{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:13:12Z","timestamp":1792782792548,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Erasmus+ Programme of the European Union","award":["2013-0040"],"award-info":[{"award-number":["2013-0040"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"crossref"}]},{"name":"\u2018la Caixa\u2019 Foundation"},{"name":"Cerebra Foundation for the Brain Injured Child"},{"name":"AGAUR 2014 SGR","award":["928"],"award-info":[{"award-number":["928"]}]},{"name":"\u2018la Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement de la Generalitat de Catalunya","award":["(A.P: 2014DI083)"],"award-info":[{"award-number":["(A.P: 2014DI083)"]}],"id":[{"id":"https:\/\/ror.org\/01bg62x04","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the effectiveness of mid\u2010trimester sonographic cervical consistency index (CCI) for the prediction of spontaneous preterm birth (sPTB) in low\u2010risk pregnancies and to compare its performance with that of mid\u2010trimester sonographic cervical\u2010length (CL) measurement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a prospective cohort study of women with a singleton pregnancy examined by ultrasound at 19\u2009+\u20090 to 24\u2009+\u20096\u2009weeks' gestation. All women underwent transvaginal ultrasound examination of the cervix, but CCI and CL were measured, offline, only in women without a risk factor for sPTB. Staff and participants were blinded to CL and CCI results. CCI was obtained by calculating the ratio between the anteroposterior diameter of the uterine cervix at maximum compression and at rest. The primary outcome was prediction of sPTB before 37\u2009+\u20090\u2009weeks. Receiver\u2013operating characteristics (ROC) curves were produced and sensitivity and specificity were calculated for the optimal cut\u2010off based on the ROC curve and for the 1\n                      <jats:sup>st<\/jats:sup>\n                      , 5\n                      <jats:sup>th<\/jats:sup>\n                      and 10\n                      <jats:sup>th<\/jats:sup>\n                      centiles of CCI and CL. Intraclass correlation coefficients (ICC) and Bland\u2013Altman plots were used to estimate intra\u2010 and interobserver agreement and reliability for measurement of CCI and CL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 749 women who underwent ultrasound examination of the cervix, 532 were included for analysis. The rates of sPTB before 37\u2009+\u20090 and before 34\u2009+\u20090\u2009weeks were 4.1% (22\/532) and 1.3% (7\/532), respectively. The rates of short cervix &lt;\u200925\u2009mm and \u2264\u200920\u2009mm were 0.9% (5\/532) and 0.4% (2\/532), respectively. The area under the ROC curve (AUC) with regard to predicting sPTB before 37\u2009+\u20090\u2009weeks was 0.84 (95% CI, 0.75\u20130.93) for CCI compared with 0.68 (95% CI, 0.56\u20130.81) for CL (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03). The optimal cut\u2010off based on the ROC curve was 64.6% for CCI (sensitivity, 77.3%; specificity, 82.7%) and that for CL was 37.9\u2009mm (sensitivity, 72.7%; specificity, 61.2%). The AUC with regard to predicting sPTB before 34\u2009+\u20090\u2009weeks was 0.87 (95% CI, 0.71\u20131.0) for CCI compared with 0.71 (95% CI, 0.47\u20130.94) for CL (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.25). The optimal cut\u2010off based on the ROC curve was 63.6% for CCI (sensitivity, 85.7%; specificity, 84.0%) and that for CL was 37.9\u2009mm (sensitivity, 85.7%; specificity, 61.3%). Intraobserver ICC was &gt;\u20090.90 both for CCI and CL, while interobserver ICC was 0.89 for CCI and 0.90 for CL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Second\u2010trimester CCI is a better predictor of sPTB &lt;\u200937\u2009weeks in low\u2010risk pregnancies than is CL. External validation is needed as well as studies assessing the value of CCI as a screening tool in unselected and high\u2010risk populations. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.17482","type":"journal-article","created":{"date-parts":[[2017,3,31]],"date-time":"2017-03-31T03:27:07Z","timestamp":1490930827000},"page":"629-636","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Mid\u2010trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low\u2010risk population"],"prefix":"10.1002","volume":"51","author":[{"given":"N.","family":"Ba\u00f1os","sequence":"first","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Murillo\u2010Bravo","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Juli\u00e0","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Migliorelli","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Perez\u2010Moreno","sequence":"additional","affiliation":[{"name":"Transmural Biotech S. 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Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"R\u00edos","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics &amp; Epidemiology (Universitat Autonoma de Barcelona); Medical Statistics Core Facility, IDIBAPS, (Hospital Clinic)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Gratac\u00f3s","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Valentin","sequence":"additional","affiliation":[{"name":"Sk\u00e5ne University Hospital, Malm\u00f6 Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Palacio","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal \u2013 Barcelona, Center for Maternal\u2010Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de Deu, Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,4,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.02.004"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000275287.08520.4a"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.06.071"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5847"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000174"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15953"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a2dccd"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.08.029"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12721"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12622"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-956777"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2010.01.011"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.05.015"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.9010"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14742"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)90837-8"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5256"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000428"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.12.020"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182723b1b"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2015.02.038"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067815"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.9017"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.12.003"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60030-0"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511014"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31820ca847"}],"container-title":["Ultrasound in Obstetrics &amp; 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