Three-dimensional ultrasound measurement of cervical volume effectively predicts spontaneous preterm birth: a nested case-control cohort study

GAN Hua; YAN Ping; WANG Yan; YAN Xiaoli; LIU Heying; LIANG Min; WANG Dan

doi:10.16016/j.2097-0927.202601028

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Three-dimensional ultrasound measurement of cervical volume effectively predicts spontaneous preterm birth: a nested case-control cohort study

Clinical Medicine | 更新时间：2026-05-30

- Three-dimensional ultrasound measurement of cervical volume effectively predicts spontaneous preterm birth: a nested case-control cohort study
- Journal of Army Medical University Vol. 48, Issue 10, Pages: 1444-1455(2026)
- 作者机构：
  
  陆军军医大学（第三军医大学）第一附属医院妇产科，重庆
- 作者简介：
  
  WANG Dan， E-mail： wangdan@tmmu.edu.cn
- 基金信息：
  
  the Project of Appropriate Health Technology Promotion of Chongqing(2022jstg029);the Natural Science Foundation of Chongqing(CSTB2022NSCQ-MSX0169)
- DOI：10.16016/j.2097-0927.202601028
  CLC： R322.65;R445.1;R714.21
- Received：09 January 2026，
  
  Revised：2026-02-10，
  
  Accepted：14 February 2026，
  
  Published：30 May 2026
- 稿件说明：
移动端阅览
甘华，阎萍，王琰，等.三维超声测量宫颈容积可有效预测自发性早产：一项巢式病例-对照研究［J］.陆军军医大学学报，2026，48（10）：1444-1455.DOI：10.16016/j.2097-0927.202601028.

GAN H，YAN P，WANG Y，et al.Three-dimensional ultrasound measurement of cervical volume effectively predicts spontaneous preterm birth： a nested case-control cohort study［J］.J Army Med Univ，2026，48（10）：1444-1455.DOI：10.16016/j.2097-0927.202601028.
甘华，阎萍，王琰，等.三维超声测量宫颈容积可有效预测自发性早产：一项巢式病例-对照研究［J］.陆军军医大学学报，2026，48（10）：1444-1455.DOI：10.16016/j.2097-0927.202601028. DOI：

GAN H，YAN P，WANG Y，et al.Three-dimensional ultrasound measurement of cervical volume effectively predicts spontaneous preterm birth： a nested case-control cohort study［J］.J Army Med Univ，2026，48（10）：1444-1455.DOI：10.16016/j.2097-0927.202601028. DOI：

摘要

目的

早产是导致新生儿发病和死亡的主要原因，传统二维超声测量宫颈长度（cervical length，CL）在预测自发性早产（spontaneous preterm birth，SPTB）效能上存在局限性，难以早期准确识别部分早产高危孕妇，通过探讨三维超声测量宫颈容积（cervical volume，CV）对SPTB预测的价值，为预测SPTB提供新方向。

方法

本研究采用巢式病例-对照研究设计，纳入于2024年1月至2025年11月在陆军军医大学第一附属医院妇产科进行产前检查的孕产妇，分别于妊娠12~24周、妊娠28~32周经阴道二维超声测量CL和三维超声测量CV，通过纳入和排除标准的筛选，将最终完成随访且病历资料完整的237例孕妇纳入研究。根据分娩孕周，将研究对象分为2组：将分娩孕周28~

37周的孕妇设为SPTB组（

=36），分娩孕周≥37周的设为足月分娩（full-term delivery，FTD）组（

=201）。对2组间的各项指标进行单因素分析；为避免模型不稳定，对年龄、孕期增长体质量、孕次、产次、早产史、宫颈锥切手术史、足月分娩史、胎膜早破进行1∶1倾向得分匹配（propensity score matching，PSM），采用单因素及多因素条件Logistic回归分析对PSM后的SPTB组（

=27）和FTD组（

=27）进行分析，评估CL、CV对SPTB的独立预测价值，并采用ROC曲线分析CL与CV对SPTB的预测

效能，计算AUC及最佳截断值、敏感度、特异度，采用Pearson相关性分析CL和CV关联强度。

结果

①组间分析显示，SPTB组与FTD组在年龄、孕期增长体质量、孕次、产次、宫颈锥切手术史、足月分娩史、胎膜早破等因素中差异均有统计学意义（

0.05）；②组间分析显示PSM后的SPTB组与FTD组在年龄、孕期增长体质量、孕次、产次、早产史、宫颈锥切手术史、足月分娩史、胎膜早破等因素中差异无统计学意义；③匹配后妊娠12~24周SPTB组CL略低于FTD组，但差异无统计学意义［（31.90±5.96） mm

