doi:10.1016/j.ultrasmedbio.2005.12.010 ● Original Contribution QUALITATIVE GLANDULAR CERVICAL SCORE AS A POTENTIAL NEW SONOMORPHOLOGICAL PARAMETER IN SCREENING FOR PRETERM DELIVERY OZREN GRGIC,RATKO MATIJEVIC, and OLIVER VASILJ University Department of Obstetrics and Gynecology, School of Medicine, Zagreb University, Sveti Duh Hospital, Zagreb, Croatia (Received 22 September 2005; revised 29 November 2005; in final form 9 December 2005) Abstract—This study compared diagnostic accuracy of sonographic assessment of cervical length (CL) and qualitative glandular cervical score (QGCS), in the second trimester regarding the prediction of preterm delivery (PTD) in the low-risk population. Cervical length < fifth percentile for our population was defined as shortened. The parameters evaluated in QGCS were: cervical mucus area and deepest invasion of cervical glands, and score < fifth percentile for our population was defined as low. Shortened CL was found in 6.1% whereas the low QGCS was found in 5.5%. The incidence of PTD < 34 completed wk was 2.1%, and between 34 to 37 wk it was 3%. Low QGCS in comparison with shortened CL had twofold higher likelihood ratio (LR) (23; 95% CI [12 to 43] versus 11; 95% CI [5 to 25]) for PTD < 34 completed wk and fourfold higher LR (12; 95%CI [5 to 28] versus 3; 95% CI [1 to 13]) for PTD between 34 to 37 wk. Low QGCS has the same if not better accuracy in comparison with shortened CL regarding the prediction of PTD in the low-risk population. (E-mail: ozreng@net.hr) © 2006 World Federation for Ultrasound in Medicine & Biology. Key Words: Transvaginal sonography, Second trimester, Screening test, Cervical length, Cervical mucus area, Cervical gland invasion, Preterm delivery. INTRODUCTION Regarding the prediction of preterm delivery (PTD) in asymptomatic low-risk population, numerous investiga- tors have reported the usefulness of transvaginal sono- graphic (TVS) assessment of the uterine cervix in the second trimester (Hasegawa et al. 1996; Hassan et al. 2000; Heath et al. 1998; Iams et al. 1996; Taipale and Hiilesmaa 1998). Among the different sonographic pa- rameters, majority of investigators have focused on cer- vical length (CL) measurement. It has become widely accepted as a well standardized method of cervical as- sessment, and requires a relatively short period of train- ing (Hasegawa et al. 1996; Hassan et al. 2000; Heath et al. 1998; Iams et al. 1996; Taipale and Hiilesmaa 1998). In addition, CL measurement was shown to be a better screening test regarding the prediction of PTD in low- risk population compared to other sonographic parame- ters (e.g., funneling) and to classic bimanual examination (Berghella et al. 1997; Gomez et al. 1994; Hoesli et al. 2003; Iams et al. 1996; Matijevic and Grgic 2004; Owen et al. 2001; To et al. 2001). Disadvantages of this screen- ing test are low sensitivity, low positive predictive value (PPV) and the low prevalence of PTD in a low-risk population; therefore, to get acceptable specificity the cutoff values have to be set below the fifth percentile (Hasegawa et al. 1996; Hassan et al. 2000; Heath et al. 1998; Hoesli et al. 2003; Iams et al. 1996; Taipale and Hiilesmaa 1998). Recently, cervical gland area (CGA) was described as a new sonomorphological parameter (Fukami et al. 2003; Sekiya et al. 1998; Yoshimatsu et al. 2002). The sonographic disappearance of CGA in the second trimes- ter implies accelerated cervical maturation, and could be used as an additional sonographic screening test for the prediction of PTD in low-risk population (Fukami et al. 2003). Presence or absence of cervical glands was clas- sified as an “all or nothing” phenomenon, but the inves- tigators pointed out that its qualitative assessment might have some use in prediction of PTD (Fukami et al. 2003; Sekiya et al. 1998). In this prospective study, we compared the diagnos- tic accuracy of CL measurement and qualitative glandu- Address correspondence to: Dr Ozren Grgic, Sveti Duh Hospital, University Department of Obstetrics and Gynecology, Sveti Duh 64, 10000 Zagreb, Croatia. E-mail: ozreng@net.hr Ultrasound in Med. & Biol., Vol. 32, No. 3, pp. 333–338, 2006 Copyright © 2006 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/06/$–see front matter 333