellmeyer
authors.forename: Günther
authors.initials: G
authors.lastname: Heller
authors.forename: Annette
authors.initials: A
authors.lastname: Römer
authors.forename: Maritta
authors.initials: M
authors.lastname: Kühnert
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012372:ROC Curve; D014463:Ultrasonography