（33.70±6.97） mm，

=0.314］，SPTB组较FTD组CV小［（28.45±5.67） cm

（32.72±6.23） cm

，

=0.011］；妊娠28~32周SPTB组较FTD组CL更短［（23.69±9.47） mm

（30.58±8.48） mm，

=0.007］，CV更小［（22.70±7.64） cm

（28.91±8.09） cm

，

=0.005］；④妊娠12~24周单因素模型中，CV与早产风险显著相关（

=0.768，95%

：0.612~0.964，

=0.023），将CL、CV 二者同时纳入多因素模型时，CV差异具有统计学意义（

=0.769，95%

：0.611~0.967，

=0.025），CV越小，早产风险越大；CV的AUC为0.680（95%

：0.537~0.824，

=0.023），最佳截断值为32.47 cm

，敏感度81.5%，特异度51.9%；妊娠28~32周单因素模型中，CL（

=0.864，95%

：0.771~0.968，

=0.011）和CV（

=0.827，95%

：0.688~0.994，

=0.043）均与早产风险显著相关，将CL、CV 二者同时纳入多因素模型时，二者均差异无统计学意义（

0.05），Pearson相关性分析显示CL和CV有较强的正相关关系（

=0.689，

0.001）；CL的AUC为0.717（95%

：0.580~0.855，

=0.006），以31.5 mm为截断值，敏感度81.5%，特异度63%。CV的AUC为0.706（95%

：0.567~0.846，

=0.009），以26.7 cm

为截断值，敏感度77.8%，特异度63%。⑤CL在妊娠28~32周比妊娠12~24周缩短［（27.13±9.56） mm

（32.80±6.49） mm，

0.001］；CV缩小［（25.80±8.40） cm

（30.58±6.28） cm

，

0.001］。

结论

妊娠12~24周三维超声测量CV可能具有早期识别早产高危孕妇价值。

Abstract

Objective

Preterm birth is the leading cause of neonatal morbidity and mortality. Conventional two-dimensional (2D) ultrasound measurement of cervical length (CL) has limitations in predicting spontaneous preterm birth (SPTB)

making it difficult to accurately identify some high-risk pregnant women at early stages. This study aims to investigate the value of three-dimensional (3D) ultrasound measurement of cervical volume (CV) in predicting SPTB

providing a new direction for SPTB prediction.

Methods

A nested case-control trial was conducted on the pregnant women undergoing prenatal examinations in our department from January 2024 to November 2025. Transvaginal 2D ultrasound measurement of CL and 3D ultrasound measurement of CV were performed at 12 to 24 weeks and 28 to 32 weeks of gestation

respectively. After applying our inclusion and exclusion criteria

237 cases with complete follow-up and medical records were included as study subjects. According to gestational age at delivery

the participants were divided into an SPTB group (n=36) for deliveries at 28 to

37 weeks

and a full-term delivery (FTD) group (

=201) for deliveries at ≥37 weeks. Univariate analysis was initially performed to compare various indicators between the 2 groups. To ensure model stability

1∶1 propensity score matching (PSM) was employed for age

gestational weight gain

gravidity

parity

history of preterm birth

history of cervical conization

history of full-term delivery

and premature rupture of membranes. Univariate and multivariate conditional logistic regression analyses were applied to the PSM-matched SPTB (

=27) and FTD (

=27) groups to assess the independent predictive value of CL and CV for SPTB. ROC curves were plotted to evaluate the predictive efficacy of CL and CV for SPTB

calculating AUC values

optimal cutoff values

sensitivities

and specificities. Pearson correlation analysis was conducted to assess the association between CL and CV.

Results

① Intergroup analysis showed statistically significant differences between the SPTB and FTD groups in terms of age

gestational weight gain

gravidity

parity

history of cervical conization

history of full-term delivery

and premature rupture of membranes (

0.05). ② After PSM

no significant differences were found between the SPTB and FTD groups in these above factors. ③At 12 to 24 weeks of gestation after matching

CL was slightly lower in the SPTB group than in the FTD group

but the difference was not statistically significant (31.90±5.96 mm

33.70±6.97 mm

=0.314); the CV in the SPTB group was significantly smaller than that in the FTD group (28.45±5.67 cm³

32.72±6.23 cm³

=0.011). At 28 to 32 weeks of gestation

the SPTB group exhibited both a significantly shorter CL (23.69±9.47 mm

30.58±8.48 mm

=0.007) and a significantly smaller CV (22.70±7.64 cm³

28.91±8.09 cm³

=0.005) compared to the FTD group. ④ In the univariate model at 12 to 24 weeks of gestation

CV was significantly associated with the risk of preterm birth (

=0.768

95%

: 0.612 to 0.964

=0.023). When both CL and CV were included in the multivariate model

CV remained statistically significant (

=0.769

95%

: 0.611 to 0.967

=0.025)

with smaller CV indicating greater preterm birth risk. The AUC value of CV was 0.680 (95%

: 0.537 to 0.824

=0.023)

with an optimal cutoff value of 32.47 cm³

a sensitivity of 81.5% and a specificity of 51.9%. In the univariate model at 28 to 32 weeks of gestation

both CL (

=0.864

95%

: 0.771 to 0.968

=0.011) and CV (

=0.827

95%

: 0.688 to 0.994

=0.043) were significantly

associated with the risk of preterm birth. When both were included in the multivariate model

neither showed statistical significance (

0.05). Pearson correlation analysis revealed a strong positive correlation between CL and CV (

=0.689

0.001). The AUC value of CL was 0.717 (95%

: 0.580 to 0.855

=0.006)

with an optimal cutoff value of 31.5 mm

a sensitivity of 81.5% and a specificity of 63%. The AUC value for CV was 0.706 (95%

: 0.567 to 0.846

=0.009)

with an optimal cutoff value of 26.7 cm³

a sensitivity of 77.8% and a specificity of 63%. ⑤ CL was significantly shorter at 28 to 32 weeks of gestation compared to that at 12 to 24 weeks (27.13±9.56

32.80±6.49 mm

0.001)

and CV was obviously smaller (25.80±8.40

30.58±6.28 cm³

0.001).

Conclusion

3D ultrasound measurement of CV at 12 to 24 weeks of gestation may have value in early identification of high-risk pregnant women for preterm birth.

关键词

Keywords

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